The Effects of a Cognitive Acceleration Intervention Programme on the Performance of Secondary School Pupils in Malawi.

ERIC Educational Resources Information Center

Mbano, Nellie

2003-01-01

Investigates whether the critical period for cognitive transition from concrete operations to formal operations at 12-14 years of age actually exists. Uses the Cognitive Acceleration through Science Education (CASE) intervention program in Malawi. Discusses the existence of the critical period, academic achievement, and explanations for age and…

Challenges of Implementing Contract Policies for University Academics in Malawi: A Case of Mzuzu University

ERIC Educational Resources Information Center

Shawa, Lester B.; Mgomezulu, Victor Y.

2016-01-01

Utilising critical theory, we explored the causes of the conflict that arose between academic staff on fixed-term renewable contracts and university administrators at Mzuzu University in Malawi in order to draw lessons. We collected data using semi-structured, in-depth interviews and document analysis. Ten university employees were purposively…

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).

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

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 findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi.

Gender Sensitive Educational Policy and Practice: The Case of Malawi

ERIC Educational Resources Information Center

Maluwa-Banda, Dixie

2004-01-01

This case study focuses on qualitative indicators, though a number of quantitative indicators will be included to provide context. Qualitative issues to be looked at will include: education policies and, more specifically, curriculum-related policies containing provisions aimed at gender parity and equality in all aspects of education; gender…

Scaling Up Integrated Community Case Management of Childhood Illness: Update from Malawi

PubMed Central

Nsona, Humphreys; Mtimuni, Angella; Daelmans, Bernadette; Callaghan-Koru, Jennifer A.; Gilroy, Kate; Mgalula, Leslie; Kachule, Timothy; Zamasiya, Texas

2012-01-01

The Government of Malawi (GoM) initiated activities to deliver treatment of common childhood illnesses (suspected pneumonia, fever/suspected malaria, and diarrhea) in the community in 2008. The service providers are Health Surveillance Assistants (HSAs), and they are posted nationwide to serve communities at a ratio of 1 to 1,000 population. The GoM targeted the establishment of 3,452 village health clinics (VHCs) in hard-to-reach areas by 2011. By September of 2011, 3,296 HSAs had received training in integrated case management of childhood illness, and 2,709 VHCs were functional. An assessment has shown that HSAs are able to treat sick children with quality similar to the quality provided in fixed facilities. Monitoring data also suggest that communities are using the sick child services. We summarize factors that have facilitated the scale up of integrated community case management of children in Malawi and address challenges, such as ensuring a steady supply of medicines and supportive supervision. PMID:23136278

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.

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 half of pregnancies in Malawi are unintended. Our findings should inform ongoing efforts to reduce maternal morbidity and mortality and to improve public health in Malawi. PMID:28369114

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 MiP treatment. Conclusion Although ITNs were valued as malaria prevention, health messages could address issues that reduce their use during pregnancy in particular contexts. The impact of previous side effects on adherence to IPTp and anti-malarial treatment regimens during pregnancy also requires attention. Overtreatment of MiP highlights the need to monitor the implementation of MiP case management guidelines. PMID:24257105

The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial.

PubMed

Hardy, Victoria; O'Connor, Yvonne; Heavin, Ciara; Mastellos, Nikolaos; Tran, Tammy; O'Donoghue, John; Fitzpatrick, Annette L; Ide, Nicole; Wu, Tsung-Shu Joseph; Chirambo, Griphin Baxter; Muula, Adamson S; Nyirenda, Moffat; Carlsson, Sven; Andersson, Bo; Thompson, Matthew

2017-10-11

There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries. ClinicalTrials.gov, ID: NCT02763345 . Registered on 3 May 2016.

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 graduating medical students to be able to match opportunities and retain graduating students. PMID:24393278

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 match opportunities and retain graduating students.

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

The Case of Chichewa and English in Malawi: The Impact of First Language Reading and Writing on Learning English as a Second Language

ERIC Educational Resources Information Center

Shin, Jaran; Sailors, Misty; McClung, Nicola; Pearson, P. David; Hoffman, James V.; Chilimanjira, Margaret

2015-01-01

We investigated the relationship between Chichewa (L1) and English (L2) literacies in Malawi. Through our use of hierarchical linear modeling, we found that cross-language literacy transfer between Chichewa and English did occur, but that the pattern and the strength of the relationships varied depending on the literacy domain (i.e., reading or…

Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016.

PubMed

Ng'ambi, W; Gugsa, S; Tweya, H; Girma, B; Kanyerere, H; Dambe, I; Babaye, Y; Mpunga, J; Phiri, S

2017-12-21

Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert ® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities.

HIV and Childhood Disability: A Case-Controlled Study at a Paediatric Antiretroviral Therapy Centre in Lilongwe, Malawi

PubMed Central

Devendra, Akash; Makawa, Atupele; Kazembe, Peter N.; Calles, Nancy R.; Kuper, Hannah

2013-01-01

Background 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. Study Objectives 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. Methods 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. Results 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. Conclusion This study reveals the magnitude of disability among HIV-infected children and the large unmet need for rehabilitation services. This expanding issue demands further investigation to provide an evidence base for holistic care for disabled children living with HIV. PMID:24391869

Organic sedimentation in modern lacustrine systems: A case study from Lake Malawi, East Africa

USGS Publications Warehouse

Ellis, Geoffrey S.; Barry J. Katz,; Christopher A. Scholz,; Peter K. Swart,

2015-01-01

This study examines the relationship between depositional environment and sedimentary organic geochemistry in Lake Malawi, East Africa, and evaluates the relative significance of the various processes that control sedimentary organic matter (OM) in lacustrine systems. Total organic carbon (TOC) concentrations in recent sediments from Lake Malawi range from 0.01 to 8.80 wt% and average 2.83 wt% for surface sediments and 2.35 wt% for shallow core sediments. Hydrogen index (HI) values as determined by Rock-Eval pyrolysis range from 0 to 756 mg HC g−1 TOC and average 205 mg HC g−1 TOC for surface sediments and 228 mg HC g−1 TOC for shallow core samples. On average, variations in primary productivity throughout the lake may account for ~33% of the TOC content in Lake Malawi sediments (as much as 1 wt% TOC), and have little or no impact on sedimentary HI values. Similarly, ~33% to 66% of the variation in TOC content in Lake Malawi sediments appears to be controlled by anoxic preservation of OM (~1–2 wt% TOC), although some component of the water depth–TOC relationship may be due to physical sediment transport processes. Furthermore, anoxic preservation has a minimal effect on HI values in Lake Malawi sediments. Dilution of OM by inorganic sediment may account for ~16% of variability in TOC content in Lake Malawi sediments (~0.5 wt% TOC). The effect of inputs of terrestrial sediment on the organic character of surface sediments in these lakes is highly variable, and appears to be more closely related to the local depositional environment than the regional flux of terrestrial OM. Total nitrogen and TOC content in surface sediments collected throughout the lake are found to be highly correlated (r2 = 0.95), indicating a well-homogenized source of OM to the lake bottom. The recurring suspension and deposition of terrestrial sediment may account for significant amounts of OM deposited in offshore regions of the lake. This process effectively separates denser inorganic sediment from less dense OM and allows terrestrial OM to preferentially be transported farther offshore. The conclusion is that for the organic carbon content in these regions to be elevated a mixed terrestrial-lacustrine origin is required. The hydrodynamic separation of mineral and organic constituents is most pronounced in regions with shallow bathymetric gradients, consistent with previous findings from Lake Tanganyika.

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.

Trace elements geochemistry of fractured basement aquifer in southern Malawi: A case of Blantyre rural

NASA Astrophysics Data System (ADS)

Mapoma, Harold Wilson Tumwitike; Xie, Xianjun; Nyirenda, Mathews Tananga; Zhang, Liping; Kaonga, Chikumbusko Chiziwa; Mbewe, Rex

2017-07-01

In this study, twenty one (21) trace elements in the basement complex groundwater of Blantyre district, Malawi were analyzed. The majority of the analyzed trace elements in the water were within the standards set by World Health Organization (WHO) and Malawi Standards Board (MSB). But, iron (Fe) (BH16 and 21), manganese (Mn) (BH01) and selenium (Se) (BH02, 13, 18, 19 and 20) were higher than the WHO and MSB standards. Factor analysis (FA) revealed up to five significant factors which accounted for 87.4% of the variance. Factor 1, 2 and 3 suggest evaporite dissolution and silicate weathering processes while the fourth factor may explain carbonate dissolution and pH influence on trace element geochemistry of the studied groundwater samples. According to PHREEQC computed saturation indices, dissolution, precipitation and rock-water-interaction control the levels of trace elements in this aquifer. Elevated concentrations of Fe, Mn and Se in certain boreholes are due to the geology of the aquifer and probable redox status of groundwater. From PHREEQC speciation results, variations in trace element species were observed. Based on this study, boreholes need constant monitoring and assessment for human consumption to avoid health related issues.

Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia.

PubMed

Albert, V; Mndolo, S; Harrison, E M; O'Sullivan, E; Wilson, I H; Walker, I A

2017-06-01

Pulse oximetry is an essential monitor for safe anaesthesia but is often not available in low-income countries. The aim of this study was to determine whether the introduction of pulse oximetry with training was feasible and could reduce the incidence of oxygen desaturation during anaesthesia in a low-income country. Pulse oximeters were donated, with training, to 83 non-physician anaesthetists in Malawi. Knowledge was tested immediately before and after training and at follow-up. Providers were asked to record the lowest peripheral oxygen saturation (SpO 2 ) for the first 100 cases anaesthetised after training. The primary clinical outcome was the proportion of cases with an oxygen desaturation event (SpO 2 < 90%). Seventy-seven of 83 (93%) participants completed all pre- and post-training tests. Pulse oximetry knowledge improved after training from a median (IQR [range]) score of 39 (37-42 [28-48]) to 44 (42-46 [35-50]) and this knowledge was maintained for 8 months (p < 0.001). Oxygen saturation data and provider responses were recorded for 4772 cases. The proportion of oxygen desaturation episodes decreased from 17.2% to 6.5%, representing a 36% reduction in the odds of an oxygen desaturation event in the second 50 cases compared with the first 50 (OR 0.64, 95%CI 0.50-0.82, p < 0.001). We conclude that donation of pulse oximeters, with training, in Malawi was feasible, improved knowledge and reduced the incidence of oxygen desaturation events. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Feasibility of using teleradiology to improve tuberculosis screening and case management in a district hospital in Malawi

PubMed Central

Panunzi, Isabella; Spijker, Saskia; Brant, William E; Duran, Laura Triviño; Kosack, Cara S; Murowa, Michael Mitchell

2012-01-01

Abstract Problem Malawi has one of the world’s highest rates of human immunodeficiency virus (HIV) infection (10.6%), and southern Malawi, where Thyolo district is located, bears the highest burden in the country (14.5%). Tuberculosis, common among HIV-infected people, requires radiologic diagnosis, yet Malawi has no radiologists in public service. This hinders rapid and accurate diagnosis and increases morbidity and mortality. Approach Médecins Sans Frontières, in collaboration with Malawi’s Ministry of Health, implemented teleradiology in Thyolo district to assist clinical staff in radiologic image interpretation and diagnosis. Local setting Thyolo district’s 600 000 inhabitants are mostly subsistence-level or migrant farmers living in extreme poverty. Health facilities include one public hospital and 38 primary health centres. Understaffing and the absence of a radiologist make the diagnosis of tuberculosis difficult in a population where this disease affects 66% of patients with HIV infection. Relevant changes From September 2010–2011, 159 images (from 158 patients) were reviewed by teleradiology. Teleradiology changed patient management in 36 cases (23.5%). Two (1.3%) of them were cases of pulmonary tuberculosis not previously suspected by clinical staff. In addition, the radiologist’s review corrected the misdiagnosis of tuberculosis and averted inappropriate treatment in 16 patients (10.5%). Lessons learnt Teleradiology can improve tuberculosis diagnosis and case management, especially if criteria to identify the patients most suitable for referral are developed and the radiologist is conversant with local resources and health problems. Designating a clinical focal point for teleradiology ensures sustainability. Staff need time to adapt to a new teleradiology programme. PMID:22984316

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.

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 and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi.

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 investigation to provide an evidence base for holistic care for disabled children living with HIV.

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.

High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi.

PubMed

Kohler, Racquel E; Tang, Jennifer; Gopal, Satish; Chinula, Lameck; Hosseinipour, Mina C; Liomba, N George; Chiudzu, Grace

2016-08-01

Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30-45 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2/3 or cancer). We extracted cervical Pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+. We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% CI 4.44-9.67) greater for HIV+ women. High-grade dysplasia and cervical cancer are very common among Malawian women, especially HIV+ women. HIV infection was strongly associated with CIN2+. Expanding screening to women not covered by current guidelines could avert a substantial proportion of cervical cancer cases in Malawi. © The Author(s) 2016.

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

PubMed

Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

Assessment of an undergraduate psychiatry course in an African setting.

PubMed

Baig, Benjamin J; Beaglehole, Anna; Stewart, Robert C; Boeing, Leonie; Blackwood, Douglas H; Leuvennink, Johan; Kauye, Felix

2008-04-22

International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper. An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination. There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%-84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards. The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard.

ED-WAVE tool design approach: Case of a textile wastewater treatment plant in Blantyre, Malawi

NASA Astrophysics Data System (ADS)

Chipofya, V.; Kraslawski, A.; Avramenko, Y.

The ED-WAVE tool is a PC based package for imparting training on wastewater treatment technologies. The system consists of four modules viz. Reference Library, Process Builder, Case Study Manager, and Treatment Adviser. The principles of case-based design and case-based reasoning as applied in the ED-WAVE tool are utilised in this paper to evaluate the design approach of the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory, Blantyre, Malawi. The case being compared with MDW&S in the ED-WAVE tool is Textile Case 4 in Sri Lanka (2003). Equalisation, coagulation and rotating biological contactors is the sequencing of treatment units at Textile Case 4 in Sri Lanka. Screening, oxidation ditches and sedimentation is the sequencing of treatment units at MDW&S textile and garments factory. The study suggests that aerobic biological treatment is necessary in the treatment of wastewater from a textile and garments factory. MDW&S incorporates a sedimentation process which is necessary for the removal of settleable matter before the effluent is discharged to the municipal wastewater treatment plant. The study confirmed the practical use of the ED-WAVE tool in the design of wastewater treatment systems, where after encountering a new situation; already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects.

Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014–2016

PubMed Central

Gugsa, S.; Tweya, H.; Girma, B.; Kanyerere, H.; Dambe, I.; Babaye, Y.; Mpunga, J.; Phiri, S.

2017-01-01

Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities. PMID:29584793

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 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.

HIV policy and implementation: a national policy review and an implementation case study of a rural area of northern Malawi.

PubMed

Dasgupta, Aisha N Z; Wringe, Alison; Crampin, Amelia C; Chisambo, Christina; Koole, Olivier; Makombe, Simon; Sungani, Charles; Todd, Jim; Church, Kathryn

2016-09-01

Malawi is a global leader in the design and implementation of progressive HIV policies. However, there continues to be substantial attrition of people living with HIV across the "cascade" of HIV services from diagnosis to treatment, and program outcomes could improve further. Ability to successfully implement national HIV policy, especially in rural areas, may have an impact on consistency of service uptake. We reviewed Malawian policies and guidelines published between 2003 and 2013 relating to accessibility of adult HIV testing, prevention of mother-to-child transmission and HIV care and treatment services using a policy extraction tool, with gaps completed through key informant interviews. A health facility survey was conducted in six facilities serving the population of a demographic surveillance site in rural northern Malawi to investigate service-level policy implementation. Survey data were analyzed using descriptive statistics. Policy implementation was assessed by comparing policy content and facility practice using pre-defined indicators covering service access: quality of care, service coordination and patient tracking, patient support, and medical management. ART was rolled out in Malawi in 2004 and became available in the study area in 2005. In most areas, practices in the surveyed health facilities complied with or exceeded national policy, including those designed to promote rapid initiation onto treatment, such as free services and task-shifting for treatment initiation. However, policy and/or practice were/was lacking in certain areas, in particular those strategies to promote retention in HIV care (e.g., adherence monitoring and home-based care). In some instances, though, facilities implemented alternative progressive practices aimed at improving quality of care and encouraging adherence. While Malawi has formulated a range of progressive policies aiming to promote rapid initiation onto ART, increased investment in policy implementation strategies and quality service delivery, in particular to promote long-term retention on treatment may improve outcomes further.

Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: some views from service providers

PubMed Central

Munthali, Alister C; Ngwira, Bagrey M; Taulo, Frank

2015-01-01

Background Cervical cancer is the most common reproductive health cancer in Malawi. In most cases, women report to health facilities when the disease is in its advanced stage. In this study, we investigate service providers’ perceptions about barriers for women to access cervical cancer screening and early treatment services in Malawi. Methods We conducted in-depth interviews with 13 district coordinators and 40 service providers of cervical cancer screening and early treatment services in 13 districts in Malawi. The study was conducted in 2012. The district coordinators helped the research team identify the health facilities which were providing cervical cancer screening and early treatment services. Results Almost all informants reported that cervical cancer was a major public health problem in their districts and that prevention efforts for this disease were being implemented. They were aware of the test and treat approach using visual inspection with acetic acid (VIA). They, however, said that the delivery of cervical cancer screening and early treatment services was compromised because of factors such as gross shortage of staff, lack of equipment and supplies, the lack of supportive supervision, and the use of male service providers. Informants added that the lack of awareness about the disease among community members, long distances to health facilities, the lack of involvement of husbands, and prevailing misperceptions about the disease (eg, that it is caused by the exposure to the VIA process) affect the uptake of these services. Conclusion While progress has been made in the provision of cervical cancer screening and early treatment services in Malawi, a number of factors affect service delivery and uptake. There is a need to continue creating awareness among community members including husbands and also addressing identified barriers such as shortage of staff and supplies in order to improve uptake of services. PMID:25848229

Factors associated with retention in Option B+ in Malawi: a case control study.

PubMed

Hoffman, Risa M; Phiri, Khumbo; Parent, Julie; Grotts, Jonathan; Elashoff, David; Kawale, Paul; Yeatman, Sara; Currier, Judith S; Schooley, Alan

2017-04-27

There are limited data on factors associated with retention in Option B+. We sought to explore the characteristics of women retained in Option B+ in Malawi, with a focus on the role of HIV disclosure, awareness of partner HIV status, and knowledge around the importance of Option B+ for maternal-child health. Methods We performed a case-control study of HIV-infected women in Malawi initiated on antiretroviral therapy (ART) under Option B+. Cases were enrolled if they met criteria for default from Option B+ (out of ART for >60 days), and controls were enrolled in approximately 3:1 ratio if they were retained in care for at least 12 months. We surveyed socio-demographic characteristics, HIV disclosure and awareness of partner HIV status, self-report about receiving pre-ART education, and knowledge of Option B+. Univariate logistic regression was performed to determine factors associated with retention. Multivariate logistic regression model was used to evaluate the relationship between HIV disclosure, Option B+ knowledge, and retention after adjusting for age, schooling, and travel time to clinic. We enrolled 50 cases and 153 controls. Median age was 30 years (interquartile range (IQR) 25-34), and the majority (82%) initiated ART during pregnancy at a median gestational age of 24 weeks (IQR 16-28). Ninety-one per cent of the cases (39/43) who started ART during pregnancy defaulted by three months postpartum. HIV disclosure to the primary sex partner was more common among women retained in care (100% versus 78%, p  < 0.001). Odds of retention were significantly higher among women with: age >25 years (odds ratio (OR) 2.44), completion of primary school (OR 3.06), awareness of partner HIV status (OR 5.20), pre-ART education (OR 6.17), higher number of correct answers to Option B+ knowledge questions (OR 1.82), and support while taking ART (OR 3.65). Pre-ART education and knowledge were significantly correlated ( r  = 0.43, p  < 0.001). In multivariate analysis, awareness of partner HIV status (OR 4.07, 95% confidence interval (CI) 1.51-10.94, p  = 0.02) and Option B+ knowledge (OR 1.60, 95% CI 1.15-2.23, p  = 0.004) remained associated with retention. Interventions that address partner disclosure and strengthen pre-ART education around the benefits of ART for maternal and child health should be evaluated to improve retention in Malawi's Option B+ programme.

Assessment of an undergraduate psychiatry course in an African setting

PubMed Central

Baig, Benjamin J; Beaglehole, Anna; Stewart, Robert C; Boeing, Leonie; Blackwood, Douglas H; Leuvennink, Johan; Kauye, Felix

2008-01-01

Background International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper. Methods An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination. Results There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%–84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards. Conclusion The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard. PMID:18430237

Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi.

PubMed

Hazel, Elizabeth; Chimbalanga, Emmanuel; Chimuna, Tiyese; Nsona, Humphreys; Mtimuni, Angella; Kaludzu, Ernest; Gilroy, Kate; Guenther, Tanya

2017-09-27

Health Surveillance Assistants (HSAs) have been providing integrated community case management (iCCM) for sick children in Malawi since 2008. HSAs report monthly iCCM program data but, at the time of this study, little of it was being used for service improvement. Additionally, HSAs and facility health workers did not have the tools to compile and visualize the data they collected to make evidence-based program decisions. From 2012 to 2013, we worked with Ministry of Health staff and partners to develop and pilot a program in Dowa and Kasungu districts to improve data quality and use at the health worker level. We developed and distributed wall chart templates to display and visualize data, provided training to 426 HSAs and supervisors on data analysis using the templates, and engaged health workers in program improvement plans as part of a data quality and use (DQU) package. We assessed the package through baseline and endline surveys of the HSAs and facility and district staff in the study areas, focusing specifically on availability of reporting forms, completeness of the forms, and consistency of the data between different levels of the health system as measured through results verification ratio (RVR). We found evidence of significant improvements in reporting consistency for suspected pneumonia illness (from overreporting cases at baseline [RVR=0.82] to no reporting inconsistency at endline [RVR=1.0]; P =.02). Other non-significant improvements were measured for fever illness and gender of the patient. Use of the data-display wall charts was high; almost all HSAs and three-fourths of the health facilities had completed all months since January 2013. Some participants reported the wall charts helped them use data for program improvement, such as to inform community health education activities and to better track stock-outs. Since this study, the DQU package has been scaled up in Malawi and expanded to 2 other countries. Unfortunately, without the sustained support and supervision provided in this project, use of the tools in the Malawi scale-up is lower than during the pilot period. Nevertheless, this pilot project shows community and facility health workers can use data to improve programs at the local level given the opportunity to access and visualize the data along with supervision support. © Hazel et al.

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…

Comparative study of general public owl knowledge in Costa Rica, Central America and Malawi, Africa

Treesearch

Paula A. Enriquez; Heimo Mikkola

1997-01-01

The public knowledge of owls in Central America and Africa was compared based on 162 interviews in Costa Rica and 147 in Malawi. General knowledge of owls included: species, common names, habitats, food, and calls, and was quite similar in both study areas. In Malawi, more than 90 percent of the respondents connected owls with bad luck, witchcraft, and death. In Costa...

Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption.

PubMed

Rodríguez, Daniela C; Banda, Hastings; Namakhoma, Ireen

2015-12-01

In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation (i.e. iCCM) and of the institutions involved in the policy process. Data analysis is founded on a documentary review and 21 in-depth stakeholder interviews across institutions in Malawi. Findings indicate that the characteristics of iCCM made it a suitable policy to address persistent challenges in child mortality, namely that ill children were not interacting with health workers on a timely basis and consequently were dying in their communities. Further, iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children's Fund (UNICEF) and implementing organizations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organizational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channelling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development. Despite several outstanding concerns, the compatibility between iCCM as a policy alternative and the local context laid the foundation for Malawi's road to early adoption of iCCM. © The Author 2015. 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.

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 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.

Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy.

PubMed

Banda, Hastings T; Thomson, Rachael; Mortimer, Kevin; Bello, George A F; Mbera, Grace B; Malmborg, Rasmus; Faragher, Brian; Squire, S Bertel

2017-01-01

No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities. To understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases. A population proportional, cross-sectional study was conducted to determine the proportion of the population with chronic respiratory symptoms that had a diagnosis of tuberculosis or chronic airways disease in two rural communities in Malawi. Households were randomly selected using Google Earth Pro software. Smart phones loaded with Open Data Kit Essential software were used for data collection. Interviews were conducted with 15795 people aged 15 years and above to enquire about symptoms of chronic cough, wheeze and shortness of breath. Overall 3554 (22.5%) participants reported at least one of these respiratory symptoms. Cough was reported by 2933, of whom 1623 (55.3%) reported cough only and 1310 (44.7%) combined with wheeze and/or shortness of breath. Only 4.6% (164/3554) of participants with chronic respiratory symptoms had one or more of the following diagnoses in their health passports (patient held medical records): TB, asthma, bronchitis and chronic obstructive pulmonary disease). The high prevalence of chronic respiratory symptoms coupled with limited recorded diagnoses in patient-held medical records in these rural communities suggests a high chronic respiratory disease burden and unmet health need.

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'…

"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…

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 system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.

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.

Bubble continuous positive airway pressure in the treatment of severe paediatric pneumonia in Malawi: a cost-effectiveness analysis

PubMed Central

Kortz, Teresa Bleakly; Herzel, Benjamin; Marseille, Elliot; Kahn, James G

2017-01-01

Objectives Pneumonia is the largest infectious cause of death in children under 5 years globally, and limited resource settings bear an overwhelming proportion of this disease burden. Bubble continuous positive airway pressure (bCPAP), an accepted supportive therapy, is often thought of as cost-prohibitive in these settings. We hypothesise that bCPAP is a cost-effective intervention in a limited resource setting and this study aims to determine the cost-effectiveness of bCPAP, using Malawi as an example. Design Cost-effectiveness analysis. Setting District and central hospitals in Malawi. Participants Children aged 1 month–5 years with severe pneumonia, as defined by WHO criteria. Interventions Using a decision tree analysis, we compared standard of care (including low-flow oxygen and antibiotics) to standard of care plus bCPAP. Primary and secondary outcome measures For each treatment arm, we determined the costs, clinical outcomes and averted disability-adjusted life years (DALYs). We assigned input values from a review of the literature, including applicable clinical trials, and calculated an incremental cost-effectiveness ratio (ICER). Results In the base case analysis, the cost of bCPAP per patient was $15 per day and $41 per hospitalisation, with an incremental net cost of $64 per pneumonia episode. bCPAP averts 5.0 DALYs per child treated, with an ICER of $12.88 per DALY averted compared with standard of care. In one-way sensitivity analyses, the most influential uncertainties were case fatality rates (ICER range $9–32 per DALY averted). In a multi-way sensitivity analysis, the median ICER was $12.97 per DALY averted (90% CI, $12.77 to $12.99). Conclusion bCPAP is a cost-effective intervention for severe paediatric pneumonia in Malawi. These results may be used to inform policy decisions, including support for widespread use of bCPAP in similar settings. PMID:28698327

Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi

PubMed Central

2010-01-01

Background The district resource allocation formula in Malawi was recently reviewed to include stunting as a proxy measure of socioeconomic status. In many countries where the concept of need has been incorporated in resource allocation, composite indicators of socioeconomic status have been used. In the Malawi case, it is important to ascertain whether there are differences between using single variable or composite indicators of socioeconomic status in allocations made to districts, holding all other factors in the resource allocation formula constant. Methods Principal components analysis was used to calculate asset indices for all districts from variables that capture living standards using data from the Malawi Multiple Indicator Cluster Survey 2006. These were normalized and used to weight district populations. District proportions of national population weighted by both the simple and composite indicators were then calculated for all districts and compared. District allocations were also calculated using the two approaches and compared. Results The two types of indicators are highly correlated, with a spearman rank correlation coefficient of 0.97 at the 1% level of significance. For 21 out of the 26 districts included in the study, proportions of national population weighted by the simple indicator are higher by an average of 0.6 percentage points. For the remaining 5 districts, district proportions of national population weighted by the composite indicator are higher by an average of 2 percentage points. Though the average percentage point differences are low and the actual allocations using both approaches highly correlated (ρ of 0.96), differences in actual allocations exceed 10% for 8 districts and have an average of 4.2% for the remaining 17. For 21 districts allocations based on the single variable indicator are higher. Conclusions Variations in district allocations made using either the simple or composite indicators of socioeconomic status are not statistically different to recommend one over the other. However, the single variable indicator is favourable for its ease of computation. PMID:20053274

Bubble continuous positive airway pressure in the treatment of severe paediatric pneumonia in Malawi: a cost-effectiveness analysis.

PubMed

Kortz, Teresa Bleakly; Herzel, Benjamin; Marseille, Elliot; Kahn, James G

2017-07-10

Pneumonia is the largest infectious cause of death in children under 5 years globally, and limited resource settings bear an overwhelming proportion of this disease burden. Bubble continuous positive airway pressure (bCPAP), an accepted supportive therapy, is often thought of as cost-prohibitive in these settings. We hypothesise that bCPAP is a cost-effective intervention in a limited resource setting and this study aims to determine the cost-effectiveness of bCPAP, using Malawi as an example. Cost-effectiveness analysis. District and central hospitals in Malawi. Children aged 1 month-5 years with severe pneumonia, as defined by WHO criteria. Using a decision tree analysis, we compared standard of care (including low-flow oxygen and antibiotics) to standard of care plus bCPAP. For each treatment arm, we determined the costs, clinical outcomes and averted disability-adjusted life years (DALYs). We assigned input values from a review of the literature, including applicable clinical trials, and calculated an incremental cost-effectiveness ratio (ICER). In the base case analysis, the cost of bCPAP per patient was $15 per day and $41 per hospitalisation, with an incremental net cost of $64 per pneumonia episode. bCPAP averts 5.0 DALYs per child treated, with an ICER of $12.88 per DALY averted compared with standard of care. In one-way sensitivity analyses, the most influential uncertainties were case fatality rates (ICER range $9-32 per DALY averted). In a multi-way sensitivity analysis, the median ICER was $12.97 per DALY averted (90% CI, $12.77 to $12.99). bCPAP is a cost-effective intervention for severe paediatric pneumonia in Malawi. These results may be used to inform policy decisions, including support for widespread use of bCPAP in similar settings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Capturing Complexities of Relationship-Level Family Planning Trajectories in Malawi.

PubMed

Furnas, Hannah E

2016-09-01

In a transitioning fertility climate, preferences and decisions surrounding family planning are constantly in flux. Malawi provides an ideal case study of family planning complexities as fertility preferences are flexible, the relationship context is unstable, and childbearing begins early. I use intensive longitudinal data from Tsogolo la Thanzi-a research project in Malawi that follows young adults in romantic partnerships through the course of their relationship. I examine two questions: (1) What are the typical patterns of family planning as young adults transition through a relationship? (2) How are family planning trajectories related to individual and relationship-level characteristics? I use sequence analysis to order family planning across time and to contextualize it within each relationship. I generate and cluster the family planning trajectories and find six distinct groups of young adults who engage in family planning in similar ways. I find that family planning is complex, dynamic, and unique to each relationship. I argue that (a) family planning research should use the relationship as the unit of analysis and (b) family planning behaviors and preferences should be sequenced over time for a better understanding of key concepts, such as unmet need. © 2016 The Population Council, Inc.

Capturing Complexities of Relationship-Level Family Planning Trajectories in Malawi

PubMed Central

Furnas, Hannah E.

2017-01-01

In a transitioning fertility climate, preferences and decisions surrounding family planning are constantly in flux. Malawi provides an ideal case study of family planning complexities as fertility preferences are flexible, the relationship context is unstable, and childbearing begins early. I use intensive longitudinal data from Tsogolo la Thanzi—a research project in Malawi that follows young adults in romantic partnerships through the course of their relationship and allows me to ask two questions: (1) What are the typical patterns of family planning as young adults transition through a relationship? (2) How are family planning trajectories related to individual and relationship-level characteristics? I use sequence analysis to order family planning across time and to contextualize it within each relationship. I generate and cluster the family planning trajectories and find six distinct groups of young adults who engage in family planning in similar ways. I find that family planning is complex, dynamic, and unique to each relationship. I argue that (a) family planning research should use the relationship as the unit of analysis and (b) family planning behaviors and preferences should be sequenced over time for a better understanding of key concepts, such as unmet need. PMID:27517867

On the Analysis of Case-Control Studies in Cluster-correlated Data Settings.

PubMed

Haneuse, Sebastien; Rivera-Rodriguez, Claudia

2018-01-01

In resource-limited settings, long-term evaluation of national antiretroviral treatment (ART) programs often relies on aggregated data, the analysis of which may be subject to ecological bias. As researchers and policy makers consider evaluating individual-level outcomes such as treatment adherence or mortality, the well-known case-control design is appealing in that it provides efficiency gains over random sampling. In the context that motivates this article, valid estimation and inference requires acknowledging any clustering, although, to our knowledge, no statistical methods have been published for the analysis of case-control data for which the underlying population exhibits clustering. Furthermore, in the specific context of an ongoing collaboration in Malawi, rather than performing case-control sampling across all clinics, case-control sampling within clinics has been suggested as a more practical strategy. To our knowledge, although similar outcome-dependent sampling schemes have been described in the literature, a case-control design specific to correlated data settings is new. In this article, we describe this design, discuss balanced versus unbalanced sampling techniques, and provide a general approach to analyzing case-control studies in cluster-correlated settings based on inverse probability-weighted generalized estimating equations. Inference is based on a robust sandwich estimator with correlation parameters estimated to ensure appropriate accounting of the outcome-dependent sampling scheme. We conduct comprehensive simulations, based in part on real data on a sample of N = 78,155 program registrants in Malawi between 2005 and 2007, to evaluate small-sample operating characteristics and potential trade-offs associated with standard case-control sampling or when case-control sampling is performed within clusters.

An allelic series at pax7a is associated with colour polymorphism diversity in Lake Malawi cichlid fish.

PubMed

Roberts, Reade B; Moore, Emily C; Kocher, Thomas D

2017-05-01

Despite long-standing interest in the evolution and maintenance of discrete phenotypic polymorphisms, the molecular genetic basis of such polymorphism in the wild is largely unknown. Female sex-associated blotched colour polymorphisms found in cichlids of Lake Malawi, East Africa, represent a highly successful polymorphic phenotype, found and maintained in four genera across the geographic expanse of the lake. Previously, we identified an association with an allelic variant of the paired-box transcription factor gene pax7a and blotched colour morphs in Lake Malawi cichlid fishes. Although a diverse range of blotched phenotypes are present in Lake Malawi cichlid species, they all appeared to result from an allele of pax7a that produces increased levels of transcript. Here, we examine the developmental and genetic basis of variation among blotched morphs. First, we confirm that pax7a-associated blotch morphs result primarily from modulation of melanophore development and survival. From laboratory crosses and natural population studies, we identify at least three alleles of pax7a associated with discrete subtypes of blotched morphs, in addition to the ancestral pax7a allele. Genotypes at pax7a support initial evolution of a novel pax7a allele to produce the blotched class of morphs, followed by subsequent evolution of that pax7a blotched allele to produce additional alleles associated with discrete colour morphs. Variant alleles of pax7a produce different levels of pax7a transcript, correlating with pigmentation phenotype at the cellular level. This naturally selected allelic series should serve as a case study for understanding the molecular genetic control of pax7a expression and the evolution of sex-associated alleles. © 2016 John Wiley & Sons Ltd.

The rise and fall of tuberculosis in Malawi: associations with HIV infection and antiretroviral therapy.

PubMed

Kanyerere, Henry; Harries, Anthony D; Tayler-Smith, Katie; Jahn, Andreas; Zachariah, Rony; Chimbwandira, Frank M; Mpunga, James

2016-01-01

Since 1985, Malawi has experienced a dual epidemic of HIV and tuberculosis (TB) which has been moderated recently by the advent of antiretroviral therapy (ART). The aim of this study was to describe the association over several decades between HIV/AIDS, the scale-up of ART and TB case notifications. Aggregate data were extracted from annual reports of the National TB Control Programme, the Ministry of Health HIV Department and the National Statistics Office. ART coverage was calculated using the total HIV population as denominator (derived from UNAIDS Spectrum software). In 1970, there were no HIV-infected persons but numbers had increased to a maximum of 1.18 million by 2014. HIV prevalence reached a maximum of 10.8% in 2000, thereafter decreasing to 7.5% by 2014. Numbers alive on ART increased from 2586 in 2003 to 536 527 (coverage 45.3%) by 2014. In 1985, there were 5286 TB cases which reached a maximum of 28 234 in 2003 and then decreased to 17 723 by 2014 (37% decline from 2003). There were increases in all types of new TB between 1998-2003 which then declined by 30% for extrapulmonary TB, by 37% for new smear-positive PTB and by 50% for smear-negative PTB. Previously treated TB cases reached a maximum of 3443 in 2003 and then declined by 42% by 2014. The rise and fall of TB in Malawi between 1985 and 2014 was strongly associated with HIV infection and ART scale-up; this has implications for ending the TB epidemic in high HIV-TB burden countries. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi.

PubMed

Bates, M J; Mijoya, A

2015-09-01

Cervical cancer is the commonest cancer affecting women in Malawi, which has the highest rate of this disease in the world. Most cases are diagnosed at an advanced stage. To describe the symptom burden, palliative care interventions, and outcomes of cervical cancer patients who entered care at Tiyanjane Clinic in Blantyre, Malawi, between January and December 2012. We reviewed the case files of 72 patients presenting to our hospital-based palliative care service over one year. The mean age was 49.5 years. Twenty-six patients (36%) were HIV-positive and the majority of these (n = 22; 85%) were on antiretroviral medication at presentation to palliative care. Pain (n = 66; 92%), vaginal discharge (n = 44; 61%), and unpleasant odour (n = 37; 51%) were commonly reported. Over a third of patients (n = 26; 36%) reported pain in two or more sites. Fourteen patients (19%) reported vaginal bleeding. Spousal breakdown (through widowhood or divorce) was noted in over half (n = 41; 57%) of all cases. Pain relief was provided to 69 (96%) of the patients (morphine to 40 patients; 56%). Common interventions provided included metronidazole tablets (used vaginally), sanitary items, and counselling. At the end of the study period, 18 patients (25%) were still under the care of palliative services. Access to medications such as morphine, metronidazole and tranexamic acid can improve quality of life, even when radiotherapy is limited. Health care teams require necessary skills and training, including how to perform a comprehensive assessment, with an emphasis on the provision of psychosexual counselling, to assist with the complexity of symptoms occurring in this vulnerable group.

Evaluation of groundwater quality in rural-areas of northern Malawi: Case of Zombwe Extension Planning Area in Mzimba

NASA Astrophysics Data System (ADS)

Chidya, Russel C. G.; Matamula, Swithern; Nakoma, Oliver; Chawinga, Charles B. J.

2016-06-01

Many people in in the Sub-Saharan region rely on groundwater for drinking and other household uses. Despite this significance, information on the chemical composition of the water in the boreholes and emperical data on groundwater quality is limited in some rural areas of Malawi. This study was conducted to evaluate the physico-chemical quality of water from boreholes (n = 20) in Zombwe Extension Planning Area (EPA), Mzimba in Northern Malawi to ascertain their safety. Desktop studies and participatory approaches were employed to assess the socio-economic activities and water supply regime in the study areas. The water samples were analysed for pH, conductivity (EC), turbidity, water temperature, nitrate (NO3-), magnesium (Mg), calcium (Ca), zinc (Zn), fluoride (F-), and sulphate (SO42-). In-situ and laboratory analyses were carried out using portable meters and standard procedures. The results were compared with national (Malawi Bureau of Standards - MBS) and international standards (World Health Organization - WHO) for drinking water. The following ranges were obtained: pH (6.00-7.80), EC (437-3128 μS/cm), turbidity (0.10-5.80 NTU), water temperature (27.0-30.60 °C), NO3- (0.30-30.00 mg/L), F- (0.10-8.10 mg/L), Mg (31.00-91.00 mg/L), Ca (20.00-197.10 mg/L), SO42- (10.20-190 mg/L), Fe (0.10-3.60 mg/L) and Zn (0.00-5.10 mg/L). Generally, some parameters tested at several sites (>80%, n = 20) complied with both MBS and WHO limits. No significant differences (p > 0.05) was observed for most parameters (>65%, n = 11). Groundwater contamination was not significant in the area despite some parameters like F-, Ca and SO42- showing higher levels at other sites. Some sites registered very hard water (244.60-757.80 mg/L CaCO3) probably due to mineralization influenced by underground rock material. Further studies are needed to ascertain the groundwater quality of other parameters (like F-, and SO42-) which registered higher levels at some sites. Routine monitoring of the groundwater in the study area and entire Malawi is needed for spatio-temporal variation assessment and to ensure good public health.

Gender and Education for All: Progress and Problems in Achieving Gender Equity

ERIC Educational Resources Information Center

Chisamya, Grace; DeJaeghere, Joan; Kendall, Nancy; Khan, Marufa Aziz

2012-01-01

The paper explores the effects of rapid increases in gender parity in primary schooling in Bangladesh and Malawi on gender inequities in schools and communities. Based on an analysis of comparative case studies of marginalized communities, we argue that educational initiatives focused on achieving gender parity provide limited evidence that girls'…

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

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.

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.

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 result of the upsurge in the number of orphans as a result of the HIV and AIDS epidemic. The study recommends that Malawi should take investments in ECD programmes as a priority.

The Cooking and Pneumonia Study (CAPS) in Malawi: Implementation of Remote Source Data Verification

PubMed Central

Weston, William; Smedley, James; Bennett, Andrew; Mortimer, Kevin

2016-01-01

Background Source data verification (SDV) is a data monitoring procedure which compares the original records with the Case Report Form (CRF). Traditionally, on-site SDV relies on monitors making multiples visits to study sites requiring extensive resources. The Cooking And Pneumonia Study (CAPS) is a 24- month village-level cluster randomized controlled trial assessing the effectiveness of an advanced cook-stove intervention in preventing pneumonia in children under five in rural Malawi (www.capstudy.org). CAPS used smartphones to capture digital images of the original records on an electronic CRF (eCRF). In the present study, descriptive statistics are used to report the experience of electronic data capture with remote SDV in a challenging research setting in rural Malawi. Methods At three monthly intervals, fieldworkers, who were employed by CAPS, captured pneumonia data from the original records onto the eCRF. Fieldworkers also captured digital images of the original records. Once Internet connectivity was available, the data captured on the eCRF and the digital images of the original records were uploaded to a web-based SDV application. This enabled SDV to be conducted remotely from the UK. We conducted SDV of the pneumonia data (occurrence, severity, and clinical indicators) recorded in the eCRF with the data in the digital images of the original records. Result 664 episodes of pneumonia were recorded after 6 months of follow-up. Of these 664 episodes, 611 (92%) had a finding of pneumonia in the original records. All digital images of the original records were clear and legible. Conclusion Electronic data capture using eCRFs on mobile technology is feasible in rural Malawi. Capturing digital images of the original records in the field allows remote SDV to be conducted efficiently and securely without requiring additional field visits. We recommend these approaches in similar settings, especially those with health endpoints. PMID:27355447

The Cooking and Pneumonia Study (CAPS) in Malawi: Implementation of Remote Source Data Verification.

PubMed

Weston, William; Smedley, James; Bennett, Andrew; Mortimer, Kevin

2016-01-01

Source data verification (SDV) is a data monitoring procedure which compares the original records with the Case Report Form (CRF). Traditionally, on-site SDV relies on monitors making multiples visits to study sites requiring extensive resources. The Cooking And Pneumonia Study (CAPS) is a 24- month village-level cluster randomized controlled trial assessing the effectiveness of an advanced cook-stove intervention in preventing pneumonia in children under five in rural Malawi (www.capstudy.org). CAPS used smartphones to capture digital images of the original records on an electronic CRF (eCRF). In the present study, descriptive statistics are used to report the experience of electronic data capture with remote SDV in a challenging research setting in rural Malawi. At three monthly intervals, fieldworkers, who were employed by CAPS, captured pneumonia data from the original records onto the eCRF. Fieldworkers also captured digital images of the original records. Once Internet connectivity was available, the data captured on the eCRF and the digital images of the original records were uploaded to a web-based SDV application. This enabled SDV to be conducted remotely from the UK. We conducted SDV of the pneumonia data (occurrence, severity, and clinical indicators) recorded in the eCRF with the data in the digital images of the original records. 664 episodes of pneumonia were recorded after 6 months of follow-up. Of these 664 episodes, 611 (92%) had a finding of pneumonia in the original records. All digital images of the original records were clear and legible. Electronic data capture using eCRFs on mobile technology is feasible in rural Malawi. Capturing digital images of the original records in the field allows remote SDV to be conducted efficiently and securely without requiring additional field visits. We recommend these approaches in similar settings, especially those with health endpoints.

Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi.

PubMed

Kayser, Georgia L; Amjad, Urooj; Dalcanale, Fernanda; Bartram, Jamie; Bentley, Margaret E

2015-04-01

Human health is greatly affected by inadequate access to sufficient and safe drinking water, especially in low and middle-income countries. Drinking water governance improvements may be one way to better drinking water quality. Over the past decade, many projects and international organizations have been dedicated to water governance; however, water governance in the drinking water sector is understudied and how to improve water governance remains unclear. We analyze drinking water governance challenges in three countries-Brazil, Ecuador, and Malawi-as perceived by government, service providers, and civil society organizations. A mixed methods approach was used: a clustering model was used for country selection and qualitative semi-structured interviews were used with direct observation in data collection. The clustering model integrated political, economic, social and environmental variables that impact water sector performance, to group countries. Brazil, Ecuador and Malawi were selected with the model so as to enhance the generalizability of the results. This comparative case study is important because similar challenges are identified in the drinking water sectors of each country; while, the countries represent diverse socio-economic and political contexts, and the selection process provides generalizability to our results. We find that access to safe water could be improved if certain water governance challenges were addressed: coordination and data sharing between ministries that deal with drinking water services; monitoring and enforcement of water quality laws; and sufficient technical capacity to improve administrative and technical management of water services at the local level. From an analysis of our field research, we also developed a conceptual framework that identifies policy levers that could be used to influence governance of drinking water quality on national and sub-national levels, and the relationships between these levers.

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.

Demand-Side Financing in Education: a Critical Examination of a Girls' Scholarship Program in Malawi--(Case Study)

ERIC Educational Resources Information Center

Sineta, Abraham

2012-01-01

Despite the push for universal education, many disadvantaged and poor children in developing countries still do not have access to basic education. This among other reasons is due to poverty where poor families cannot afford the cost of basic education even when it is "free" of tuition (McDonald, 2007). Demand-side financing…

Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

PubMed

Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

2015-10-01

Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR system is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive system (CAS) may enable designers of technology to effectively model change processes to mitigate these barriers. Copyright © 2015. Published by Elsevier Ireland Ltd.

Barriers to using eHealth data for clinical performance feedback in Malawi: A case study

PubMed Central

Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

2016-01-01

Introduction Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. Objective The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. Methods We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. Results We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Conclusion Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive system (CAS) may enable designers of technology to effectively model change processes to mitigate these barriers. PMID:26238704

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

Malawi secondary school curriculum has been offering Geo sciences Education since the dawn of independence from the British rule in 1964. Qualified primary and secondary school teachers are responsible for the teaching of Geo sciences. The assumption is that trained teachers are more likely to produce successful students thus making geoscience a successful subject. To make the subject more relevant and captivating to stakeholders, the government revised Geo science curriculum and incorporated other topics. Among additional topic was the solar system that was covered in great detail in secondary school. The solar system is a Geo science concept taught in Geography curriculum from primary school for 8 years and in secondary school for 4 years. Despite the solar system being one of the traditional topics in Malawi school curriculum and Government's effort to revise the curriculum in the interest of learners and improving the pass rate, number of students conversant with the topic has been failing sharply over the years. The disparity between the input in terms of effort to improve familiarity with solar system among learners and the outcomes is of great concern and worth hard investigation to inform education policy and curriculum revision decisions. Based on empirical data collected through qualitative research design, the paper establishes that regardless of imploring such interventions, there are still indicators that students continue to fail in solar system related subjects. Malawi National Examination report (2015) reveals that Geography at Malawi School Certificate Examinations pass rate has been going down ranging from 69.49 to 60.78 per cent from 2009 to 2014. The report advances that lack of instruction materials across the schools have contributed to deteriorating knowledge in solar system education. For instance, the school may have no simple models such as globes that clarify the shape of the earth better. As such, the teacher may improvise by getting an 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)

It's the context!

USDA-ARS?s Scientific Manuscript database

This editorial was written to summarize 3 large clinical trials, one among pregnant women in Malawi, another in pregnant women in Ghana and the third in children in Cambodia. The Ghana study showed a benefit from food supplements, while the studies in Malawi and Cambodia found little benefit from ...

Does the University-Industry Link Affect Solving Challenges of the Job Market? Lessons From Teacher Education and the Ministry of Education in Malawi

PubMed Central

Mkandawire, Matthews Tiwaone; Luo, Zubing; Maulidi, Felix Kondwani

2018-01-01

About half of the secondary school teachers in Malawi are professionally unqualified. Furthermore, the net enrolment of eligible pupils in secondary schools is at 36% per year. Hence, this study sought to establish factors affecting access to quality and relevant secondary education in Malawi with reference to coordination, collaboration, and feedback between secondary school teacher education institutions and the Ministry of Education. Officials from the Ministry of Education and secondary school teacher training colleges participated in the study. Findings suggest that there is weak collaboration, coordination, and feedback between teacher training institutions and the Ministry of Education which is affecting the quality and relevance of education in Malawi. The study has also established that the weak linkage has resulted into perceived mismatches between expectations of the ministry and those of the education institutions about the problem in question. Theoretical and practical implications of this study are discussed in this article. PMID:29417093

Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey.

PubMed

Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-02-20

Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, health facility survey was conducted in Malawi to assess patient-, health worker-, and health facility-level factors associated with malaria case management quality using multivariate Poisson regression models. Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (p<0.0001). Complaint of cough was associated with a 27% decreased likelihood of correct malaria treatment (p=0.001). Lower-level cadres of health workers were more likely to prescribe anti-malarials for patients, increasing the likelihood of both correct treatment and overtreatment, but no other health worker or health facility-level factors were significantly associated with case management quality. Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools.

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 Medical Journal. Clinical and basic research, which is mostly funded externally, in the fields of malaria in pregnancy, severe malaria and vector and/or agent dynamics dominated, while health policy and system research was least supported. The quantity may reflect scientific research activity but the initial primary impact is contribution to policy development.

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.

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

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 "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options.

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 for and against the medical "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options. PMID:17176457

Early career retention of Malawian medical graduates: a retrospective cohort study.

PubMed

Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylene; Gwesele, Lyson; Dzowela, Titha; Hanson, Kara; Muula, Adamson S

2015-01-01

There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Reflections on the health workers' strike at Malawi's major tertiary hospital, QECH, Blantyre, 2001: a case study.

PubMed

Muula, A S; Phiri, A

2003-03-01

Health workers and support staff at Malawi's major referral hospital, the Queen Elizabeth Central Hospital, Blantyre, were on strike between 5th and 19th October 2001. The health workers' grievances included: lack of risk allowances; poor professional allowances; low salaries; and low housing allowances. The strike resulted in almost total closure of the 1500-bed hospital; only the burns and orthopaedic wards continued to serve patients. Volunteer staff, comprising the Red Cross, and nursing and medical students provided services. Verbal and written threats by the authorities had minimal effect on terminating the strike; rather, they encouraged the resolve to continue with the industrial action. We report aspects of the genesis, progress and resolution of the strike. Although not much seems to have been achieved, both the employer and the workers need to draw lessons from the experience.

Circulating soluble endoglin levels in pregnant women in Cameroon and Malawi--associations with placental malaria and fetal growth restriction.

PubMed

Silver, Karlee L; Conroy, Andrea L; Leke, Rose G F; Leke, Robert J I; Gwanmesia, Philomina; Molyneux, Malcolm E; Taylor, Diane Wallace; Wallace, Diane Taylor; Rogerson, Stephen J; Kain, Kevin C

2011-01-01

Placental infections with Plasmodium falciparum are associated with fetal growth restriction resulting in low birth weight (LBW). The mechanisms that mediate these effects have yet to be completely described; however, they are likely to involve inflammatory processes and dysregulation of angiogenesis. Soluble endoglin (sEng), a soluble receptor of transforming growth factor (TGF)-β previously associated with preeclampsia in pregnant women and with severe malaria in children, regulates the immune system and influences angiogenesis. We hypothesized that sEng may play a role in development of LBW associated with placental malaria (PM). Plasma levels of sEng were measured in women (i) followed prospectively throughout pregnancy in Cameroon (n = 52), and (ii) in a case-control study at delivery in Malawi (n = 479). The relationships between sEng levels and gravidity, peripheral and placental parasitemia, gestational age, and adverse outcomes of PM including maternal anemia and LBW were determined. In the longitudinal cohort from Cameroon, 28 of 52 women (54%) experienced at least one malaria infection during pregnancy. In Malawi we enrolled two aparasitemic gravidity-matched controls for every case with PM. sEng levels varied over the course of gestation and were significantly higher in early and late gestation as compared to delivery (P<0.006 and P<0.0001, respectively). Circulating sEng levels were higher in primigravidae than multigravidae from both Cameroon and Malawi, irrespective of malarial infection status (p<0.046 and p<0.001, respectively). Peripheral parasitemia in Cameroonian women and PM in Malawian women were each associated with elevated sEng levels following correction for gestational age and gravidity (p = 0.006 and p = 0.033, respectively). Increased sEng was also associated with the delivery of LBW infants in primigravid Malawian women (p = 0.017); the association was with fetal growth restriction (p = 0.003) but not pre-term delivery (p = 0.286). Increased circulating maternal sEng levels are associated with P. falciparum infection in pregnancy and with fetal growth restriction in primigravidae with PM.

Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management

PubMed Central

Enarson, Penelope M.; Gie, Robert P.; Mwansambo, Charles C.; Maganga, Ellubey R.; Lombard, Carl J.; Enarson, Donald A.; Graham, Stephen M.

2014-01-01

Objective To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management. Methods A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1st 2000 until 31st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital. Findings Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335). Conclusions The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research. PMID:25050894

Promoting universal financial protection: contracting faith-based health facilities to expand access--lessons learned from Malawi.

PubMed

Chirwa, Maureen L; Kazanga, Isabel; Faedo, Giulia; Thomas, Stephen

2013-08-19

Public-private collaborations are increasingly being utilized to universalize health care. In Malawi, the Ministry of Health contracts selected health facilities owned by the main faith-based provider, the Christian Health Association of Malawi (CHAM), to deliver care at no fee to the most vulnerable and underserved populations in the country through Service Level Agreements (SLAs). This study examined the features of SLAs and their effectiveness in expanding universal coverage. The study involved a policy analysis focusing on key stakeholders around SLAs as well as a case study approach to analyse how design and implementation of SLAs affect efficiency, equity and sustainability of services delivered by SLAs. The study employed both qualitative and quantitative research methods to address the research questions and was conducted in five CHAM health facilities: Mulanje Mission, Holy Family, and Mtengowanthenga Hospitals, and Mabiri and Nkope Health Centres. National and district level decision makers were interviewed while providers and clients associated with the health facilities were surveyed on their experiences. A total of 155 clients from an expected 175 were recruited in the study. The study findings revealed key aspects of how SLAs were operating, the extent to which their objectives were being attained and why. In general, the findings demonstrated that SLAs had the potential to improve health and universal health care coverage, particularly for the vulnerable and underserved populations. However, the findings show that the performance of SLAs in Malawi were affected by various factors including lack of clear guidelines, non-revised prices, late payment of bills, lack of transparency, poor communication, inadequate human and material resources, and lack of systems to monitor performance of SLAs, amongst others. There was strong consensus and shared interest between the government and CHAM regarding SLAs. It was clear that free services provided by SLAs had a great impact on the impoverished locals that used the facilities. However, lack of supporting systems, inadequate infrastructure and shortage of health care providers affected SLA performance. The paper provides recommendations to policy makers for the replication and strengthening of SLA implementation in the roll-out of universalization policy.

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.

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

Eighty per cent of Malawi's 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health. Managed clinical networks have been found to improve equity of care in rural districts and to ensure that the correct care is provided as close to home as possible. A network for paediatric care in Malawi with mentoring of non-physician clinicians based in a district hospital by paediatricians based at the central hospitals will establish and sustain clinical referral pathways in both directions. Ultimately, the plan envisages four managed paediatric clinical networks, each radiating from one of Malawi's four central hospitals and covering the entire country. This model of task sharing within four hub-and-spoke networks may facilitate wider dissemination of scarce expertise and improve child healthcare in Malawi close to the child's home. Funding has been secured to train sufficient personnel to staff all central and district hospitals in Malawi with teams of paediatric specialists in the central hospitals and specialist non-physician clinicians in each government district hospital. The hypothesis will be tested using a natural experiment model. Data routinely collected by the Ministry of Health will be corroborated at the district. This will include case fatality rates for common childhood illness, perinatal mortality and process 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.

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…

Easier said than done!: methodological challenges with conducting maternal death review research in Malawi.

PubMed

Combs Thorsen, Viva; Sundby, Johanne; Meguid, Tarek; Malata, Address

2014-02-21

Maternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi. Critical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation. Challenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses. Conducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized.

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

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

Nearly 3 million people in resource-poor countries receive antiretrovirals for the treatment of HIV/AIDS, yet millions more require treatment. Key barriers to treatment scale up are shortages of trained health care workers, and challenges integrating HIV/AIDS care with primary care. PALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilizes a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. The research consists of a cluster randomized trial in 30 public health centres in Zomba District that measures the effect of the intervention on staff satisfaction and retention, quality of patient care, and costs through quantitative, qualitative and health economics methods. In the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, 3 to 4 staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned. Dignitas International and the Knowledge Translation Unit at the University of Cape Town Lung Institute have led the adaptation and development of the PALM PLUS intervention, using experience gained through the implementation of the South African precursor, PALSA PLUS. The Malawian partners, REACH Trust and the Research Unit at the Ministry of Health, have led the qualitative and economic evaluations. Dignitas and Ministry of Health have facilitated interaction with 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.

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…

Measurement and valuation of health providers' time for the management of childhood pneumonia in rural Malawi: an empirical study.

PubMed

Bozzani, Fiammetta Maria; Arnold, Matthias; Colbourn, Timothy; Lufesi, Norman; Nambiar, Bejoy; Masache, Gibson; Skordis-Worrall, Jolene

2016-07-28

Human resources are a major cost driver in childhood pneumonia case management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in Malawi can lead to savings on staff time and salaries due to reductions in pneumonia cases requiring admission. Reliable estimates of human resource costs are vital for use in economic evaluations of PCV-13 introduction. Twenty-eight severe and twenty-four very severe pneumonia inpatients under the age of five were tracked from admission to discharge by paediatric ward staff using self-administered timesheets at Mchinji District Hospital between June and August 2012. All activities performed and the time spent on each activity were recorded. A monetary value was assigned to the time by allocating a corresponding percentage of the health workers' salary. All costs are reported in 2012 US$. A total of 1,017 entries, grouped according to 22 different activity labels, were recorded during the observation period. On average, 99 min (standard deviation, SD = 46) were spent on each admission: 93 (SD = 38) for severe and 106 (SD = 55) for very severe cases. Approximately 40 % of activities involved monitoring and stabilization, including administering non-drug therapies such as oxygen. A further 35 % of the time was spent on injecting antibiotics. Nurses provided 60 % of the total time spent on pneumonia admissions, clinicians 25 % and support staff 15 %. Human resource costs were approximately US$ 2 per bed-day and, on average, US$ 29.5 per severe pneumonia admission and US$ 37.7 per very severe admission. Self-reporting was successfully used in this context to generate reliable estimates of human resource time and costs of childhood pneumonia treatment. Assuming vaccine efficacy of 41 % and 90 % coverage, PCV-13 introduction in Malawi can save over US$ 2 million per year in staff costs alone.

Sexual Behavior and STI/HIV Status Among Adolescents in Rural Malawi: An Evaluation of the Effect of Interview Mode on Reporting

PubMed Central

Mensch, Barbara S.; Hewett, Paul C.; Gregory, Richard; Helleringer, Stephane

2008-01-01

This study investigates the reporting of premarital sex in rural southern Malawi. It summarizes the results of an interview-mode experiment conducted with unmarried young women aged 15–21 in which respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. Prior to collecting the biomarkers, nurses conducted a short face-to-face interview in which they repeated questions about sexual behavior. The study builds on earlier research among adolescents in Kenya where we first investigated the feasibility and effectiveness of ACASI. In both Malawi and Kenya, the mode of interviewing and questions about types of sexual partners affect the reporting of sexual activity. Yet the results are not always in accordance with expectations. Reporting for “ever had sex” and “sex with a boyfriend” is higher in the FTF mode. When we ask about other partners as well as multiple lifetime partners, however, the reporting is consistently higher with ACASI, in many cases significantly so. The FTF mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. The association between infection status and reporting of sexual behavior is stronger in the FTF mode, although in both modes a number of young women who denied ever having sex test positive for STIs/HIV. PMID:19248718

Cancer Treatment in Malawi: A Disease of Palliation.

PubMed

Kendig, Claire E; Samuel, Jonathan C; Tyson, Anna F; Khoury, Amal L; Boschini, Laura P; Mabedi, Charles; Cairns, Bruce A; Varela, Carlos; Shores, Carol G; Charles, Anthony G

2013-06-01

Worldwide, new cancer cases will nearly double in the next 20 years while disproportionately affecting low and middle income countries (LMICs). Cancer outcomes in LMICs also remain bleaker than other regions of the world. Despite this, little is known about cancer epidemiology and surgical treatment in LMICs. To address this we sought to describe the characteristics of cancer patients presenting to the Surgery Department at Kamuzu Central Hospital in Lilongwe, Malawi. We conducted a retrospective review of adult (18 years or older) surgical oncology services at Kamuzu Central Hospital in Lilongwe, Malawi from 2007 - 2010. Data obtained from the operating theatre logs included patient demographics, indication for operative procedure, procedure performed, and operative procedures (curative, palliative, or staging). Of all the general surgery procedures performed during this time period (7,076 in total), 16% (406 cases) involved cancer therapy. The mean age of male and female patients in this study population was 52 years and 47 years, respectively. Breast cancer, colorectal cancer, gastric cancer, and melanoma were the most common cancers among women, whereas prostate, colorectal, pancreatic, and, gastric were the most common cancers in men. Although more than 50% of breast cancer operations were performed with curative intent, most procedures were palliative including prostate cancer (98%), colorectal cancer (69%), gastric cancer (71%), and pancreatic cancer (94%). Patients with colorectal, gastric, esophageal, pancreatic, and breast cancer presented at surprisingly young ages. The paucity of procedures with curative intent and young age at presentation reveals that many Malawians miss opportunities for cure and many potential years of life are lost. Though KCH now has pathology services, a cancer registry and a surgical training program, the focus of surgical care remains palliative. Further research should address other methods of increasing early cancer detection and treatment in such populations.

Quality of Malaria Case Management in Malawi: Results from a Nationally Representative Health Facility Survey

PubMed Central

Steinhardt, Laura C.; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-01-01

Background Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. Methods In April–May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. Results At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Conclusions Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved. PMID:24586497

Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

PubMed

Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-01-01

Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved.

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 transitioning to eastward thickening at the northern termination of the Central Basin near the Manda, Tanzania.

Genetic sex determination in Astatotilapia calliptera, a prototype species for the Lake Malawi cichlid radiation.

PubMed

Peterson, Erin N; Cline, Maggie E; Moore, Emily C; Roberts, Natalie B; Roberts, Reade B

2017-06-01

East African cichlids display extensive variation in sex determination systems. The species Astatotilapia calliptera is one of the few cichlids that reside both in Lake Malawi and in surrounding waterways. A. calliptera is of interest in evolutionary studies as a putative immediate outgroup species for the Lake Malawi species flock and possibly as a prototype ancestor-like species for the radiation. Here, we use linkage mapping to test association of sex in A. calliptera with loci that have been previously associated with genetic sex determination in East African cichlid species. We identify a male heterogametic XY system segregating at linkage group (LG) 7 in an A. calliptera line that originated from Lake Malawi, at a locus previously shown to act as an XY sex determination system in multiple species of Lake Malawi cichlids. Significant association of genetic markers and sex produce a broad genetic interval of approximately 26 megabases (Mb) using the Nile tilapia genome to orient markers; however, we note that the marker with the strongest association with sex is near a gene that acts as a master sex determiner in other fish species. We demonstrate that alleles of the marker are perfectly associated with sex in Metriaclima mbenjii, a species from the rock-dwelling clade of Lake Malawi. While we do not rule out the possibility of other sex determination loci in A. calliptera, this study provides a foundation for fine mapping of the cichlid sex determination gene on LG7 and evolutionary context regarding the origin and persistence of the LG7 XY across diverse, rapidly evolving lineages.

Genetic sex determination in Astatotilapia calliptera, a prototype species for the Lake Malawi cichlid radiation

NASA Astrophysics Data System (ADS)

Peterson, Erin N.; Cline, Maggie E.; Moore, Emily C.; Roberts, Natalie B.; Roberts, Reade B.

2017-06-01

East African cichlids display extensive variation in sex determination systems. The species Astatotilapia calliptera is one of the few cichlids that reside both in Lake Malawi and in surrounding waterways. A. calliptera is of interest in evolutionary studies as a putative immediate outgroup species for the Lake Malawi species flock and possibly as a prototype ancestor-like species for the radiation. Here, we use linkage mapping to test association of sex in A. calliptera with loci that have been previously associated with genetic sex determination in East African cichlid species. We identify a male heterogametic XY system segregating at linkage group (LG) 7 in an A. calliptera line that originated from Lake Malawi, at a locus previously shown to act as an XY sex determination system in multiple species of Lake Malawi cichlids. Significant association of genetic markers and sex produce a broad genetic interval of approximately 26 megabases (Mb) using the Nile tilapia genome to orient markers; however, we note that the marker with the strongest association with sex is near a gene that acts as a master sex determiner in other fish species. We demonstrate that alleles of the marker are perfectly associated with sex in Metriaclima mbenjii, a species from the rock-dwelling clade of Lake Malawi. While we do not rule out the possibility of other sex determination loci in A. calliptera, this study provides a foundation for fine mapping of the cichlid sex determination gene on LG7 and evolutionary context regarding the origin and persistence of the LG7 XY across diverse, rapidly evolving lineages.

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.

Cultural and Environmental Influences on Footedness: Cross-Sectional Study in Urban and Semi-Urban Malawi

ERIC Educational Resources Information Center

Zverev, Y. P.; Mipando, M.

2007-01-01

The present study was designed to assess cultural and environmental pressure against left-foot preference in urban and semi-urban Malawi. The findings demonstrated that, when compared to handedness, footedness appeared to be less biased behavioral laterality in culturally restrictive communities. The percentage of responders with negative views on…

The ethics of developed nations recruiting nurses from developing countries: the case of Malawi.

PubMed

Muula, Adamson S; Mfutso-Bengo, Joseph M; Makoza, Joan; Chatipwa, Elita

2003-07-01

There is currently a global shortage of nurses. Developing countries such as Malawiare among those hardest hit by this shortage. The demands on available nurses have increased and at the same time there is a lack of interest in becoming a nurse owing to the poor working conditions among those still employed in the service. It is questionable if developed nations should recruit nurses from countries such as Malawi, where severe human resource constraints are being experienced. We argue in this article that the current phenomenon of nurses leaving developing nations for western countries is complex. Human rights issues of individual autonomy and public interest are at stake.

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 involving men are designed to welcome men as full partners in the overall goals for improving maternal, neonatal and child health outcomes.

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…

Moral competence among nurses in Malawi: A concept analysis approach.

PubMed

Maluwa, Veronica Mary; Gwaza, Elizabeth; Sakala, Betty; Kapito, Esnath; Mwale, Ruth; Haruzivishe, Clara; Chirwa, Ellen

2018-01-01

Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. Analysis of moral competence concept was done using Walker and Avant's strategy of concept analysis. Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi.

Re-Examining Language Shift Cases in Malawi in the Context of Fishman's GIDS

ERIC Educational Resources Information Center

Matiki, Alfred Jana

2009-01-01

This paper explores language shift cases in three Malawian languages using Fishman's Graded Intergenerational Disruption Scale (GIDS) in order to gain some insight into the extent to which these languages should be regarded as threatened and therefore in need of reversal support. The paper shows that Chingoni, in its current state of attrition, is…

Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi.

PubMed

Kundrick, Avery; Huang, Zhuojie; Carran, Spencer; Kagoli, Matthew; Grais, Rebecca Freeman; Hurtado, Northan; Ferrari, Matthew

2018-06-15

Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (R E ) in the context of the 2010 measles epidemic in Malawi. Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, R E , at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated R E ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern. Furthermore, the spatial scale at which each metric is calculated impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns. These methods may be used to allocate effort for prophylactic campaigns or to prioritize response for outbreak response vaccination.

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey

PubMed Central

Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi’s Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers. PMID:28301484

Eye-tracking-based assessment of cognitive function in low-resource settings.

PubMed

Forssman, Linda; Ashorn, Per; Ashorn, Ulla; Maleta, Kenneth; Matchado, Andrew; Kortekangas, Emma; Leppänen, Jukka M

2017-04-01

Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings. The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40). Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks. High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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.

What Do Secondary Trainee Teachers Say about Teaching as a Profession of Their "Choice" in Malawi?

ERIC Educational Resources Information Center

Mtika, Peter; Gates, Peter

2011-01-01

This interview-based qualitative study is concerned with the recruitment of secondary teachers in Malawi. This study shows a range of perspectives for pursuing a teacher training course: failure to follow a desired career, springboard to other careers, to upgrade, and teaching out of vocation. It shows that trainee teachers held a range of images…

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.

Disclosure of Sexual Violence Among Girls and Young Women Aged 13 to 24 Years: Results From the Violence Against Children Surveys in Nigeria and Malawi.

PubMed

Nguyen, Kimberly H; Kress, Howard; Atuchukwu, Victor; Onotu, Dennis; Swaminathan, Mahesh; Ogbanufe, Obinna; Msungama, Wezi; Sumner, Steven A

2018-02-01

Understanding factors that are associated with disclosure of sexual violence (SV) is important for the delivery of health services as well as developing strategies for prevention and response. The Violence Against Children Surveys were conducted in Malawi and Nigeria. We examined the prevalence of SV, help-seeking behaviors, and factors associated with disclosure among girls and young women aged 13 to 24. The self-reported prevalence of SV was similar in Nigeria (26%) and Malawi (27%). Among females who experienced SV, approximately one third (37%) in Nigeria and one half (55%) in Malawi ever disclosed their experience of SV. Females in Nigeria were significantly more likely to disclose to their parents (31.8%) than females in Malawi (9.5%). The most common reason for nondisclosure in Nigeria was not feeling a need or desire to tell anyone (34.9%) and in Malawi was embarrassment (29.3%). Very close relationships with one or both parents were significantly associated with disclosure among Nigerian females (odds ratio [OR] = 5.5, 95% confidence interval [CI] = [2.1, 14.6]) but were inversely associated with disclosure among Malawian females (OR = 0.05, 95% CI = [0.01, 0.33]). Reasons for nondisclosure of SV and factors associated with disclosure among females differ in the African nations studied. The stigma associated with shame of SV may prevent females from disclosing and thus receiving necessary support and health, social, and other services. This study demonstrates a need to reduce barriers for disclosure to improve the delivery of health, social, and other response services across African nations, as well as to develop culturally appropriate strategies for its response.

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.

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.

Costs of postabortion care in public sector health facilities in Malawi: a cross-sectional survey.

PubMed

Benson, Janie; Gebreselassie, Hailemichael; Mañibo, Maribel Amor; Raisanen, Keris; Johnston, Heidi Bart; Mhango, Chisale; Levandowski, Brooke A

2015-12-17

Health systems could obtain substantial cost savings by providing safe abortion care rather than providing expensive treatment for complications of unsafely performed abortions. This study estimates current health system costs of treating unsafe abortion complications and compares these findings with newly-projected costs for providing safe abortion in Malawi. We conducted in-depth surveys of medications, supplies, and time spent by clinical personnel dedicated to postabortion care (PAC) for three treatment categories (simple, severe non-surgical, and severe surgical complications) and three uterine evacuation (UE) procedure types (manual vacuum aspiration (MVA), dilation and curettage (D&C) and misoprostol-alone) at 15 purposively-selected public health facilities. Per-case treatment costs were calculated and applied to national, annual PAC caseload data. The median cost per D&C case ($63) was 29% higher than MVA treatment ($49). Costs to treat severe non-surgical complications ($63) were almost five times higher than those of a simple PAC case ($13). Severe surgical complications were especially costly to treat at $128. PAC treatment in public facilities cost an estimated $314,000 annually. Transition to safe, legal abortion would yield an estimated cost reduction of 20%-30%. The method of UE and severity of complications have a large impact on overall costs. With a liberalized abortion law and implementation of induced abortion services with WHO-recommended UE methods, current PAC costs to the health system could markedly decrease.

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…

An Evaluation of the Role of Sensory Drive in the Evolution of Lake Malawi Cichlid Fishes

PubMed Central

Smith, Adam R.; van Staaden, Moira J.; Carleton, Karen L.

2012-01-01

Although the cichlids of Lake Malawi are an important model system for the study of sensory evolution and sexual selection, the evolutionary processes linking these two phenomena remain unclear. Prior works have proposed that evolutionary divergence is driven by sensory drive, particularly as it applies to the visual system. While evidence suggests that sensory drive has played a role in the speciation of Lake Victoria cichlids, the findings from several lines of research on cichlids of Lake Malawi are not consistent with the primary tenets of this hypothesis. More specifically, three observations make the sensory drive model implausible in Malawi: (i) a lack of environmental constraint due to a broad and intense ambient light spectrum in species rich littoral habitats, (ii) pronounced variation in receiver sensory characteristics, and (iii) pronounced variability in male courtship signal characteristics. In the following work, we synthesize the results from recent studies to draw attention to the importance of sensory variation in cichlid evolution and speciation, and we suggest possible avenues of future research. PMID:22779029

Characteristics and critical success factors for implementing problem-based learning in a human resource-constrained country.

PubMed

Giva, Karen R N; Duma, Sinegugu E

2015-08-31

Problem-based learning (PBL) was introduced in Malawi in 2002 in order to improve the nursing education system and respond to the acute nursing human resources shortage. However, its implementation has been very slow throughout the country. The objectives of the study were to explore and describe the goals that were identified by the college to facilitate the implementation of PBL, the resources of the organisation that facilitated the implementation of PBL, the factors related to sources of students that facilitated the implementation of PBL, and the influence of the external system of the organisation on facilitating the implementation of PBL, and to identify critical success factors that could guide the implementation of PBL in nursing education in Malawi. This is an ethnographic, exploratory and descriptive qualitative case study. Purposive sampling was employed to select the nursing college, participants and documents for review.Three data collection methods, including semi-structured interviews, participant observation and document reviews, were used to collect data. The four steps of thematic analysis were used to analyse data from all three sources. Four themes and related subthemes emerged from the triangulated data sources. The first three themes and their subthemes are related to the characteristics related to successful implementation of PBL in a human resource-constrained nursing college, whilst the last theme is related to critical success factors that contribute to successful implementation of PBL in a human resource-constrained country like Malawi. This article shows that implementation of PBL is possible in a human resource-constrained country if there is political commitment and support.

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.

Determinants of Integrated Management of Childhood Illness (IMCI) non-severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census.

PubMed

Johansson, Emily White; Nsona, Humphreys; Carvajal-Aguirre, Liliana; Amouzou, Agbessi; Hildenwall, Helena

2017-12-01

Research shows inadequate Integrated Management of Childhood Illness (IMCI)-pneumonia care in various low-income settings but evidence is largely from small-scale studies with limited evidence of patient-, provider- and facility-levels determinants of IMCI non-severe pneumonia classification and its management. The Malawi Service Provision Assessment 2013-2014 included 3149 outpatients aged 2-59 months with completed observations, interviews and re-examinations. Mixed-effects logistic regression models quantified the influence of patient-, provider and facility-level determinants on having IMCI non-severe pneumonia and its management in observed consultations. Among 3149 eligible outpatients, 590 (18.7%) had IMCI non-severe pneumonia classification in re-examination. 228 (38.7%) classified cases received first-line antibiotics and 159 (26.9%) received no antibiotics. 18.6% with cough or difficult breathing had 60-second respiratory rates counted during consultations, and conducting this assessment was significantly associated with IMCI training ever received (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.29-4.31) and negative rapid diagnostic test results (OR = 3.21, 95% CI: 1.45-7.13). Older children had lower odds of assessments than infants (OR = 48-59 months: 0.35, 95% CI: 0.16-0.75). Children presenting with any of the following complaints also had reduced odds of assessment: fever, diarrhea, skin problem or any danger sign. First-line antibiotic treatment for classified cases was significantly associated with high temperatures (OR = 3.26, 95% CI: 1.24-8.55) while older children had reduced odds of first-line treatment compared to infants (OR = 48-59 months: 0.29, 95% CI: 0.10-0.83). RDT-confirmed malaria was a significant predictor of no antibiotic receipt for IMCI non-severe pneumonia (OR = 10.65, 95% CI: 2.39-47.36). IMCI non-severe pneumonia care was sub-optimal in Malawi health facilities in 2013-2014 with inadequate assessments and prescribing practices that must be addressed to reduce this leading cause of mortality. Child's symptoms and age, malaria diagnosis and provider training were primary influences on assessment and treatment practices. Current evidence could be used to better target IMCI training and support to improve pneumonia care for sick children in Malawi facilities.

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.

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

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 assessment of non-severe maternal morbidity.

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 is available, to ensure more robust assessment of non-severe maternal morbidity. PMID:26390124

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 become evident within a period when coverage reaches optimal levels. PMID:23638008

Neurologic manifestations associated with an outbreak of typhoid fever, Malawi--Mozambique, 2009: an epidemiologic investigation.

PubMed

Sejvar, James; Lutterloh, Emily; Naiene, Jeremias; Likaka, Andrew; Manda, Robert; Nygren, Benjamin; Monroe, Stephan; Khaila, Tadala; Lowther, Sara A; Capewell, Linda; Date, Kashmira; Townes, David; Redwood, Yanique; Schier, Joshua; Barr, Beth Tippett; Demby, Austin; Mallewa, Macpherson; Kampondeni, Sam; Blount, Ben; Humphrys, Michael; Talkington, Deborah; Armstrong, Gregory L; Mintz, Eric

2012-01-01

The bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness. Describe neurologic features complicating typhoid fever during an outbreak in Malawi-Mozambique Persons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate. Between March - November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs. Neurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas.

Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi.

PubMed

Laidlaw, Rebecca; Dixon, Diane; Morse, Tracy; Beattie, Tara K; Kumwenda, Save; Mpemberera, Grant

2017-07-05

mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness. This two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi. Stage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research. This study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.

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

Background Nearly 3 million people in resource-poor countries receive antiretrovirals for the treatment of HIV/AIDS, yet millions more require treatment. Key barriers to treatment scale up are shortages of trained health care workers, and challenges integrating HIV/AIDS care with primary care. The research PALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilizes a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. The research consists of a cluster randomized trial in 30 public health centres in Zomba District that measures the effect of the intervention on staff satisfaction and retention, quality of patient care, and costs through quantitative, qualitative and health economics methods. Results and outcomes In the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, 3 to 4 staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned. The partnership Dignitas International and the Knowledge Translation Unit at the University of Cape Town Lung Institute have led the adaptation and development of the PALM PLUS intervention, using experience gained through the implementation of the South African precursor, PALSA PLUS. The Malawian partners, REACH Trust and the Research Unit at the Ministry of Health, have led the qualitative and economic evaluations. 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

Factors associated with retention in Option B+ in Malawi: a case control study

PubMed Central

Hoffman, Risa M; Phiri, Khumbo; Parent, Julie; Grotts, Jonathan; Elashoff, David; Kawale, Paul; Yeatman, Sara; Currier, Judith S; Schooley, Alan

2017-01-01

Abstract Introduction: There are limited data on factors associated with retention in Option B+. We sought to explore the characteristics of women retained in Option B+ in Malawi, with a focus on the role of HIV disclosure, awareness of partner HIV status, and knowledge around the importance of Option B+ for maternal–child health. Methods: We performed a case-control study of HIV-infected women in Malawi initiated on antiretroviral therapy (ART) under Option B+. Cases were enrolled if they met criteria for default from Option B+ (out of ART for >60 days), and controls were enrolled in approximately 3:1 ratio if they were retained in care for at least 12 months. We surveyed socio-demographic characteristics, HIV disclosure and awareness of partner HIV status, self-report about receiving pre-ART education, and knowledge of Option B+. Univariate logistic regression was performed to determine factors associated with retention. Multivariate logistic regression model was used to evaluate the relationship between HIV disclosure, Option B+ knowledge, and retention after adjusting for age, schooling, and travel time to clinic. Results: We enrolled 50 cases and 153 controls. Median age was 30 years (interquartile range (IQR) 25–34), and the majority (82%) initiated ART during pregnancy at a median gestational age of 24 weeks (IQR 16–28). Ninety-one per cent of the cases (39/43) who started ART during pregnancy defaulted by three months postpartum. HIV disclosure to the primary sex partner was more common among women retained in care (100% versus 78%, p < 0.001). Odds of retention were significantly higher among women with: age >25 years (odds ratio (OR) 2.44), completion of primary school (OR 3.06), awareness of partner HIV status (OR 5.20), pre-ART education (OR 6.17), higher number of correct answers to Option B+ knowledge questions (OR 1.82), and support while taking ART (OR 3.65). Pre-ART education and knowledge were significantly correlated (r = 0.43, p < 0.001). In multivariate analysis, awareness of partner HIV status (OR 4.07, 95% confidence interval (CI) 1.51–10.94, p = 0.02) and Option B+ knowledge (OR 1.60, 95% CI 1.15–2.23, p = 0.004) remained associated with retention. Conclusions: Interventions that address partner disclosure and strengthen pre-ART education around the benefits of ART for maternal and child health should be evaluated to improve retention in Malawi’s Option B+ programme. PMID:28453243

Baseline characteristics of study sites and women enrolled in a three-arm cluster randomized controlled trial: PMTCT uptake and retention (pure) Malawi.

PubMed

van Lettow, Monique; Tweya, Hannock; Rosenberg, Nora E; Trapence, Clement; Kayoyo, Virginia; Kasende, Florence; Kaunda, Blessings; Hosseinipour, Mina C; Eliya, Michael; Cataldo, Fabian; Gugsa, Salem; Phiri, Sam

2017-07-11

Malawi introduced an ambitious public health program known as "Option B+" which provides all HIV-infected pregnant and breastfeeding women with lifelong combination antiretroviral therapy, regardless of WHO clinical stage or CD4 cell count. The PMTCT Uptake and REtention (PURE) study aimed at evaluating the effect of peer-support on care-seeking and retention in care. PURE Malawi was a three-arm cluster randomized controlled trial that compared facility-based and community-based models of peer support to standard of care under Option B+ strategy. Each arm was expected to enroll a minimum of 360 women with a total minimum sample size of 1080 participants. 21 sites (clusters) were selected for inclusion in the study. This paper describes the site selection, recruitment, enrollment process and baseline characteristics of study sites and women enrolled in the trial. Study implementation was managed by 3 partner organizations; each responsible for 7 study sites. The trial was conducted in the South East, South West, and Central West zones of Malawi, the zones where the implementing partners operate. Study sites included 2 district hospitals, 2 mission hospitals, 2 rural hospitals, 13 health centers and 1 private clinic. Enrollment occurred from November 2013 to November 2014, over a median period of 31 weeks (range 17-51) by site. A total of 1269 HIV-infected pregnant (1094) and breastfeeding (175) women, who were eligible to initiate ART under Option B+, were enrolled. Each site reached or surpassed the minimum sample size. Comparing the number of women enrolled versus antenatal cohort reports, sites recruited a median of 90% (IQR 75-100) of eligible reported women. In the majority of sites the ratio of pregnant and lactating women enrolled in the study was similar to the ratio of reported pregnant and lactating women starting ART in the same sites. The median age of all women was 27 (IQR 22-31) years. All women have ≥20 months of possible follow-up time; 96% ≥ 2 years (24-32 months). The PURE Malawi study showed that 3 implementing partner organizations could successfully recruit a complex cohort of pregnant and lactating women across 3 geographical zones in Malawi within a reasonable timeline. This study is registered at clinicaltrials.gov - ID Number NCT02005835 . Registered 4 December, 2013.

Associations between Violence in School and at Home and Education Outcomes in Rural Malawi: A Longitudinal Analysis

ERIC Educational Resources Information Center

Psaki, Stephanie R.; Mensch, Barbara S.; Soler-Hampejsek, Erica

2017-01-01

Growing evidence of the prevalence of school-related gender-based violence (SRGBV) has raised concerns about negative effects on education. Previous quantitative research on this topic has been limited by descriptive and cross-sectional data. Using longitudinal data from the Malawi Schooling and Adolescent Study, we investigate associations…

Education, Health, and Labor Force Supply: Broadening Human Capital for National Development in Malawi

ERIC Educational Resources Information Center

Smith, William C.; Ikoma, Sakiko; Baker, David P.

2016-01-01

Education and health are both capital investments in national development, often viewed as independent factors on a country's labor force supply and productivity. This study uses the 2010-2011 Third Integrated Household Survey in Malawi to propose an Education-enhanced Health Human Capital (EHHC) model where education influences labor force supply…

Outcomes of an HIV Prevention Peer Group Intervention for Rural Adults in Malawi

ERIC Educational Resources Information Center

Kaponda, Chrissie P. N.; Norr, Kathleen F.; Crittenden, Kathleen S.; Norr, James L.; McCreary, Linda L.; Kachingwe, Sitingawawo I.; Mbeba, Mary M.; Jere, Diana L. N.; Dancy, Barbara L.

2011-01-01

This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention.…

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.

Risk Communication of Groundwater Quality in Northern Malawi, Africa

NASA Astrophysics Data System (ADS)

Holm, R.

2011-12-01

Malawi lies in Africa's Great Rift Valley. Its western border is defined by Lake Malawi, the third largest lake in Africa. Over 80% of Malawians live in rural areas and 90% of the labor force is associated with agriculture. More than half of the population lives below the poverty line. Area characteristics indicate a high likelihood of nitrate and total coliform in community drinking water. Infants exposed to high nitrate are at risk of developing methemoglobinemia. In addition, diarrheal diseases from unsafe drinking water are one of the top causes of mortality in children under five. Without sufficient and sustainable supplies of clean water, these challenges will continue to threaten Malawi's ability to overcome the devastating impact of diarrheal diseases on its population. Therefore, Malawi remains highly dependent on outside assistance and influence to reduce or eliminate the threat posed by unsafe drinking water. This research presents a literature review of nitrate and total coliform groundwater quality and a proposed risk communication plan for drinking water in northern Malawi.

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.

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.

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

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.

[Resident training in ophthalmology: can the German system learn from the Malawian one?].

PubMed

Schulze Schwering, M; Batumba, H N

2013-01-01

Training regulations in Germany and Malawi are compared. One German "Facharztausbildungsordnung" was compared with the syllabus of the Malawian Master of Medicine Degree in Ophthalmology. Germany nowadays has got 7000 ophthalmologists, Malawi nine; population in Germany 80 million, in Malawi 14 million. We present a written comparison underlined with one illustrative table. Modalities in resident training are very different. Training period: Germany 60 months, Malawi 48 months. Training manner: In Germany mostly theoretical private studies at hospitals and in private practices. Practical advice comes from senior residents, specialists and consultants. It is qualitywise and quantitatively very different within the country. The Malawian syllabus is very structured according to teaching in theory and practice. There are 250 hours of regular teaching each year. Lecturers are especially paid for teaching from outside the country. Training aim in Germany is mainly a medical ophthalmologist whereas in Malawi it is an ophthalmic surgeon. Exams: Germans take part in an oral exam of 30 minutes after 60 months training. Malawian residents take exams every two years: written, oral, practical. Furthermore they are supposed to take part in exams of the ICO (International Council of Ophthalmology) - until now with 100% success for the first attempts. German residents have lots of academic freedom during their training. It is non-uniform. Training aim in Germany is mainly a medical ophthalmologist whereas in Malawi it is an ophthalmic surgeon. The Malawian postgraduate training is uniform with scheduled instructions. That is why quality among candidates can be better compared. © Georg Thieme Verlag KG Stuttgart · New York.

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.

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+.

'I Have Learnt to Love the Child and Give Opportunities to Play with Peers': A Feasibility Study of the Training Programme to Support Parents of Young Children with Visual Impairment in Malawi

ERIC Educational Resources Information Center

Lynch, Paul; Gladstone, Melissa; McLinden, Michael; Douglas, Graeme; Jolley, Emma; Schmidt, Elena; Chimoyo, Josephine

2018-01-01

This is a first mixed-methods study, which created, adapted and tested the feasibility of a training programme targeted at parents, community professionals, specialist teachers and volunteers to provide advice on developmental stimulation for children with visual impairment in their homes in rural and urban settings of Malawi. The study followed…

Redressing Gender Inequalities in Education. A Review of Constraints and Priorities in Malawi, Zambia, and Zimbabwe.

ERIC Educational Resources Information Center

Swainson, Nicola

The causes and manifestations of gender inequalities in education in Malawi, Zambia, and Zimbabwe and policy options for redressing them were examined through a review of literature on the causes, nature, and extent of gender disparities in education in the study region and information on efforts to eliminate gender inequality. Special attention…

Pre-Service Teacher Training in Malawi: Findings of a Pilot Study on the Viability of Media Players for Teacher Development

ERIC Educational Resources Information Center

Carrier, Carol; Finholt-Daniel, Matt; Sales, Gregory C.

2012-01-01

As part of the United States Agency for International Development (USAID) funded Malawi Teacher Professional Development Support project, a sub-task was the piloting of an alternative technology that could be used for improving the quality and consistency of teacher continued professional development (CPD). The pilot, which included 26 open and…

Growth and HIV-free survival of HIV-exposed infants in Malawi: A randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy

USDA-ARS?s Scientific Manuscript database

The objective of this study was to compare the growth of HIV-exposed children receiving 1 of 2 complementary foods after prevention of mother-to-child HIV transmission through maternal lifelong antiretroviral therapy (ART). In rural Malawi, 280 HIV-infected pregnant women were consecutively identifi...

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…

Schooling and Basic Aspects of Intelligence: A Natural Quasi-Experiment in Malawi

ERIC Educational Resources Information Center

Van de Vijver, Fons J. R.; Brouwers, Symen A.

2009-01-01

The relationship between educational age and chronological age and measures of information processing and intelligence was studied in a group of children of 7 to 14 years of age (N=268) in a rural area in the Ntcheu district (Malawi). There was a relatively weak relationship between chronological and educational age in this area, and the impact of…

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…

Perceptions of Special Educational Practices in Malawi: Voices from Primary Schools and Communities

ERIC Educational Resources Information Center

Lubeski, Nancy J.

2011-01-01

This doctoral research work explores the quality of educational experiences and access to opportunities for girls with disabilities in selected rural primary schools in Malawi. The context for this study lies within four of the six goals contained within the World Declaration on Education for All doctrine, a document which lays out a framework for…

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.

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…

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.

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

Taking the health aid debate to the subnational level: the impact and allocation of foreign health aid in Malawi

PubMed Central

Marty, Robert; Dolan, Carrie B; Leu, Matthias; Runfola, Daniel

2017-01-01

Objective Cross-national studies provide inconclusive results as to the effectiveness of foreign health aid. We highlight a novel application of using subnational data to evaluate aid impacts, using Malawi as a case study. Design We employ two rounds of nationally representative household surveys (2004/2005 and 2010/2011) and geo-referenced foreign aid data. We examine the determinants of Malawi's traditional authorities receiving aid according to health, environmental risk, socioeconomic and political factors. We use two approaches to estimate the impact of aid on reducing malaria prevalence and increasing healthcare quality: difference-in-difference models, which include traditional authority and month-of-interview fixed effects and control for individual and household level time-varying factors, and entropy balancing, where models balance on health-related and socioeconomic baseline characteristics. General health aid and four specific health aid sectors are examined. Results Traditional authorities with greater proportions of individuals living in urban areas, more health facilities and greater proportions of those in major ethnic groups were more likely to receive aid. Difference-in-difference models show health infrastructure and parasitic disease control aid reduced malaria prevalence by 1.20 (95% CI −0.36 to 2.76) and 2.20 (95% CI 0.43 to 3.96) percentage points, respectively, and increased the likelihood of individuals reporting healthcare as more than adequate by 12.1 (95% CI 1.51 to 22.68) and 14.0 (95% CI 0.11 to 28.11) percentage points. Entropy balancing shows similar results. Conclusions Aid was targeted to areas with greater existing health infrastructure rather than areas most in need, but still effectively reduced malaria prevalence and enhanced self-reported healthcare quality. PMID:28588997

[Visual impairment and blindness in children in a Malawian school for the blind].

PubMed

Schulze Schwering, M; Nyrenda, M; Spitzer, M S; Kalua, K

2013-08-01

The aim of this study was to determine the anatomic sites of severe visual impairment and blindness in children in an integrated school for the blind in Malawi, and to compare the results with those of previous Malawian blind school studies. Children attending an integrated school for the blind in Malawi were examined in September 2011 using the standard WHO/PBL eye examination record for children with blindness and low vision. Visual acuity [VA] of the better eye was classified using the standardised WHO reporting form. Fifty-five pupils aged 6 to 19 years were examined, 39 (71 %) males, and 16 (29 %) females. Thirty eight (69%) were blind [BL], 8 (15 %) were severely visually impaired [SVI], 8 (15 %) visually impaired [VI], and 1 (1.8 %) was not visually impaired [NVI]. The major anatomic sites of visual loss were optic nerve (16 %) and retina (16 %), followed by lens/cataract (15 %), cornea (11 %) and lesions of the whole globe (11 %), uveal pathologies (6 %) and cortical blindness (2 %). The exact aetiology of VI or BL could not be determined in most children. Albinism accounted for 13 % (7/55) of the visual impairments. 24 % of the cases were considered to be potentially avoidable: refractive amblyopia among pseudophakic patients and corneal scaring. Optic atrophy, retinal diseases (mostly albinism) and cataracts were the major causes of severe visual impairment and blindness in children in an integrated school for the blind in Malawi. Corneal scarring was now the fourth cause of visual impairment, compared to being the commonest cause 35 years ago. Congenital cataract and its postoperative outcome were the commonest remedial causes of visual impairment. Georg Thieme Verlag KG Stuttgart · New York.

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

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 South Africa and Malawi. PMID:21791048

Malawi's contribution to "3 by 5": achievements and challenges.

PubMed

Libamba, Edwin; Makombe, Simon D; Harries, Anthony D; Schouten, Erik J; Yu, Joseph Kwong-Leung; Pasulani, Olesi; Mhango, Eustice; Aberle-Grasse, John; Hochgesang, Mindy; Limbambala, Eddie; Lungu, Douglas

2007-02-01

Many resource-poor countries have started scaling up antiretroviral therapy (ART). While reports from individual clinics point to successful implementation, there is limited information about progress in government institutions at a national level. Malawi started national ART scale-up in 2004 using a structured approach. There is a focus on one generic, fixed-dose combination treatment with stavudine, lamivudine and nevirapine. Treatment is delivered free of charge to eligible patients with HIV and there is a standardized system for recruiting patients, monthly follow-up, registration, monitoring and reporting of cases and outcomes. All treatment sites receive quarterly supervision and evaluation. In January 2004, there were nine public sector facilities delivering ART to an estimated 4 000 patients. By December 2005, there were 60 public sector facilities providing free ART to 37,840 patients using national standardized systems. Analysis of quarterly cohort treatment outcomes at 12 months showed 80% of patients were alive, 10% dead, 9% lost to follow-up and 1% had stopped treatment. Achievements were the result of clear national ART guidelines, implementing partners working together, an intensive training schedule focused on clinical officers and nurses, a structured system of accrediting facilities for ART delivery, quarterly supervision and monitoring, and no stock-outs of antiretroviral drugs. The main challenges are to increase the numbers of children, pregnant women and patients with tuberculosis being started on ART, and to avert high early mortality and losses to follow-up. The capacity of the health sector to cope with escalating case loads and to scale up prevention alongside treatment will determine the future success of ART delivery in Malawi.

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.

STI patients are effective recruiters of undiagnosed cases of HIV: results of a social contact recruitment study in Malawi.

PubMed

Rosenberg, Nora E; Kamanga, Gift; Pettifor, Audrey E; Bonongwe, Naomi; Mapanje, Clement; Rutstein, Sarah E; Ward, Michelle; Hoffman, Irving F; Martinson, Francis; Miller, William C

2014-04-15

Patients with newly diagnosed HIV may be part of social networks with elevated prevalence of undiagnosed HIV infection. Social network recruitment by persons with newly diagnosed HIV may efficiently identify undiagnosed cases of HIV infection. We assessed social network recruitment as a strategy for identifying undiagnosed cases of HIV infection. In a sexually transmitted infection (STI) clinic in Lilongwe, Malawi, 3 groups of 45 "seeds" were enrolled: STI patients with newly diagnosed HIV, STI patients who were HIV-uninfected, and community controls. Seeds were asked to recruit up to 5 social "contacts" (sexual or nonsexual). Mean number of contacts recruited per group was calculated. HIV prevalence ratios (PRs) and number of contacts needed to test to identify 1 new case of HIV were compared between groups using generalized estimating equations with exchangeable correlation matrices. Mean number of contacts recruited was 1.3 for HIV-infected clinic seeds, 1.8 for HIV-uninfected clinic seeds, and 2.3 for community seeds. Contacts of HIV-infected clinic seeds had a higher HIV prevalence (PR: 3.2, 95% confidence interval: 1.3 to 7.8) than contacts of community seeds, but contacts of HIV-uninfected clinic seeds did not (PR: 1.1, 95% confidence interval: 0.4 to 3.3). Results were similar when restricted to nonsexual contacts. To identify 1 new case of HIV, it was necessary to test 8 contacts of HIV-infected clinic seeds, 10 contacts of HIV-uninfected clinic seeds, and 18 contacts of community seeds. Social contact recruitment by newly diagnosed STI patients efficiently led to new HIV diagnoses. Research to replicate findings and guide implementation is needed.

Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

PubMed Central

Chilopora, Garvey; Pereira, Caetano; Kamwendo, Francis; Chimbiri, Agnes; Malunga, Eddie; Bergström, Staffan

2007-01-01

Background Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. Methods During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers. Results During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death. Conclusion Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians. PMID:17570847

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001-12: a retrospective observational study.

PubMed

Lazzerini, Marzia; Seward, Nadine; Lufesi, Norman; Banda, Rosina; Sinyeka, Sophie; Masache, Gibson; Nambiar, Bejoy; Makwenda, Charles; Costello, Anthony; McCollum, Eric D; Colbourn, Tim

2016-01-01

Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi's Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children's clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2-11 months of age, and 12-59 months of age using separate multivariable mixed effects logistic regression models. Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92·7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6·6% (95% CI 6·4-6·7). The case fatality rate significantly decreased between 2001 (15·2% [13·4-17·1]) and 2012 (4·5% [4·1-4·9]; ptrend<0·0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2-11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11·8%), severe undernutrition (15·4%), severe acute malnutrition (34·8%), and symptom duration of more than 21 days (9·0%). Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi. Bill & Melinda Gates Foundation. Copyright © 2016 Lazzerini et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Implementation of Regional and International HIV and AIDS Prevention, Treatment, Care and Support Conventions and Declarations in Lesotho, Malawi and Mozambique

ERIC Educational Resources Information Center

Kalanda, Boniface; Mamimine, Patrick; Taela, Katia; Chingandu, Louis; Musuka, Godfrey

2010-01-01

The governments across the world have endorsed numerous international Conventions and Declarations (C&Ds) that enhance interventions to reduce the impact of HIV and AIDS. The objective of this study was to assess the extent to which the governments of Lesotho, Malawi and Mozambique have implemented HIV and AIDS international and regional…

'It's a very complicated issue here': understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study.

PubMed

Cook, Sinead; de Kok, Bregje; Odland, Maria Lisa

2017-04-01

Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective. © The Author 2016. 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.

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 standardised and more targeted HRH strategies than has been practised to date. PMID:23364090

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)

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…

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...

The cost of the district hospital: a case study in Malawi.

PubMed

Mills, A J; Kapalamula, J; Chisimbi, S

1993-01-01

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.

The cost of the district hospital: a case study in Malawi.

PubMed Central

Mills, A. J.; Kapalamula, J.; Chisimbi, S.

1993-01-01

Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed. PMID:8324852

Revitalization of the shared commons: education for sustainability and marginalized cultures

NASA Astrophysics Data System (ADS)

Glasson, George E.

2010-06-01

Education for sustainability provides a vision for revitalizing the environmental commons while preserving cultural traditions and human rights. What happens if the environmental commons is shared by two politically disparate and conflicting cultures? As in many shared common lands, what happens if one culture is dominant and represents a more affluent society with more resources and educational opportunities? In the case of the Tal and Alkaher study (Cult Stud Sci Edu, 2009), asymmetric power differences between the dominant Israeli society and the minority Arab population yielded different environmental narratives and perceptions of students involved in learning about a mediated conflict in national park land. Similarly, marginalized indigenous cultures in Malawi, Africa share common lands with the dominant European landowners but have distinctly different environmental narratives. Although indigenous ways of living with nature contribute to the sustainability of the environment and culture, African funds of knowledge are conspicuously absent from the Eurocentric school science curriculum. In contrast, examples of experiential learning and recent curriculum development efforts in sustainability science in Malawi are inclusive of indigenous knowledge and practices and are essential for revitalizing the shared commons.

Validating the WHO maternal near miss tool: comparing high- and low-resource settings.

PubMed

Witteveen, Tom; Bezstarosti, Hans; de Koning, Ilona; Nelissen, Ellen; Bloemenkamp, Kitty W; van Roosmalen, Jos; van den Akker, Thomas

2017-06-19

WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received ≥1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.

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.

Public engagement in Malawi through a health-talk radio programme ‘Umoyo nkukambirana’: A mixed-methods evaluation

PubMed Central

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O’byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2016-01-01

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. PMID:27365364

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

The term "intimate partner violence" (IPV) encompasses physical, sexual and psychological violence, or any combination of these acts, and globally is the most common type of violence against women. This study aims to examine the lifetime prevalence of different types of intimate partner violence (IPV) among Malawi women ages 15 to 49, and its association with age, education, and living in rural versus urban areas. Data was obtained from a cross-sectional study of data as part of the 2004 Malawi Demographic and Health Survey. Women were eligible for the study if they met the following criteria: 1) lived in one of the 15,041 households randomly selected from 522 rural and urban clusters located in 10 large districts of Malawi; 2) were married or cohabitating; and 3) were between the ages of 15 and 49 years. Consenting, eligible women responded to a comprehensive questionnaire covering demographic factors, health issues, as well as items related to physical, emotional and sexual IPV. To assess bivariate associations, chi-squared tests and multivariate logistic regressions were conducted. Among the 8291 respondents, 13% reported emotional violence; 20% reported being pushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as being strangled or burned, threatened with a knife, gun or with another weapon; and 13% reported sexual violence. Data showed women ages 15 to 19 were significantly less likely to report emotional IPV, women ages 25 to 29 were significantly more likely to report being pushed or shaken, slapped or punched (OR 1.35; CI: 1.05-1.73), and women ages 30 to 34 were significantly more likely to report sexual IPV, compared to women ages 45 to 49 (OR 1.40; CI: 1.03-1.90). Finally, women who had no ability to read were less likely to report sexual IPV than their counterparts who could read a full sentence (OR 0.76; CI: 0.66-0.87). The prevalence of different types of IPV in 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.

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

Abstract: Background: The term “intimate partner violence” (IPV) encompasses physical, sexual and psychological violence, or any combination of these acts, and globally is the most common type of violence against women. This study aims to examine the lifetime prevalence of different types of intimate partner violence (IPV) among Malawi women ages 15 to 49, and its association with age, education, and living in rural versus urban areas. Methods: Data was obtained from a cross-sectional study of data as part of the 2004 Malawi Demographic and Health Survey. Women were eligible for the study if they met the following criteria: 1) lived in one of the 15,041 households randomly selected from 522 rural and urban clusters located in 10 large districts of Malawi; 2) were married or cohabitating; and 3) were between the ages of 15 and 49 years. Consenting, eligible women responded to a comprehensive questionnaire covering demographic factors, health issues, as well as items related to physical, emotional and sexual IPV. To assess bivariate associations, chi-squared tests and multivariate logistic regressions were conducted. Results: Among the 8291 respondents, 13% reported emotional violence; 20% reported being pushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as being strangled or burned, threatened with a knife, gun or with another weapon; and 13% reported sexual violence. Data showed women ages 15 to 19 were significantly less likely to report emotional IPV, women ages 25 to 29 were significantly more likely to report being pushed or shaken, slapped or punched (OR 1.35; CI: 1.05-1.73), and women ages 30 to 34 were significantly more likely to report sexual IPV, compared to women ages 45 to 49 (OR 1.40; CI: 1.03-1.90). Finally, women who had no ability to read were less likely to report sexual IPV than their counterparts who could read a full sentence (OR 0.76; CI: 0.66-0.87). Conclusions: The prevalence of different types of IPV in 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

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

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.

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.

Determinants of Integrated Management of Childhood Illness (IMCI) non–severe pneumonia classification and care in Malawi health facilities: Analysis of a national facility census

PubMed Central

Johansson, Emily White; Nsona, Humphreys; Carvajal–Aguirre, Liliana; Amouzou, Agbessi; Hildenwall, Helena

2017-01-01

Background Research shows inadequate Integrated Management of Childhood Illness (IMCI)–pneumonia care in various low–income settings but evidence is largely from small–scale studies with limited evidence of patient–, provider– and facility–levels determinants of IMCI non–severe pneumonia classification and its management. Methods The Malawi Service Provision Assessment 2013–2014 included 3149 outpatients aged 2–59 months with completed observations, interviews and re–examinations. Mixed–effects logistic regression models quantified the influence of patient–, provider and facility–level determinants on having IMCI non–severe pneumonia and its management in observed consultations. Findings Among 3149 eligible outpatients, 590 (18.7%) had IMCI non–severe pneumonia classification in re–examination. 228 (38.7%) classified cases received first–line antibiotics and 159 (26.9%) received no antibiotics. 18.6% with cough or difficult breathing had 60–second respiratory rates counted during consultations, and conducting this assessment was significantly associated with IMCI training ever received (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.29–4.31) and negative rapid diagnostic test results (OR = 3.21, 95% CI: 1.45–7.13). Older children had lower odds of assessments than infants (OR = 48–59 months: 0.35, 95% CI: 0.16–0.75). Children presenting with any of the following complaints also had reduced odds of assessment: fever, diarrhea, skin problem or any danger sign. First–line antibiotic treatment for classified cases was significantly associated with high temperatures (OR = 3.26, 95% CI: 1.24–8.55) while older children had reduced odds of first–line treatment compared to infants (OR = 48–59 months: 0.29, 95% CI: 0.10–0.83). RDT–confirmed malaria was a significant predictor of no antibiotic receipt for IMCI non–severe pneumonia (OR = 10.65, 95% CI: 2.39–47.36). Conclusions IMCI non–severe pneumonia care was sub–optimal in Malawi health facilities in 2013–2014 with inadequate assessments and prescribing practices that must be addressed to reduce this leading cause of mortality. Child’s symptoms and age, malaria diagnosis and provider training were primary influences on assessment and treatment practices. Current evidence could be used to better target IMCI training and support to improve pneumonia care for sick children in Malawi facilities. PMID:29163934

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…

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

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…

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…

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.

Professional Skills Development in a Resource-Poor Setting: The Case of Pharmacy in Malawi

ERIC Educational Resources Information Center

Lim, Zoe; Anderson, C.; McGrath, S.

2012-01-01

The dominance of the human capital approach in vocational skills development has been increasingly questioned for being de-humanised and de-contextualised. Contrary to this trend, the discourse in health professional skills development has shown increasing enthusiasm for consolidating this existing paradigm. To debate whether professional skills…

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.

Leukaemia at Queen Elizabeth Central Hospital in Blantyre, Malawi.

PubMed

Mukiibi, J M; Nyirenda, C M; Adewuyi, J O; Mzula, E L; Magombo, E D; Mbvundula, E M

2001-07-01

To determine the patterns of leukaemias seen in Malawians at Queen Elizabeth Central Hospital (QECH) and to compare the findings with those from elsewhere. An overview of the problems encountered in the management of leukaemia in developing countries especially those in sub-Saharan Africa are highlighted. Retrospective descriptive analysis of consecutive leukaemia cases seen from January 1994 through December 1998. Of the 95 leukaemia patients diagnosed during the study period, childhood (0-15 years) leukaemia occurred in 27 (28.4%) patients while adulthood (above 15 years) leukaemia accounted for 68 (71.6%) patients. The main leukaemia types were: acute lymphoblastic leukaemia (ALL) 14 (14.7%), acute myeloblastic leukaemia (AML) 25 (26.3%), chronic myeloid (granulocytic) leukaemia (CML) 32 (33.7%), chronic lymphocytic (lymphatic) leukaemia (CLL) 22 (23.2%) and hairy cell leukaemia (HCL) two (2.1%) patients. Most of the acute leukaemia (AL) cases occurred in the six to 15 year age bracket with a male preponderance. In ALL, lymphadenopathy was the commonest presenting feature followed by pallor (92.9%) while in the AML group, pallor occurred in 80% of cases. Abdominal swelling (87.5%) due to splenomegaly (81.3%) were the main clinical features in the CML group whereas lymphadenopathy (63.6%) followed by splenomegaly (59.1%) were the dominant presenting features in CLL. Haematologically, although leucocytosis characterised both acute and chronic leukaemias, most cases of acute leukaemia presented with more severe anaemia (Hb < 7 g/dl) and marked thrombocytopenia (Platelet count < 50 x 10(9)/l) than the chronic leukaemias. The study shows that leukaemias are not rare in Malawi and cases which were diagnosed in this series probably only represent the tip of the iceberg. While there is need to increase diagnostic awareness among clinicians and laboratory staff, the severe chronic shortage of cytotoxic drugs and lack of supportive care facilities commonly encountered in developing countries should be realistically addressed through cost-sharing, cost recovery, adequate government subvention and donations from charitable organisations.

Mobile instant messaging for rural community health workers: a case from Malawi.

PubMed

Pimmer, Christoph; Mhango, Susan; Mzumara, Alfred; Mbvundula, Francis

2017-01-01

Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources. The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.

Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

PubMed

Mann, Carlyn; Ng, Courtney; Akseer, Nadia; Bhutta, Zulfiqar A; Borghi, Josephine; Colbourn, Tim; Hernández-Peña, Patricia; Huicho, Luis; Malik, Muhammad Ashar; Martinez-Alvarez, Melisa; Munthali, Spy; Salehi, Ahmad Shah; Tadesse, Mekonnen; Yassin, Mohammed; Berman, Peter

2016-09-12

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data. Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20-64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005-2010) for RMNH expenditures (2005-2010) and 165 % for CH expenditures (2005-2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements. Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures across countries are still needed to better understand whether domestic and global health financing initiatives lead to improved outcomes as RMNCH continues to be a priority under the Sustainable Development Goals.

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…

Prevalence and correlates of hunger among primary and secondary school children in Malawi: results from the 2009 Global School-based Health Survey.

PubMed

Mwambene, J B; Muula, A S; Leo, J C

2013-06-01

Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi. The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chi-squared test and logistic regression. A total of 2359 students were available for analysis. The overall self-reported prevalence of hunger within the last 30 days was 12.5% (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger. Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger.

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 intermediate host species are Bulinus globosus and Bulinus nyassanus for urinary schistosomiasis and Biomphalaria pfeifferi for intestinal schistosomiasis. Seasonality of transmission tends to vary according to geographical, environmental, biological and behavioural factors. Transmission of schistosomiasis in Malawi appears to be highly focal, with considerable variation in space and time. Many locations have not been covered by epidemiological investigations and, thus, information on the transmission of schistosomiasis in Malawi remains fragmented. Functional infection risk assessment systems based on systematic investigations and surveillance are required for developing informed prevention and control strategies.

Cohort Profile: The Malawi Longitudinal Study of Families and Health (MLSFH).

PubMed

Kohler, Hans-Peter; Watkins, Susan C; Behrman, Jere R; Anglewicz, Philip; Kohler, Iliana V; Thornton, Rebecca L; Mkandawire, James; Honde, Hastings; Hawara, Augustine; Chilima, Ben; Bandawe, Chiwoza; Mwapasa, Victor; Fleming, Peter; Kalilani-Phiri, Linda

2015-04-01

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-standing, publicly available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries. The MLSFH was initially established in 1998 to study social network influences on fertility behaviours and HIV risk perceptions, and over time the focus of the study expanded to include health, sexual behaviours, intergenerational relations and family/household dynamics. The currently available data include MLSFH rounds collected in 1998, 2001, 2004, 2006, 2008, 2010 and 2012 for up to 4000 individuals, providing information about socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MLSFH public use data can be requested on the project website: http://www.malawi.pop.upenn.edu/. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Policy Concerns Relating to Teacher Recruitment and Deployment in Malawi. Education Sector Planning Policy Discussion Papers. Teacher Education Policy Position Papers. Paper # 1

ERIC Educational Resources Information Center

Sedere, Upali M.

2005-01-01

This paper outlines the issues relating to teacher education and teacher supply in Malawi. Malawi has a severe shortage of teachers. Over the years, particularly since EFA the student numbers has gone up yet the teacher supply has not followed the increased student numbers. This paper outlines the broader picture as a basis for further…

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

Achieving the sustainable development goals: a case study of the complexity of water quality health risks in Malawi.

PubMed

Holm, Rochelle; Wandschneider, Philip; Felsot, Allan; Msilimba, Golden

2016-07-15

Suppose 35 % of the households with children under 5 years of age in a low-income suburban neighborhood in a developing country have diarrhea where improved water sources are available. Clearly, something is amiss-but what? In addition to focusing on the need to examine water quality among water sources that meet the 'improved' category when assessing health risk, the relative importance of the range of transmission routes for diarrhea is unknown. In Malawi, relevant baseline data affecting human health are simply not available, and acquiring data is hampered by a lack of local analytical capacity for characterizing drinking water quality. The objective of this work is to develop a risk communication program with partnership among established regional development professionals for effectively meeting the sustainable development goals. A field study was conducted in the city of Mzuzu, Malawi, to study water quality (total coliform and Escherichia coli) and human dimensions leading to development of a public health risk communication strategy in a peri-urban area. A structured household questionnaire was administered to adult residents of 51 households, encompassing 284 individuals, who were using the 30 monitored shallow wells. The water quality data and human dimension questionnaire results were used to develop a household risk presentation. Sixty-seven percent and 50 % of well water and household drinking water samples, respectively, exceeded the WHO health guideline of zero detections of E. coli. Technology transfer was advanced by providing knowledge through household risk debriefing/education, establishing a water quality laboratory at the local university, and providing training to local technicians. Communicating the science of water quality and health risks in developing countries requires sample collection and analysis by knowledgeable personnel trained in the sciences, compiling baseline data, and, ultimately, an effective risk presentation back to households to motivate behavioral changes to effectively protect future water resources and human health.

Population Impact and Effectiveness of Monovalent Rotavirus Vaccination in Urban Malawian Children 3 Years After Vaccine Introduction: Ecological and Case-Control Analyses

PubMed Central

Bar-Zeev, Naor; Jere, Khuzwayo C.; Bennett, Aisleen; Pollock, Louisa; Tate, Jacqueline E.; Nakagomi, Osamu; Iturriza-Gomara, Miren; Costello, Anthony; Mwansambo, Charles; Parashar, Umesh D.; Heyderman, Robert S.; French, Neil; Cunliffe, Nigel A.

2016-01-01

Background. Rotavirus vaccines have been introduced in many low-income African countries including Malawi in 2012. Despite early evidence of vaccine impact, determining persistence of protection beyond infancy, the utility of the vaccine against specific rotavirus genotypes, and effectiveness in vulnerable subgroups is important. Methods. We compared rotavirus prevalence in diarrheal stool and hospitalization incidence before and following rotavirus vaccine introduction in Malawi. Using case-control analysis, we derived vaccine effectiveness (VE) in the second year of life and for human immunodeficiency virus (HIV)–exposed and stunted children. Results. Rotavirus prevalence declined concurrent with increasing vaccine coverage, and in 2015 was 24% compared with prevaccine mean baseline in 1997–2011 of 32%. Since vaccine introduction, population rotavirus hospitalization incidence declined in infants by 54.2% (95% confidence interval [CI], 32.8–68.8), but did not fall in older children. Comparing 241 rotavirus cases with 692 test-negative controls, VE was 70.6% (95% CI, 33.6%–87.0%) and 31.7% (95% CI, −140.6% to 80.6%) in the first and second year of life, respectively, whereas mean age of rotavirus cases increased from 9.3 to 11.8 months. Despite higher VE against G1P[8] than against other genotypes, no resurgence of nonvaccine genotypes has occurred. VE did not differ significantly by nutritional status (78.1% [95% CI, 5.6%–94.9%] in 257 well-nourished and 27.8% [95% CI, −99.5% to 73.9%] in 205 stunted children; P = .12), or by HIV exposure (60.5% [95% CI, 13.3%–82.0%] in 745 HIV-unexposed and 42.2% [95% CI, −106.9% to 83.8%] in 174 exposed children; P = .91). Conclusions. Rotavirus vaccination in Malawi has resulted in reductions in disease burden in infants <12 months, but not in older children. Despite differences in genotype-specific VE, no genotype has emerged to suggest vaccine escape. VE was not demonstrably affected by HIV exposure or stunting. PMID:27059359

Population Impact and Effectiveness of Monovalent Rotavirus Vaccination in Urban Malawian Children 3 Years After Vaccine Introduction: Ecological and Case-Control Analyses.

PubMed

Bar-Zeev, Naor; Jere, Khuzwayo C; Bennett, Aisleen; Pollock, Louisa; Tate, Jacqueline E; Nakagomi, Osamu; Iturriza-Gomara, Miren; Costello, Anthony; Mwansambo, Charles; Parashar, Umesh D; Heyderman, Robert S; French, Neil; Cunliffe, Nigel A

2016-05-01

Rotavirus vaccines have been introduced in many low-income African countries including Malawi in 2012. Despite early evidence of vaccine impact, determining persistence of protection beyond infancy, the utility of the vaccine against specific rotavirus genotypes, and effectiveness in vulnerable subgroups is important. We compared rotavirus prevalence in diarrheal stool and hospitalization incidence before and following rotavirus vaccine introduction in Malawi. Using case-control analysis, we derived vaccine effectiveness (VE) in the second year of life and for human immunodeficiency virus (HIV)-exposed and stunted children. Rotavirus prevalence declined concurrent with increasing vaccine coverage, and in 2015 was 24% compared with prevaccine mean baseline in 1997-2011 of 32%. Since vaccine introduction, population rotavirus hospitalization incidence declined in infants by 54.2% (95% confidence interval [CI], 32.8-68.8), but did not fall in older children. Comparing 241 rotavirus cases with 692 test-negative controls, VE was 70.6% (95% CI, 33.6%-87.0%) and 31.7% (95% CI, -140.6% to 80.6%) in the first and second year of life, respectively, whereas mean age of rotavirus cases increased from 9.3 to 11.8 months. Despite higher VE against G1P[8] than against other genotypes, no resurgence of nonvaccine genotypes has occurred. VE did not differ significantly by nutritional status (78.1% [95% CI, 5.6%-94.9%] in 257 well-nourished and 27.8% [95% CI, -99.5% to 73.9%] in 205 stunted children;P= .12), or by HIV exposure (60.5% [95% CI, 13.3%-82.0%] in 745 HIV-unexposed and 42.2% [95% CI, -106.9% to 83.8%] in 174 exposed children;P= .91). Rotavirus vaccination in Malawi has resulted in reductions in disease burden in infants <12 months, but not in older children. Despite differences in genotype-specific VE, no genotype has emerged to suggest vaccine escape. VE was not demonstrably affected by HIV exposure or stunting. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Lake Malawi cichlid evolution along a benthic/limnetic axis.

PubMed

Hulsey, C D; Roberts, R J; Loh, Y-H E; Rupp, M F; Streelman, J T

2013-07-01

Divergence along a benthic to limnetic habitat axis is ubiquitous in aquatic systems. However, this type of habitat divergence has largely been examined in low diversity, high latitude lake systems. In this study, we examined the importance of benthic and limnetic divergence within the incredibly species-rich radiation of Lake Malawi cichlid fishes. Using novel phylogenetic reconstructions, we provided a series of hypotheses regarding the evolutionary relationships among 24 benthic and limnetic species that suggests divergence along this axis has occurred multiple times within Lake Malawi cichlids. Because pectoral fin morphology is often associated with divergence along this habitat axis in other fish groups, we investigated divergence in pectoral fin muscles in these benthic and limnetic cichlid species. We showed that the eight pectoral fin muscles and fin area generally tended to evolve in a tightly correlated manner in the Lake Malawi cichlids. Additionally, we found that larger pectoral fin muscles are strongly associated with the independent evolution of the benthic feeding habit across this group of fish. Evolutionary specialization along a benthic/limnetic axis has occurred multiple times within this tropical lake radiation and has produced repeated convergent matching between exploitation of water column habitats and locomotory morphology.

Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi.

PubMed

Weinhardt, Lance S; Galvao, Loren W; Yan, Alice F; Stevens, Patricia; Mwenyekonde, Thokozani Ng'ombe; Ngui, Emmanuel; Emer, Lindsay; Grande, Katarina M; Mkandawire-Valhmu, Lucy; Watkins, Susan C

2017-03-01

The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18-, and 36-months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29-2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07-4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63-0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants' outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.

Perspectives of health care providers on the provision of intermittent preventive treatment in pregnancy in health facilities in Malawi.

PubMed

Yoder, P Stanley; Nsabagasani, Xavier; Eckert, Erin; Moran, Allisyn; Yé, Yazoumé

2015-08-29

Nearly 20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55% of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010. Although several reasons for the low coverage have been suggested, few studies have examined the views of health care providers. This study examined the experiences of the nurses and midwives in providing antenatal care (ANC) services. This study was conducted in health facilities in Malawi that provide routine ANC services. Providers of ANC in Malawi were selected from in eight health care facilities of Malawi. Selected providers were interviewed using a semi-structured interview guide designed to address a series of themes related to their working conditions and their delivery of IPTp. Nurses displayed detailed knowledge of ANC services and the rationale behind them. Nurses understood that they should provide two doses of IPTp during a pregnancy, but they did not agree on the timing of the doses. Nurses gave SP as directly observed therapy (DOT) at the clinic. Nurses did not give SP pills to women to take home with them because they did not trust that women would take the pills. Women who resisted taking SP explained they do not take drugs if they had not eaten, or they feared side effects, or they were not sick. Reasons for not giving the first or second dose of SP included a delay in the first ANC visit, testing positive for HIV, and presenting with malaria. None of the nurses were able to show any specific written guidelines on when to give SP. The challenges faced by the nurses include being overworked and persuading women to take SP under observation. The findings show that the nurses had gained the knowledge and technical skills to provide appropriate ANC services. With regard to IPTp, nurses need guidelines that would be available at the health facility about how and when to give SP. The adoption of the WHO guidelines and their diffusion to health care facilities could help increase the coverage of IPTp2 (at least two doses of sulfadoxine-pyrimethamine) in Malawi.

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.

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.

Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

PubMed

Abdu, Mohammed; Wilson, Amie; Mhango, Chisale; Taki, Fatima; Coomarasamy, Arri; Lissauer, David

2018-02-01

To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

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 treatment exceeded the daily wage of a low-paid government worker in Malawi and therefore had to be considered as unaffordable for a major part of the population. Conclusions Continued efforts are required to improve the availability of essential medicines in Malawi. The free provision of medicines in the public health care system remains important in order to achieve universal health coverage, due to the low income in this country. PMID:28419126

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 basins that extend from the Malawi Rift north to the Rukwa Rift. The presence of this offshore basin confirms that the corridor between the Rukwa and Malawi Rifts has experienced prolonged periods of extension, likely thinning the lithosphere there, and thus providing a mechanism for focusing of long-lived magmatism at the Rungwe Volcanic Center.

Ischio-pubic index in adult black Malawians.

PubMed

Igbigbi, P S; Msamati, B C

2000-09-01

To determine the ischiopubic index in adult black Malawians. A retrospective study on patients investigated in two hospitals and skeletal specimens from the College of Medicine, University of Malawi. Radiographs of pelvis were collected from the archives of Queen Elizabeth Central and Seventh Day Adventist Hospitals in Blantyre city and available skeletal specimens from the Department of Anatomy, College of Medicine, University of Malawi. Antero-posterior x-ray films of pelvis of 255 adult subjects aged between 18 and 65 years were studied. The ischio-pubic index was used to determine the sex of the individuals. The mean ischio-pubic index of females was significantly greater than that of males (p<0.001). The mean length of female pubis was significantly longer than for males (p<0.001), and similarly the mean length of the ischium in males was significantly longer than that of females (p<0.001). Using the x-ray films, sex could be accurately assigned to 87.8% of males and 100% of females while with the skeletal bones, sex could be assigned to 92.3% males and 100% females. The ischio-pubic index was used to determine sex in adult black Malawians. We recommend this simple and less sophisticated method in medico-legal cases in Africa and other developing countries.

The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi

PubMed Central

Stevens, Warren; Wiseman, Virginia; Ortiz, Juan; Chavasse, Desmond

2005-01-01

Background Insecticide-treated nets (ITNs) are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold. Methods The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY) and cost per net distributed. Results The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN) to $3.44 in year five (720,577 ITN). Cost/ITN distributed dropped from $5.04 to $1.92. Conclusion Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved. PMID:15885143

The distribution and implications of BCG scars in northern Malawi.

PubMed Central

Fine, P. E.; Ponnighaus, J. M.; Maine, N.

1989-01-01

Reported are data on the BCG scar status of more than 112,000 individuals who were surveyed in Karonga District, northern Malawi, between 1979 and 1984. The age and sex patterns of apparent BCG scars reflect the history of BCG vaccination activities in the district. Repeated independent examinations of large numbers of people revealed that the proportions remaining with the same observed scar status among those initially classified as being scar "positive" or scar "negative" were each approximately 90%. The repeatability of positive scar reading was lower among children and older adults than among young adults aged 15-24 years, and blind follow-up of children known to have been vaccinated as infants in child health clinics indicated that less than 60% had a detectable scar 3 years after receiving the vaccine. "Negative" repeatability increased consistently with age. The implications of these findings for estimating BCG vaccine uptake and for assessing its efficacy in case-control and cohort studies are discussed. The finding that BCG scars may be difficult to read suggests there is a danger of observer bias that could lead to distortion--in particular, to overestimates of vaccine efficacy. PMID:2706726

Any link between sexual inactivity and treadle pump performance characteristics: The Malawi case

NASA Astrophysics Data System (ADS)

Joseph, Chidanti-Malunga; Yamikani, Malunga

In mitigating the effects of climate change in Malawi, government promotes the use of low cost irrigation technologies to small-scale farmers, especially in wetlands where water is available. The treadle pump is one such technology. The pump is a manual water lifting device operated by feet. Although the technology has been widely accepted by small-scale farmers, there are documented reports that some farmers abandon the technology, preferring other technologies such as river diversion. One theory for the abandonment is that female farmers claim that the technology makes their male counterparts sexually inactive. This research seeks to find an explanation to the misconception. The study analyzed the physical characteristics of the treadle pump and its users. The results show that the technology is male-dominated (30% were females out of a sample of 40). The results also show that the technology is labor-intensive with very small discharge rates (an average of 0.78 l/s) achieved regardless of the BMI of the operator. With such small discharge rates, in order to fulfill irrigation requirements of a crop, the operator has to pump for long hours. This exercise makes men naturally tired, perhaps making them sexually inactive as well.

Circulating Soluble Endoglin Levels in Pregnant Women in Cameroon and Malawi—Associations with Placental Malaria and Fetal Growth Restriction

PubMed Central

Leke, Rose G. F.; Leke, Robert J. I.; Gwanmesia, Philomina; Molyneux, Malcolm E.; Wallace, Diane Taylor; Rogerson, Stephen J.; Kain, Kevin C.

2011-01-01

Placental infections with Plasmodium falciparum are associated with fetal growth restriction resulting in low birth weight (LBW). The mechanisms that mediate these effects have yet to be completely described; however, they are likely to involve inflammatory processes and dysregulation of angiogenesis. Soluble endoglin (sEng), a soluble receptor of transforming growth factor (TGF)-β previously associated with preeclampsia in pregnant women and with severe malaria in children, regulates the immune system and influences angiogenesis. We hypothesized that sEng may play a role in development of LBW associated with placental malaria (PM). Plasma levels of sEng were measured in women (i) followed prospectively throughout pregnancy in Cameroon (n = 52), and (ii) in a case-control study at delivery in Malawi (n = 479). The relationships between sEng levels and gravidity, peripheral and placental parasitemia, gestational age, and adverse outcomes of PM including maternal anemia and LBW were determined. In the longitudinal cohort from Cameroon, 28 of 52 women (54%) experienced at least one malaria infection during pregnancy. In Malawi we enrolled two aparasitemic gravidity-matched controls for every case with PM. sEng levels varied over the course of gestation and were significantly higher in early and late gestation as compared to delivery (P<0.006 and P<0.0001, respectively). Circulating sEng levels were higher in primigravidae than multigravidae from both Cameroon and Malawi, irrespective of malarial infection status (p<0.046 and p<0.001, respectively). Peripheral parasitemia in Cameroonian women and PM in Malawian women were each associated with elevated sEng levels following correction for gestational age and gravidity (p = 0.006 and p = 0.033, respectively). Increased sEng was also associated with the delivery of LBW infants in primigravid Malawian women (p = 0.017); the association was with fetal growth restriction (p = 0.003) but not pre-term delivery (p = 0.286). Increased circulating maternal sEng levels are associated with P. falciparum infection in pregnancy and with fetal growth restriction in primigravidae with PM. PMID:21966395

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 water. The main challenge is the degradation of water resources which result into siltation that blocks the water sources due to rain while in the dry season the water level in reservoirs goes down. Other challenges include inadequate service coverage, insufficient literacy on climate change, inadequate mitigation measures for water related disasters and inadequate promotion of hygiene and sanitation. Bwaila Secondary School in Malawi is no exception in experiencing inadequate water service coverage amidst opportunities such as availability of relatively abundant water resources, political will, active women and youth. The formal education curriculum in secondary schools has enriched students' knowledge of environmental management in subjects such as Geography, Agriculture and Biology to improve their understanding of natural resource management. However, the primary gap is that students do not use the skills in environmental management acquired from the formal school setting in their day to day life henceforth rendering it to be a mere academic exercise confined within classroom walls. It is against such background that Grassroots Environmental Literacy (GEL), an environmental management social marketing franchise in non-formal education was established to fill in the gap. GEL's mission is to inspire students to become change agents in environmental management in their own lives in both formal and non-formal settings in Malawi. GEL believes that the cultivation of broad-based private and public support is the key to bringing about positive and lasting environmental change hence contributing to water security. The education sector in general and school attendance in particular is largely affected by water security. Furthermore, technological limitations have also affected the accessibility of water resources. UNICEF (2008) asserts that water resources may be scarce as it is capital intensive to sink a bore hole in Malawi. Bwaila secondary school is one of the examples to illuminate the water challenges. The school has low attendance when water supply is low. Girls are more affected as water shortage affects them hygienically. Consequently, girls cannot attend classes when there is no water in schools. This has affected the academic performance of girls. Sometimes, the school is prematurely closed as a preventive measure because lack of water access may result in the spread of water borne diseases. In conclusion, water security at Bwaila Secondary School is a concern because of its impact on the attendance of students and the potential to spread of water borne pathogens. This paper seeks to explore ways of mitigating water problems at Bwaila Secondary School through GEL. GEL proposes that sustainable solution to improve students' attendance at school would be to better equip students in core competencies of water management in non-formal settings in Malawi. Additionally, the GEL will initiate the construction of a water reservoir and promote sanitation and hygiene practice. GEL's believe cultivation of broad-based private and public support to these education initiatives is the key to bringing about positive and lasting way solutions to access to water access issues in Malawi.

Factors influencing women's utilization of public health care services during childbirth in Malawi Public health facility utilization.

PubMed

Machira, Kennedy; Palamuleni, Martin

2017-06-01

Maternal mortality remains a public health challenge claiming many lives at the time of giving birth lives. However, there have been scanty studies investigating factors influencing women's use of public health facilities during childbirth. The aim of the study was to explore the factors associated with women choice of public health facility during childbirth. The study used 2010 Malawi Demographic Health Survey dataset and a binary logistics regression analysis to estimate the determinants influencing women's use of public health facilities at the time they give birth. Of 23020 women respondents, 8454(36.7%) chose to give birth in public health facilities. Multivariate analysis reported that frequency of antenatal care (ANC), birth order, women's education, wealth status and quality of care were the major predictors increasing women's choice to use public health facilities at childbirth. There is need to use multimedia approach to engage women on significance of utilizing public health facilities during childbirth and promote quality of care in facilities if their health outcome is to improve in Malawi.

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.

Incubating Innovation for Rural Electrification. Executive Summary

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

NONE

In June, the team held a workshop on ''Low Carbon Sustainable Rural Electrification'' in Salima, Malawi. Co-organized with the Government of Malawi's Department of Energy, this event gathered participants from the energy, telecom, non-profit, banking sectors as well as from governmental and international agencies to discuss the potential development of private led off-grid electrification in Malawi where only 9% of the population has currently access to electricity. A very active participation provided us with insightful feedback and valuable recommendations.

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, metamorphic and sedimentary rocks are also used as dimension stones. Discovery and preservation of more natural stone deposits through research is essential in the country .Natural stone preservation has not only the potential to generate significant direct and indirect economic benefits for Malawi but also to preserve its heritage .

Mobile instant messaging for rural community health workers: a case from Malawi

PubMed Central

Pimmer, Christoph; Mhango, Susan; Mzumara, Alfred; Mbvundula, Francis

2017-01-01

ABSTRACT Background: Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. Objectives: It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. Methods: The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources. Results: The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Conclusions: Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work. PMID:28914165

Paediatric burns in LMICs: An evaluation of the barriers and facilitators faced by staff involved in burns education training programmes in Blantyre, Malawi.

PubMed

Harris, Lyndsey; Fioratou, Evridiki; Broadis, Emily

2016-08-01

A burn prevention and education programme - the Reduction of Burn and Scald Mortality and Morbidity in Children in Malawi project - was implemented from January 2010-2013 in Queen Elizabeth Central Hospital, Malawi. This study aimed to investigate the barriers and facilitators of implementing education-training programmes. Semi-structured interviews with 14 Scottish and Malawian staff delivering and receiving teaching at training education programmes were conducted. All interviews were recorded, transcribed and analysed using thematic analysis. Overarching barriers and facilitators were similar for both sets of staff. Scottish participants recognised that limited experience working in LMICs narrowed the challenges they anticipated. Time was a significant barrier to implementation of training courses for both sets of participants. Lack of hands on practical experience was the greatest barrier to implementing the skills learnt for Malawian staff. Sustainability was a significant facilitator to successful implementation of training programmes. Encouraging involvement of Malawian staff in the co-ordination and delivery of teaching enabled those who attend courses to teach others. A recognition of and response to the barriers and facilitators associated with introducing paediatric burn education training programmes can contribute to the development of sustainable programme implementation in Malawi and other LMICs. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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.

Adherence to national guidelines for the diagnosis and management of severe malaria: a nationwide, cross-sectional survey in Malawi, 2012.

PubMed

Shah, Monica P; Briggs-Hagen, Melissa; Chinkhumba, Jobiba; Bauleni, Andy; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Mathanga, Don P; Lindblade, Kim A

2016-07-19

Severe malaria has a case fatality rate of 10-20 %; however, few studies have addressed the quality of severe malaria case management. This study evaluated the diagnostic and treatment practices of malaria patients admitted to inpatient health facilities (HF) in Malawi. In July-August 2012, a nationwide, cross-sectional survey of severe malaria management was conducted in 36 HFs selected with equal probability from all eligible public sector HFs in Malawi. Patient records from all admissions during October 2011 and April 2012 (low and high season, respectively) were screened for an admission diagnosis of malaria or prescription of any anti-malarial. Eligible records were stratified by age (< 5 or ≥ 5 years). A maximum of eight records was randomly selected within each age and month stratum. Severe malaria was defined by admission diagnosis or documentation of at least one sign or symptom of severe malaria. Treatment with intravenous (IV) quinine or artesunate was considered correct. Patients without documentation of severe malaria were analysed as uncomplicated malaria patients; treatment with an artemisinin-based combination therapy (ACT) or oral quinine based on malaria test results was considered correct. All analyses accounted for HF level clustering and sampling weights. The analysis included 906 records from 35 HFs. Among these, 42 % (95 % confidence interval [CI] 35-49) had a severe malaria admission diagnosis and 50 % (95 % CI 44-57) had at least one severe malaria sign or symptom documented. Severe malaria patients defined by admission diagnosis (93, 95 % CI 86-99) were more likely to be treated correctly compared to patients defined by a severe sign (82, 95 % CI 75-89) (p < 0.0001). Among uncomplicated malaria patients, 26 % (95 % CI 18-35) were correctly treated and 53 % (95 % CI 42-64) were adequately treated with IV quinine alone or in combination with an ACT or oral quinine. A majority of patients diagnosed with severe malaria received the recommended IV therapy in accordance with national treatment guidelines. However, the inconsistencies between diagnosis of severe malaria and documentation of severe signs and symptoms highlight the need to improve healthcare worker recognition and documentation of severe signs and symptoms.

Seasonal variation of malaria cases in children aged less than 5 years old following weather change in Zomba district, Malawi.

PubMed

Hajison, Precious L; Mwakikunga, Bonex W; Mathanga, Don P; Feresu, Shingairai A

2017-07-03

Malaria is seasonal and this may influence the number of children being treated as outpatients in hospitals. The objective of this study was to investigate the degree of seasonality in malaria in lakeshore and highland areas of Zomba district Malawi, and influence of climatic factors on incidence of malaria. Secondary data on malaria surveillance numbers and dates of treatment of children <5 years of age (n = 374,246) were extracted from the Zomba health information system for the period 2012-2016, while data on climatic variables from 2012 to 2015 were obtained from meteorological department. STATA version 13 was used to analyse data using non-linear time series correlation test to suggest a predictor model of malaria epidemic over explanatory variable (rainfall, temperature and humidity). Malaria cases of children <5 years of age in Zomba district accounts for 45% of general morbidity. There was no difference in seasonality of malaria in highland compared to lakeshore in Zomba district. This study also found that an increase in average temperature and relative humidity was associated of malaria incidence in children <5 year of age in Zomba district. On the other hand, the difference of maximum and minimum temperature (diurnal temperature range), had a strong negative association (correlation coefficients of R 2  = 0.563 [All Zomba] β = -1295.57 95% CI -1683.38 to -907.75 p value <0.001, R 2  = 0.395 [Zomba Highlands] β = -137.74 95% CI -195.00 to -80.47 p value <0.001 and R 2  = 0.470 [Zomba Lakeshores] β = -263.05 95% CI -357.47 to -168.63 p value <0.001) with malaria incidence of children <5 year in Zomba district, Malawi. The diminishing of malaria seasonality, regardless of strong rainfall seasonality, and marginal drop of malaria incidence in Zomba can be explained by weather variation. Implementation of seasonal chemoprevention of malaria in Zomba could be questionable due to reduced seasonality of malaria. The lower diurnal temperature range contributed to high malaria incidence and this must be further investigated.

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 workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects. PMID:16899130

Patterns and determinants of malaria risk in urban and peri-urban areas of Blantyre, Malawi.

PubMed

Mathanga, Don P; Tembo, Atupele Kapito; Mzilahowa, Themba; Bauleni, Andy; Mtimaukenena, Kondwani; Taylor, Terrie E; Valim, Clarissa; Walker, Edward D; Wilson, Mark L

2016-12-08

Although malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study. A health facility-based, age and location-matched, case-control study of children 6-59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively. A total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones (OR = 5.1; 95% CI = 1.62, 15.8). Use of long-lasting insecticide nets (LLINs) the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households. Travel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is critical to the design of more targeted interventions for the urban setting.

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

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.

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.

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.

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

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 number of lifetime partners are correlates to HIV status while circumcised men who have had ritual sex are more likely to be diagnosed with HIV than circumcised men who have not had ritual sex.

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.

Health Care Factors Influencing Teen Mothers' Use Of Contraceptives in Malawi.

PubMed

Machira, Kennedy; Palamuleni, Martin E

2017-06-01

The study seeks to examine factors associated with teen mothers' use of modern contraceptives after giving birth. The 2010 Malawi Demographic and Health Survey data was used to test the study objective. A sample of 12, 911 teen mothers aged between 10 and 18 years were extracted from 23, 020 women and were asked of contraceptive usage after first birth experiences, in which, a logistic regression model was employed to estimate correlates of contraceptive usage. The study found that 54.8% of the teen mothers are still at a risk of having a repeat teenage pregnancy due to their non-use of contraceptives. This implies that less than 50% of teen mothers use contraceptives after experiencing teen birth. It is noted that health care factors such as use of antenatal care, awareness of pregnancy complications, attainment of primary education and exposure to media predict teen mothers' use of modern contraceptives. Despite endeavours made by government to improve access to family planning, health care challenges still exist affecting women's use of contraceptives in Malawi. Ameliorating these health encounters call for wide-range approaches aimed at addressing teen birth comprehensively in order to prevent early motherhood and subsequently high fertility. None declared.

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.

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.

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.

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.

A comparison of economic performance between high-yielding temperate breeds and zebu-crossbreds on smallholder dairy farms in Southern Malawi with particular focus on reproductive performance.

PubMed

Gazzarin, Christian; Banda, M C; Lips, M

2018-04-23

As in other sub-Saharan African countries, purebred dairy genetics such as Holsteins were imported to Malawi. The study investigated their economic performance by comparing them with local Zebu-crossbreds based on 131 smallholder dairy farm observations from Southern Malawi. High-yielding purebred cows and crossbred cows showed no significant differences in lactation yield and calving interval. Looking at the farms' actual costs, by-products such as maize bran clearly dominated the cost structure for both breeds, but crossbreeds showed significantly lower concentrate costs. While there was no statistically significant difference in income for both breed types, a substantial share (23%) of farms under investigation shows negative incomes. Based on survey data, two typical farms were established representing standard costs with homogenous assumptions such as identical milk price. The comparison of typical farms covering the full dairy system clearly indicated that crossbred dairy cows outperformed purebreds. In addition, a simulation of a shorter calving interval for both typical farms revealed a substantial positive impact on income for both breed types with more than 30% increase. We conclude that focusing on crossbreds in combination with improved feeding and fertility management offers a more promising strategy for smallholder dairy farms in Southern Malawi than just acquiring high-yielding purebreds.

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.

Drinking Water Quality Governance: A Comparative Case Study of Brazil, Ecuador, and Malawi

PubMed Central

Kayser, Georgia L.; Amjad, Urooj; Dalcanale, Fernanda; Bartram, Jamie; Bentley, Margaret E.

2015-01-01

Human health is greatly affected by inadequate access to sufficient and safe drinking water, especially in low and middle-income countries. Drinking water governance improvements may be one way to better drinking water quality. Over the past decade, many projects and international organizations have been dedicated to water governance; however, water governance in the drinking water sector is understudied and how to improve water governance remains unclear. We analyze drinking water governance challenges in three countries—Brazil, Ecuador, and Malawi—as perceived by government, service providers, and civil society organizations. A mixed methods approach was used: a clustering model was used for country selection and qualitative semi-structured interviews were used with direct observation in data collection. The clustering model integrated political, economic, social and environmental variables that impact water sector performance, to group countries. Brazil, Ecuador and Malawi were selected with the model so as to enhance the generalizability of the results. This comparative case study is important because similar challenges are identified in the drinking water sectors of each country; while, the countries represent diverse socio-economic and political contexts, and the selection process provides generalizability to our results. We find that access to safe water could be improved if certain water governance challenges were addressed: coordination and data sharing between ministries that deal with drinking water services; monitoring and enforcement of water quality laws; and sufficient technical capacity to improve administrative and technical management of water services at the local level. From an analysis of our field research, we also developed a conceptual framework that identifies policy levers that could be used to influence governance of drinking water quality on national and sub-national levels, and the relationships between these levers. PMID:25798068

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.

Criteria-based audit to improve a district referral system in Malawi: a pilot study.

PubMed

Kongnyuy, Eugene J; Mlava, Grace; van den Broek, Nynke

2008-09-22

To study the feasibility of using criteria-based audit to improve a district referral system. A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases). There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001); delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014); clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001) and feedback given to the referring health centres (1.7% vs 91.9%; p <0.001). The rest of the three standards showed a high level of attainment (>95%) in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

Emergence of Double- and Triple-Gene Reassortant G1P[8] Rotaviruses Possessing a DS-1-Like Backbone after Rotavirus Vaccine Introduction in Malawi.

PubMed

Jere, Khuzwayo C; Chaguza, Chrispin; Bar-Zeev, Naor; Lowe, Jenna; Peno, Chikondi; Kumwenda, Benjamin; Nakagomi, Osamu; Tate, Jacqueline E; Parashar, Umesh D; Heyderman, Robert S; French, Neil; Cunliffe, Nigel A; Iturriza-Gomara, Miren

2018-02-01

To combat the high burden of rotavirus gastroenteritis, multiple African countries have introduced rotavirus vaccines into their childhood immunization programs. Malawi incorporated a G1P[8] rotavirus vaccine (Rotarix) into its immunization schedule in 2012. Utilizing a surveillance platform of hospitalized rotavirus gastroenteritis cases, we examined the phylodynamics of G1P[8] rotavirus strains that circulated in Malawi before (1998 to 2012) and after (2013 to 2014) vaccine introduction. Analysis of whole genomes obtained through next-generation sequencing revealed that all randomly selected prevaccine G1P[8] strains sequenced ( n = 32) possessed a Wa-like genetic constellation, whereas postvaccine G1P[8] strains ( n = 18) had a DS-1-like constellation. Phylodynamic analyses indicated that postvaccine G1P[8] strains emerged through reassortment events between human Wa- and DS-1-like rotaviruses that circulated in Malawi from the 1990s and hence were classified as atypical DS-1-like reassortants. The time to the most recent common ancestor for G1P[8] strains was from 1981 to 1994; their evolutionary rates ranged from 9.7 × 10 -4 to 4.1 × 10 -3 nucleotide substitutions/site/year. Three distinct G1P[8] lineages chronologically replaced each other between 1998 and 2014. Genetic drift was the likely driver for lineage turnover in 2005, whereas replacement in 2013 was due to reassortment. Amino acid substitution within the outer glycoprotein VP7 of G1P[8] strains had no impact on the structural conformation of the antigenic regions, suggesting that it is unlikely that they would affect recognition by vaccine-induced neutralizing antibodies. While the emergence of DS-1-like G1P[8] rotavirus reassortants in Malawi was therefore likely due to natural genotype variation, vaccine effectiveness against such strains needs careful evaluation. IMPORTANCE The error-prone RNA-dependent RNA polymerase and the segmented RNA genome predispose rotaviruses to genetic mutation and genome reassortment, respectively. These evolutionary mechanisms generate novel strains and have the potential to lead to the emergence of vaccine escape mutants. While multiple African countries have introduced a rotavirus vaccine, there are few data describing the evolution of rotaviruses that circulated before and after vaccine introduction. We report the emergence of atypical DS-1-like G1P[8] strains during the postvaccine era in Malawi. Three distinct G1P[8] lineages circulated chronologically from 1998 to 2014; mutation and reassortment drove lineage turnover in 2005 and 2013, respectively. Amino acid substitutions within the outer capsid VP7 glycoprotein did not affect the structural conformation of mapped antigenic sites, suggesting a limited effect on the recognition of G1-specific vaccine-derived antibodies. The genes that constitute the remaining genetic backbone may play important roles in immune evasion, and vaccine effectiveness against such atypical strains needs careful evaluation. Copyright © 2018 Jere et al.

Emergence of Double- and Triple-Gene Reassortant G1P[8] Rotaviruses Possessing a DS-1-Like Backbone after Rotavirus Vaccine Introduction in Malawi

PubMed Central

2017-01-01

ABSTRACT To combat the high burden of rotavirus gastroenteritis, multiple African countries have introduced rotavirus vaccines into their childhood immunization programs. Malawi incorporated a G1P[8] rotavirus vaccine (Rotarix) into its immunization schedule in 2012. Utilizing a surveillance platform of hospitalized rotavirus gastroenteritis cases, we examined the phylodynamics of G1P[8] rotavirus strains that circulated in Malawi before (1998 to 2012) and after (2013 to 2014) vaccine introduction. Analysis of whole genomes obtained through next-generation sequencing revealed that all randomly selected prevaccine G1P[8] strains sequenced (n = 32) possessed a Wa-like genetic constellation, whereas postvaccine G1P[8] strains (n = 18) had a DS-1-like constellation. Phylodynamic analyses indicated that postvaccine G1P[8] strains emerged through reassortment events between human Wa- and DS-1-like rotaviruses that circulated in Malawi from the 1990s and hence were classified as atypical DS-1-like reassortants. The time to the most recent common ancestor for G1P[8] strains was from 1981 to 1994; their evolutionary rates ranged from 9.7 × 10−4 to 4.1 × 10−3 nucleotide substitutions/site/year. Three distinct G1P[8] lineages chronologically replaced each other between 1998 and 2014. Genetic drift was the likely driver for lineage turnover in 2005, whereas replacement in 2013 was due to reassortment. Amino acid substitution within the outer glycoprotein VP7 of G1P[8] strains had no impact on the structural conformation of the antigenic regions, suggesting that it is unlikely that they would affect recognition by vaccine-induced neutralizing antibodies. While the emergence of DS-1-like G1P[8] rotavirus reassortants in Malawi was therefore likely due to natural genotype variation, vaccine effectiveness against such strains needs careful evaluation. IMPORTANCE The error-prone RNA-dependent RNA polymerase and the segmented RNA genome predispose rotaviruses to genetic mutation and genome reassortment, respectively. These evolutionary mechanisms generate novel strains and have the potential to lead to the emergence of vaccine escape mutants. While multiple African countries have introduced a rotavirus vaccine, there are few data describing the evolution of rotaviruses that circulated before and after vaccine introduction. We report the emergence of atypical DS-1-like G1P[8] strains during the postvaccine era in Malawi. Three distinct G1P[8] lineages circulated chronologically from 1998 to 2014; mutation and reassortment drove lineage turnover in 2005 and 2013, respectively. Amino acid substitutions within the outer capsid VP7 glycoprotein did not affect the structural conformation of mapped antigenic sites, suggesting a limited effect on the recognition of G1-specific vaccine-derived antibodies. The genes that constitute the remaining genetic backbone may play important roles in immune evasion, and vaccine effectiveness against such atypical strains needs careful evaluation. PMID:29142125

Working relationships between obstetric care staff and their managers: a critical incident analysis.

PubMed

Chipeta, Effie; Bradley, Susan; Chimwaza-Manda, Wanangwa; McAuliffe, Eilish

2016-08-26

Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi's disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres' providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers' lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers' job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.

Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.

PubMed

Cataldo, Fabian; Chiwaula, Levison; Nkhata, Misheck; van Lettow, Monique; Kasende, Florence; Rosenberg, Nora E; Tweya, Hannock; Sampathkumar, Veena; Hosseinipour, Mina; Schouten, Erik; Kapito-Tembo, Atupele; Eliya, Michael; Chimbwandira, Frank; Phiri, Sam

2017-04-15

Malawi has embarked on a "test-and-treat" approach to prevent mother-to-child transmission (PMTCT) of HIV, known as "Option B+," offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding "Option B+" for patients and health care workers (HCWs) in Malawi. Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in "Option B+" (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework. Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to "digest" a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies. As "Option B+" continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.

Non-treatment of children with community health worker-diagnosed fast-breathing pneumonia in rural Malawi: exploratory subanalysis of a prospective cohort study.

PubMed

King, Carina; Colbourn, Tim; Mankhambo, Limangeni; Beard, James; Hay Burgess, Debbie C; Costello, Anthony; Izadnegahdar, Rasa; Lufesi, Norman; Mwansambo, Charles; Nambiar, Bejoy; Johnson, Eric S; Platt, Robert W; Mukanga, David; McCollum, Eric D

2016-11-16

Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2-59 months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines. Children were followed at days 5 and 14 with a clinical assessment of recovery. We conducted bivariate and multivariable logistic regression for the association between treatment of fast-breathing pneumonia and recovery, adjusting for potential confounders. We followed up 847 children, of whom 78 (9%) had not been given antibiotics (non-treatment). Non-treatment cases had higher baseline rates of diarrhoea, non-severe hypoxaemia and fever. Non-recovery (persistence or worsening of symptoms) was 13% and 23% at day 5 in those who did receive and those who did not receive co-trimoxazole. Non-recovery, when defined as worsening of symptoms only, at day 5 was 7% in treatment and 10% in non-treatment cases. For both definitions, combined co-trimoxazole and lumefantrine-artemether (LA) treatment trended towards protection (adjusted OR (aOR) 0.28; 95% CI 0.12 to 0.68/aOR 0.29; 95% CI 0.08 to 1.01). We found that children who did not receive co-trimoxazole treatment had worse clinical outcomes; malaria co-diagnosis and treatment also play a significant role in non-recovery. Further research into non-treatment of fast-breathing pneumonia, using a pragmatic approach with consideration for malaria co-diagnosis and HIV status is needed to guide refinement of community treatment algorithms in this region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The effect of increased primary schooling on adult women's HIV status in Malawi and Uganda: Universal Primary Education as a natural experiment.

PubMed

Behrman, Julia Andrea

2015-02-01

This paper explores the causal relationship between primary schooling and adult HIV status in Malawi and Uganda, two East African countries with some of the highest HIV infection rates in the world. Using data from the 2010 Malawi Demographic Health Survey and the 2011 Uganda AIDS Indicator Survey, the paper takes advantage of a natural experiment, the implementation of Universal Primary Education policies in the mid 1990s. An instrumented regression discontinuity approach is used to model the relationship between increased primary schooling and adult women's HIV status. Results indicate that a one-year increase in schooling decreases the probability of an adult woman testing positive for HIV by 0.06 (p < 0.01) in Malawi and by 0.03 (p < 0.05) in Uganda. These results are robust to a variety of model specifications. In a series of supplementary analyses a number of potential pathways through which such effects may occur are explored. Findings indicate increased primary schooling positively affects women's literacy and spousal schooling attainment in Malawi and age of marriage and current household wealth in Uganda. However primary schooling has no effect on recent (adult) sexual behavior. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

Economic aspects of the use of impregnated mosquito nets for malaria control.

PubMed Central

Brinkmann, U.; Brinkmann, A.

1995-01-01

The use of pyrethroids to impregnate mosquito nets has had a good impact on the incidence of morbidity and mortality from malaria. These nets are therefore likely to be used on a large scale as an important strategy of malaria control in the future. Published information on the cost and effectiveness of mosquito nets is presented and analysed. In two examples, from Malawi and Cameroon, the per household expenditure to purchase and use impregnated mosquito nets compares favourably with the costs of malaria. Thus, we expect that the economic losses from malaria would be reduced by 37.3% over a 3-year period in Malawi. Even if the impact of malaria on productivity is not taken into account, the introduction of nets will result in gains, as shown in Cameroon; savings of 9.3% and 11.2% in two places resulted as a consequence of a diminished need for case treatment. The role of government programmes in the promotion of bednets is indirect and concerned mainly with facilitation and the dissemination of information. Much depends on the capability of the private sector and the willingness of the target population to buy the nets for a programme to be effective. Specific studies by health economists on this subject are lacking. PMID:8846491

An Analysis of the Extent of Social Inclusion and Equity Consideration in Malawi's National HIV and AIDS Policy Review Process.

PubMed

Chinyama, Mathews Junior; MacLachlan, Malcolm; McVeigh, Joanne; Huss, Tessy; Gawamadzi, Sylvester

2017-07-29

Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy. While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

The cost-effectiveness of treating male trichomoniasis to avert HIV transmission in men seeking sexually transmitted disease care in Malawi.

PubMed

Price, Matthew A; Stewart, Scott R; Miller, William C; Behets, Frieda; Dow, William H; Martinson, Francis E A; Chilongozi, David; Cohen, Myron S

2006-10-01

Allocation of funds to program areas where they may have an impact is critical to the success of any HIV control program. We examined the cost-effectiveness of providing first-line treatment for male trichomoniasis in Malawi, a condition not commonly considered in syndromic management throughout sub-Saharan Africa. We used decision tree analysis to assess program costs and outcomes among a 1-year population of male sexually transmitted disease (STD) clinic attendees estimated at 10,000 in Lilongwe. Our main outcomes were program costs from the government perspective and HIV infections averted. We conducted univariate and multivariate sensitivity analyses on selected parameters. In our study population of male STD clinic attendees with an HIV prevalence of 44% and a Trichomonas vaginalis prevalence of 20%, including universal metronidazole as a first-line treatment for trichomoniasis at $0.05 per dose would increase program costs by $277 (year 2000 US dollars) and avert 23 cases of HIV. The incremental cost-effectiveness ratio (ICER) over the current STD management guidelines was $15.42 per case of HIV averted. The number of HIV infections averted under sensitivity analysis ranged from 2 to 52, with attendant ICERs varying from cost savings to $162.92. Consideration of wider social benefits, such as the costs of HIV infections to the individual or the government, would further enhance the cost-effectiveness of this program. As part of a larger program to control STDs, incorporating metronidazole to treat male trichomoniasis could represent a cost-effective means to reduce HIV transmission in this high-risk group.

Using decision mapping to inform the development of a stated choice survey to elicit youth preferences for sexual and reproductive health and HIV services in rural Malawi.

PubMed

Michaels-Igbokwe, Christine; Lagarde, Mylene; Cairns, John; Terris-Prestholt, Fern

2014-03-01

The process of designing and developing discrete choice experiments (DCEs) is often under reported. The need to adequately report the results of qualitative work used to identify attributes and levels used in a DCE is recognised. However, one area that has received relatively little attention is the exploration of the choice question of interest. This paper provides a case study of the process used to design a stated preference survey to assess youth preferences for integrated sexual and reproductive health (SRH) and HIV outreach services in Malawi. Development and design consisted of six distinct but overlapping and iterative stages. Stage one was a review of the literature. Stage two involved developing a decision map to conceptualise the choice processes involved. Stage three included twelve focus group discussions with young people aged 15-24 (n = 113) and three key informant interviews (n = 3) conducted in Ntcheu District, Malawi. Stage four involved analysis of qualitative data and identification of potential attributes and levels. The choice format and experimental design were selected in stages five and six. The results of the literature review were used to develop a decision map outlining the choices that young people accessing SRH services may face. For youth that would like to use services two key choices were identified: the choice between providers and the choice of service delivery attributes within a provider type. Youth preferences for provider type are best explored using a DCE with a labelled design, while preferences for service delivery attributes associated with a particular provider are better understood using an unlabelled design. Consequently, two DCEs were adopted to jointly assess preferences in this context. Used in combination, the results of the literature review, the decision mapping process and the qualitative work provided robust approach to designing the DCEs individually and as complementary pieces of work. Copyright © 2014 Elsevier Ltd. All rights reserved.

Moving malaria in pregnancy programs from neglect to priority: experience from Malawi, Senegal, and Zambia.

PubMed

Roman, Elaine; Wallon, Michelle; Brieger, William; Dickerson, Aimee; Rawlins, Barbara; Agarwal, Koki

2014-02-01

Pregnant women and infants are particularly vulnerable to malaria. National malaria in pregnancy (MIP) programs in Malawi, Senegal, and Zambia were reviewed to identify promising strategies that have helped these countries achieve relatively high coverage of MIP interventions as well as ongoing challenges that have inhibited further progress. We used a systematic case study methodology to assess health system strengths and challenges in the 3 countries, including desk reviews of available reports and literature and key informant interviews with national stakeholders. Data were collected between 2009 and 2011 and analyzed across 8 MIP health systems components: (1) integration of programs and services, (2) policy, (3) commodities, (4) quality assurance, (5) capacity building, (6) community involvement, (7) monitoring and evaluation, and (8) financing. Within each program area, we ranked degree of scale up across 4 stages and synthesized the findings in a MIP table of analysis to reveal common themes related to better practices, remaining bottlenecks, and opportunities to accelerate MIP coverage, strengthen MIP programs, and improve results. Each of the 3 countries has malaria policies in place that reflect current MIP guidance from the World Health Organization. The 3 countries successfully integrated MIP interventions into a platform of antenatal care services, but coordination at the national level was disjointed. All 3 countries recognized the importance of having a MIP focal person to ensure collaboration and planning at the national level, but only Malawi had appointed one. Commodity stockouts were frequent due to problems at all levels of the logistics system, from quantification to distribution. Lack of support for quality assurance and weak monitoring and evaluation mechanisms across all 3 countries affected optimal coverage. MIP programs should address all 8 interconnected MIP health systems areas holistically, in the context of a health systems approach to building successful programs. The MIP table of analysis can be a useful tool for other malaria-endemic countries to review their programs and improve MIP outcomes.

Water demand management in Malawi: problems and prospects for its promotion

NASA Astrophysics Data System (ADS)

Mulwafu, W.; Chipeta, C.; Chavula, G.; Ferguson, A.; Nkhoma, B. G.; Chilima, G.

This paper discusses the status of water demand management (WDM) in Malawi. Findings from the study indicate that, while WDM is highly advocated in the urban and peri-urban areas, very few aspects of WDM are practiced in the rural areas. The water pricing structure that the supplying institutions established serves as a disincentive for water wastages in the urban areas. Both private firms and individuals use various measures to conserve water as a way of minimizing water consumption. The motives for water conservation range from profit maximization to inadequate financial resources to meet the costs of water respectively. In the rural areas where water is supplied at no cost, the people tend to pay less attention to water conservation. In cases where water providers attempted to institute factors of cost sharing, the rural inhabitants tended to be reluctant to contribute. This is so because people view water as a social good that should be supplied to them free of charge. The paper demonstrates that although some aspects of WDM are being practiced in the country, the existing conditions on the ground militate against its increased expansion as a strategy for promoting an efficient and equitable use of existing water resources. A large section of the population still lack access to potable water and the Malawi government is committed to the provision of basic water services. Yet WDM will become even more critical in future because of the growing competition for water resources, particularly due to the growing population and the increasing economic activities such as farming, industrialization and urbanization. The paper argues that despite the promising benefits that WDM has, its promotion must necessarily be infused with ideas of water supply, considering that the largest population still lacks access to potable water. Coupled with this will be the need for a proper policy framework that promotes public awareness for people to start appreciating the economic value of water especially in the rural areas.

An Analysis of the Extent of Social Inclusion and Equity Consideration in Malawi’s National HIV and AIDS Policy Review Process

PubMed Central

Chinyama, Mathews Junior; MacLachlan, Malcolm; McVeigh, Joanne; Huss, Tessy; Gawamadzi, Sylvester

2018-01-01

Background: Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. Methods: This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. Results: Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy. Conclusion: While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened. PMID:29626397

An Innovative Approach to Integrated Training for Smallholder Dairying

ERIC Educational Resources Information Center

Chagunda, Mizeck Gift Gibson; Munthali, David Pusi; Gondwe, Timothy N.; Wood, Bethan; Roberts, David J.

2014-01-01

Purpose: This paper assesses an integrated approach in smallholder dairy training through a partnership between Malawi and Scotland. Design/ methodology/ approach: Acute staff shortages and inadequate expertise hamper progress in Malawi's smallholder dairy production despite its potential to substantially contribute to sustainable household…

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…

Enhancing global health and education in Malawi, Zambia, and the United States through an interprofessional global health exchange program.

PubMed

Wilson, Lynda Law; Somerall, D'Ann; Theus, Lisa; Rankin, Sally; Ngoma, Catherine; Chimwaza, Angela

2014-05-01

This article describes participant outcomes of an interprofessional collaboration between health professionals and faculty in Malawi, Zambia, and the United States (US). One strategy critical for improving global health and addressing Millennium Development goals is promotion of interprofessional education and collaboration. Program participants included 25 health professionals from Malawi and Zambia, and 19 faculty/health professionals from Alabama and California. African Fellows participated in a 2 week workshop on Interprofessional Education in Alabama followed by 2 weeks working on individual goals with faculty collaborators/mentors. The US Fellows also spent 2 weeks visiting their counterparts in Malawi and Zambia to develop plans for sustainable partnerships. Program evaluations demonstrated participants' satisfaction with the program and indicated that the program promoted interprofessional and cross-cultural understanding; fostered development of long-term sustainable partnerships between health professionals and educators in Zambia and the US; and created increased awareness and use of resources for global health education. © 2014.

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

Improving child nutrition and development through community-based childcare centres in Malawi - The NEEP-IE study: study protocol for a randomised controlled trial.

PubMed

Gelli, Aulo; Margolies, Amy; Santacroce, Marco; Sproule, Katie; Theis, Sophie; Roschnik, Natalie; Twalibu, Aisha; Chidalengwa, George; Cooper, Amrik; Moorhead, Tyler; Gladstone, Melissa; Kariger, Patricia; Kutundu, Mangani

2017-06-19

The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial. Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children's Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children's ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders. Assessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes. ISRCTN registry, ID: ISRCTN96497560 . Registered on 21 September 2016.

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 intention of facilitating positive behaviors towards other patients.

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

Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi.

PubMed

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

2015-03-01

Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was used to analyse factors associated with health seeking choices for CNCDs, distinguishing between no care, informal care and formal care. Descriptive statistics (mean, standard deviation and median) were used to describe related household out-of-pocket expenditure. There were 475 individuals (equivalent to 8.4% of all respondents) reporting at least one CNCD. Among them, 37.3% did not seek any care, 42.5% sought formal care (facility-based care), and 20.2% opted for informal care (traditional or home treatment). Regression analysis showed that illness severity and duration, socio-economic status, being a household head, and the proportion of household members living with a CNCD were significantly associated with health care utilization. Among those seeking care, 65.8% incurred out-of-pocket expenditure with an average of USD 1.49 spent on medical treatment and an additional USD 0.50 spent on transport. Further qualitative inquiry is needed to understand the reasons for low service utilization and to explore the potential role of supply-side factors. To increase access to care for people suffering from CNCDs, the provision of a free Essential Health Package in Malawi ought to be strengthened through the integration of system-wide screening, risk factor modification and continuity of care options for people suffering from CNCDs. This would ensure affordable services to modulate health seeking behaviour of patients at risk of major chronic illnesses. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

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

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.

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…

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.

Relative importance of climatic, geographic and socio-economic determinants of malaria in Malawi

PubMed Central

2013-01-01

Background Malaria transmission is influenced by variations in meteorological conditions, which impact the biology of the parasite and its vector, but also socio-economic conditions, such as levels of urbanization, poverty and education, which impact human vulnerability and vector habitat. The many potential drivers of malaria, both extrinsic, such as climate, and intrinsic, such as population immunity are often difficult to disentangle. This presents a challenge for the modelling of malaria risk in space and time. Methods A statistical mixed model framework is proposed to model malaria risk at the district level in Malawi, using an age-stratified spatio-temporal dataset of malaria cases from July 2004 to June 2011. Several climatic, geographic and socio-economic factors thought to influence malaria incidence were tested in an exploratory model. In order to account for the unobserved confounding factors that influence malaria, which are not accounted for using measured covariates, a generalized linear mixed model was adopted, which included structured and unstructured spatial and temporal random effects. A hierarchical Bayesian framework using Markov chain Monte Carlo simulation was used for model fitting and prediction. Results Using a stepwise model selection procedure, several explanatory variables were identified to have significant associations with malaria including climatic, cartographic and socio-economic data. Once intervention variations, unobserved confounding factors and spatial correlation were considered in a Bayesian framework, a final model emerged with statistically significant predictor variables limited to average precipitation (quadratic relation) and average temperature during the three months previous to the month of interest. Conclusions When modelling malaria risk in Malawi it is important to account for spatial and temporal heterogeneity and correlation between districts. Once observed and unobserved confounding factors are allowed for, precipitation and temperature in the months prior to the malaria season of interest are found to significantly determine spatial and temporal variations of malaria incidence. Climate information was found to improve the estimation of malaria relative risk in 41% of the districts in Malawi, particularly at higher altitudes where transmission is irregular. This highlights the potential value of climate-driven seasonal malaria forecasts. PMID:24228784

Nurses' knowledge and skills in providing mental health care to people living with HIV/AIDS in Malawi.

PubMed

Chorwe-Sungani, G

2013-09-01

Nurses are the majority of health-care professionals who frequently come in contact with people living with HIV/AIDS (PLWHA). However, most health workers such as nurses lack competence and confidence in dealing with the mental health problems (MHPs) of their clients in Malawi. The study aimed at exploring nurses' levels of knowledge and skills in providing mental health care to PLWHA. The study used a descriptive quantitative survey design. Ethical approval and permission were granted by relevant authorities to conduct the study. A convenient sample of 109 nurses was used. They gave written consent and completed self-administered questionnaires. Descriptive statistics namely: means, frequencies and percentages were used to analyse data. The findings suggest that nurses who care for PLWHA lack knowledge and skills to deal with MHPs of these people. Many participants (53.2%, n = 58) lacked knowledge and skills to care for PLWHA who have MHPs. Nurses are potentially essential human resource for dealing with MHPs of PLWHA in Malawi. Unfortunately, some nurses lack the necessary knowledge and skills to deal with MHPs. Nurses must be equipped with adequate knowledge and skills so that they are able to deal with MHPs of PLWHA. © 2013 John Wiley & Sons Ltd.

Feasibility of conducting a randomised controlled trial of a cookstove intervention in rural Malawi

PubMed Central

Kachidiku, J.; Banda, H.; Kapanga, M.; Doyle, J. V.; Banda, E.; Fox, C.; Gordon, S. B.; Mortimer, K.

2014-01-01

BACKGROUND: Exposure to household air pollution (HAP) causes 4 million deaths annually, and strategies to reduce HAP exposure are urgently required. OBJECTIVE: To evaluate the acceptability and feasibility of conducting a trial of a cookstove intervention in rural Malawi. DESIGN: Non-smoking women were randomised to continuing to use an open fire (control) or to using a wood-burning clay cookstove (intervention). Symptom burden, oxygen saturation and exhaled carbon monoxide (eCO) were assessed at baseline and 7-day follow-up. A subset of women underwent HAP exposure monitoring. RESULTS: Of 51 women recruited, 50 (98%) completed the main study. The methodology was acceptable to participants. Headache, back pain and cough were the most commonly reported symptoms at baseline and follow-up. Median eCO was within normal limits, but with a difference of 0.5 parts per million (ppm) in median change of eCO from baseline to follow-up seen between the two groups (P ∙ 0.035). The peak ambient CO concentration detected was 150 ppm. CONCLUSION: This study suggests that a large cookstove intervention trial in Malawi would be feasible with careful community sensitisation. Monitoring exposure to HAP is challenging, and further studies evaluating potential biomarkers of exposure, including eCO, should be undertaken. PMID:24429320

Social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi

PubMed Central

Koffi, Alain K.; Mleme, Tiope; Nsona, Humphreys; Banda, Benjamin; Amouzou, Agbessi; Kalter, Henry D.

2015-01-01

Background The Every Newborn Action Plan calls for reducing the neonatal mortality rates to fewer than 10 deaths per 1000 live births in all countries by 2035. The current study aims to increase our understanding of the social and modifiable factors that can be addressed or reinforced to improve and accelerate the decline in neonatal mortality in Malawi. Methods The data come from the 2013 Verbal and Social Autopsy (VASA) study that collected data in order to describe the biological causes and the social determinants of deaths of children under 5 years of age in Balaka and Salima districts of Malawi. This paper analyses the social autopsy data of the neonatal deaths and presents results of a review of the coverage of key interventions along the continuum of normal maternal and newborn care and the description of breakdowns in the care provided for neonatal illnesses within the Pathway to Survival framework. Results A total of 320 neonatal deaths were confirmed from the VASA survey. While one antenatal care (ANC) visit was high at 94%, the recommended four ANC visits was much lower at 41% and just 17% of the mothers had their urines tested during the pregnancy. 173 (54%) mothers of the deceased newborns had at least one labor/delivery complication that began at home. The caregivers of 65% (n = 75) of the 180 newborns that were born at home or born and left a health facility alive perceived them to be severely ill at the onset of their illness, yet only 44% (n = 80) attempted and 36% (n = 65)could reach the first health provider after an average of 91 minutes travel time. Distance, lack of transport and cost emerged as the most important constraints to formal care–seeking during delivery and during the newborn fatal illness. Conclusions This study suggests that maternal and neonatal health organizations and the local government of Malawi should increase the demand for key maternal and child health interventions, including the recommended 4 ANC visits, and ensure urine screening for all pregnant women. Early recognition and referrals of women with obstetric complications and interventions to promote maternal recognition of neonatal illnesses and care–seeking before the child becomes severely ill are also needed to improve newborn survival in Balaka and Salima districts of Malawi. PMID:27698997

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…

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,…

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…

Sexual and reproductive health and HIV/AIDS risk perception in the Malawi tourism industry.

PubMed

Bisika, Thomas

2009-06-01

Malawi has for a long time relied on agriculture for the generation of foreign exchange. Due to varied reasons like climate change, the Malawi government has, therefore, identified tourism as one way of boosting foreign exchange earnings and is already in the process of developing the sector especially in the area of ecotourism. However, tourism is associated with increasing prostitution, drug abuse and a whole range of other sexual and reproductive health (SRH) problems such as teenage pregnancies, HIV/AIDS and sexually transmitted infections (STIs). This paper examines the knowledge, attitudes, practices and behaviour as well as risk perceptions associated with HIV/AIDS, sexually transmitted infections and unwanted pregnancies among staff in the tourism industry and communities around tourist facilities in Malawi. The study was descriptive in nature and used both qualitative and quantitative research methods. The qualitative methods involved in-depth interviews and focus group discussions. The quantitative technique employed a survey of 205 purposively selected subjects from the tourism sector. The study concludes that people in the tourism sector are at high risk of HIV/AIDS, sexually transmitted infections and unwanted pregnancies and should be considered as a vulnerable group. The study further observes that this group of people has not adopted behaviours that can protect them from HIV/AIDS, sexually transmitted infections and unwanted pregnancies although there is high demand for voluntary counselling and testing (VCT) which offers a very good entry point for HIV prevention and treatment in the tourism sector. The study recommends that a comprehensive tourism policy covering tourists, employees and communities around tourist facilities is required. Such a policy should address the rights of HIV infected employees and the provision of prevention and treatment services for HIV/AIDS and STIs as well as a broad range of SRH and family planning services especially the condom which offers dual protection for pregnancy and STIs including HIV.

Rifting the continental lithosphere: case studies of the lithosphere-asthenosphere system in rifted settings across the western U.S. and in the southern East African Rift

NASA Astrophysics Data System (ADS)

Hopper, E.; Gaherty, J. B.; Shillington, D. J.

2016-12-01

Continental extension comes in many guises, often described in terms of two endmembers. Narrow rifting is typified by a rift valley narrower than lithospheric thickness (50-100 km), presumed to result in steep lateral changes in crustal and lithospheric topography; wide rifting by a broad zone (<1000 km) of normal faulting associated with much smaller topographic gradients. A type example for the former is the East African Rift Valley; for the latter, the Basin and Range in the western U.S.A. An important control on rift development is the state of the lithosphere: for example, its strength and thickness. We analyse common conversion point stacked Sp converted wave images of the lithosphere beneath rift systems in the contiguous U.S., both the wide Basin and Range, and narrow rift systems such as the Rio Grande Rift and Salton Trough. We use Sp waves recorded by EarthScope's Transportable Array and other available permanent and temporary broadband stations. Beneath the Basin and Range, we observe a very strong, shallow velocity decrease (the lithosphere-asthenosphere boundary, or LAB) that is relatively uniform over 100s of km. The strength of this feature indicates melt has ponded at this transition. We have not observed a clear relationship between lithospheric thickness beneath the Basin and Range, and total degree of extension, current extension rate, or age since surface volcanism. Beneath narrow rifts in the western U.S., however, more localised thinning of the lithosphere has been observed. We also compare these observations with seismic images of the Malawi Rift, at the southern end of the Western Branch of the East African Rift System, using broadband data acquired as part of the Study of Extension and MaGmatism in Malawi aNd Tanzania (SEGMeNT) experiment. The Malawi Rift is extending slowly in a magma-poor region of relatively strong lithosphere. We constrain the pattern of plate-scale extension by observations of crustal thinning, and image complex variations in deeper lithospheric structure.

Rifting the continental lithosphere: case studies of the lithosphere-asthenosphere system in rifted settings across the western U.S. and in the southern East African Rift

NASA Astrophysics Data System (ADS)

Hopper, E.; Gaherty, J. B.; Shillington, D. J.

2017-12-01

Continental extension comes in many guises, often described in terms of two endmembers. Narrow rifting is typified by a rift valley narrower than lithospheric thickness (50-100 km), presumed to result in steep lateral changes in crustal and lithospheric topography; wide rifting by a broad zone (<1000 km) of normal faulting associated with much smaller topographic gradients. A type example for the former is the East African Rift Valley; for the latter, the Basin and Range in the western U.S.A. An important control on rift development is the state of the lithosphere: for example, its strength and thickness. We analyse common conversion point stacked Sp converted wave images of the lithosphere beneath rift systems in the contiguous U.S., both the wide Basin and Range, and narrow rift systems such as the Rio Grande Rift and Salton Trough. We use Sp waves recorded by EarthScope's Transportable Array and other available permanent and temporary broadband stations. Beneath the Basin and Range, we observe a very strong, shallow velocity decrease (the lithosphere-asthenosphere boundary, or LAB) that is relatively uniform over 100s of km. The strength of this feature indicates melt has ponded at this transition. We have not observed a clear relationship between lithospheric thickness beneath the Basin and Range, and total degree of extension, current extension rate, or age since surface volcanism. Beneath narrow rifts in the western U.S., however, more localised thinning of the lithosphere has been observed. We also compare these observations with seismic images of the Malawi Rift, at the southern end of the Western Branch of the East African Rift System, using broadband data acquired as part of the Study of Extension and MaGmatism in Malawi aNd Tanzania (SEGMeNT) experiment. The Malawi Rift is extending slowly in a magma-poor region of relatively strong lithosphere. We constrain the pattern of plate-scale extension by observations of crustal thinning, and image complex variations in deeper lithospheric structure.

Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi.

PubMed

MacKenzie, Rachel K; van Lettow, Monique; Gondwe, Chrissie; Nyirongo, James; Singano, Victor; Banda, Victor; Thaulo, Edith; Beyene, Teferi; Agarwal, Mansi; McKenney, Allyson; Hrapcak, Susan; Garone, Daniela; Sodhi, Sumeet K; Chan, Adrienne K

2017-11-01

There are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care. We conducted a nested case-control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow-up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non-retained) cases and 405 (retained) controls were selected. In multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11). This study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low- and middle-income settings to prioritize interventions for ALHIV and determine their cost-effectiveness. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

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 some areas, there also have been significant forest, grass and crop loss in other areas that resulted in very minimal net changes. As for Tanzania, its most significant changes were the net deforestation and net crop expansion. Malawi's most significant changes were the net deforestation, net crop expansion, net grass expansion and net wetland loss. Finally, Namibia's most significant changes were the net deforestation and net grass expansion. The only noticeable environmental driver was in Malawi, which had a significant net wetland loss and could be due to the fact that it was the only country that had a reduction in total precipitation between the periods when the LCLU maps were developed. Not only that, but Malawi also happened to have a slight increase in temperature, which would cause more evaporation and net decrease in wetlands if the precipitation didn't increase as was the case in that country. In addition, within our studied countries, forestland expansion and loss as well as crop expansion and loss were happening in the same country almost equally in some cases. All of that implies that non-environmental factors, such as socioeconomics and governmental policies, could have been the main drivers of these LCLU changes in many of these countries in E&S Africa. It will be important to further study in the future the detailed effects of such drivers on these LCLU changes in this part of the world.

Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?

PubMed

Moucheraud, Corrina; Owen, Helen; Singh, Neha S; Ng, Courtney Kuonin; Requejo, Jennifer; Lawn, Joy E; Berman, Peter

2016-09-12

Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.

Cigarette smoking prevalence among school-going adolescents in two African capital cities: Kampala Uganda and Lilongwe Malawi.

PubMed

Muula, Adamson S; Mpabulungi, Lillian

2007-03-01

Non communicable diseases are a growing public health concern. Globally tobacco-related deaths surpass malaria deaths and yet developing countries' data are lacking. To compare prevalence of tobacco use and exposure to tobacco and tobacco-related issues among adolescents in Kampala, Uganda and Lilongwe, Malawi. Cross sectional data from the Global Youth Tobacco Survey (GYTS) w used. Data were collected in 2001 in Lilongwe and in 2002 in Uganda using a standardized questionnaire tool. The study was aimed to enrolled schoolchildren aged 13-17 years. The prevalence of tobacco smoking in Kampala and Lilongwe among adolescents was 5.6% and 6.2% (p >0.05) respectively. However, adolescents in Lilongwe were statistically significantly more likely to have ever smoked, use other tobacco products and perceived themselves as likely to initiate smoking in the coming year. Exposure to tobacco-related advertisements through billboards, newspapers and magazines was high in both settings. Adolescents are increasingly being exposed to tobacco and tobacco-related advertisements in Lilongwe, Malawi and Kampala, Uganda. There is need to enhance tobacco prevention efforts in developing nations.

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

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

Situation Report--Laos, Malawi, Pakistan, Republic of Korea, Somali Democratic Republic, and Tunisia.

ERIC Educational Resources Information Center

International Planned Parenthood Federation, London (England).

Data relating to population and family planning in six foreign countries are presented in these situation reports. Countries included are Laos, Malawi, Pakistan, Republic of Korea, Somali Democratic Republic, and Tunisia. Information is provided under two topics, general background and family planning situation, where appropriate and if it is…

Situation Report--Hong Kong, Malawi, Pakistan, Panama, Philippines, Ryukyu Islands (Okinawa), Sabah, Sarawak.

ERIC Educational Resources Information Center

International Planned Parenthood Federation, London (England).

Data relating to population and family planning in eight foreign countries are presented in these situation reports. Countries included are Hong Kong, Malawi, Pakistan, Panama, Philippines, Ryukyu Islands (Okinawa), Sabah, and Sarawak. Information is provided where appropriate and available, under two topics, general background and family planning…

"They Call Me Headmaster": Malawian and Australian Women Leaders

ERIC Educational Resources Information Center

Whitehead, Kay; Andretzke, Elaine; Binali, Valesi

2018-01-01

This article explores commonalities in the lives and work of women head teachers in Malawian secondary schools and women principals in Australian Lutheran schools. In both Australia and Malawi women are under-represented in school leadership and often appointed to complex schools and communities. We commence with a brief discussion of Malawi and…

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

The launch of new-look Chishango.

PubMed

Chavasse, D

2002-09-01

PSI/Malawi is a local affiliate of the non-profit NGO, Population Services International, which operates in over 50 countries worldwide. PSI/Malawi's mission is to "improve and sustain the health of all Malawians through cost-effective social marketing of needed and affordable health products". In this context, social marketing involves using a range of media channels to create demand for branded health products which are sold at subsidised prices through a wide range of distribution outlets (e.g. wholesalers/retailers, institutions, NGOs, the workplace, etc.). Chishango is PSI/Malawi's condom brand which was launched in 1994 to provide sexually active Malawians with an affordable means of protecting themselves and their partners from HIV transmission. In 2001, research indicated that the brand needed a 'face lift' to improve its relevance to modern Malawians and therefore lead to an increase in consistent condom use resulting in a further reduction in HIV transmission. The newly packaged and positioned Chishango was launched on the 13th May 2002. The speech below was given by the Resident Director of PSI/Malawi, Dr Desmond Chavasse at the relaunch of Chishango.

Impact of Extended Combination Antiretroviral Therapy on the Decline of HIV Prevalence in Pregnant Women in Malawi.

PubMed

Liotta, Giuseppe; Chimbwandira, Frank; Wouters, Kristien; Nielsen-Saines, Karin; Jere, Haswell; Mancinelli, Sandro; Ceffa, Susanna; Erba, Fulvio; Palombi, Leonardo; Marazzi, Maria Cristina

2016-01-01

Combination antiretroviral therapy has been shown to reduce HIV transmission and incident infections. In recent years, Malawi has significantly increased the number of individuals on combination antiretroviral drugs through more inclusive treatment policies. Using a retrospective observational cohort design, records with HIV test results were reviewed for pregnant women attending a referral hospital in Malawi over a 5-year period, with viral load measurements recorded. HIV prevalence over time was determined, and results correlated with population viral load. A total of 11 052 women were included in this analysis, with 440 (4.1%) HIV infections identified. HIV prevalence rates in pregnant women in Malawi halved from 6.4% to 3.0% over 5 years. Mean viral loads of adult patients decreased from 120 000 copies/mL to less than 20 000 copies/mL. Results suggest that community viral load has an effect on HIV incidence rates in the population, which in turn correlates with reduced HIV prevalence rates in pregnant women. © The Author(s) 2015.

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.

PREVENTING FUTURE SHOCK: A Case for Addressing Future Threats to America’s National Security

DTIC Science & Technology

2001-04-01

both home and abroad and negotiating a convention to protect endangered sea turtles, whales and other limits to trade that threaten endangered species ...Botswana, and Zimbabwe have been decimated. In a region that would have calculated life expectancies to reach 70 years of age by 2010, many will...conditions is lower that 2.7% of the 1995 Gross Domestic Product for Kenya, Tanzania, Uganda, Zimbabwe , Botswana, Zambia and Malawi.71 African

Factors Affecting Availability of Essential Medicines among Community Health Workers in Ethiopia, Malawi, and Rwanda: Solving the Last Mile Puzzle

PubMed Central

Chandani, Yasmin; Noel, Megan; Pomeroy, Amanda; Andersson, Sarah; Pahl, Michelle K.; Williams, Timothy

2012-01-01

To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation. PMID:23136287

Factors affecting availability of essential medicines among community health workers in Ethiopia, Malawi, and Rwanda: solving the last mile puzzle.

PubMed

Chandani, Yasmin; Noel, Megan; Pomeroy, Amanda; Andersson, Sarah; Pahl, Michelle K; Williams, Timothy

2012-11-01

To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation.

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 Evidence-Informed Policy Network, KTPMalawi can continue to build on its role in facilitating the use of evidence in the development and refinement of health policy in Malawi.

High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

PubMed Central

Bedell, Richard A.; Anderson, Suzanne T. B.; van Lettow, Monique; Åkesson, Ann; Corbett, Elizabeth L.; Kumwenda, Moses; Chan, Adrienne K.; Heyderman, Robert S.; Zachariah, Rony; Harries, Anthony D.; Ramsay, Andrew R.

2012-01-01

Background Tuberculosis (TB) and serious bloodstream infections (BSI) may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART) with unexplained weight loss, chronic fever or chronic diarrhea. Methods and Findings A prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg), induced sputum (IS) for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11%) had microbiological evidence of TB; 50 (11%) had a positive (non-TB) blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS) were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates). Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (<2 for all combinations). Conclusions We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations. PMID:22761767

Factors influencing the experience of sexual and reproductive healthcare for female adolescents with perinatally-acquired HIV: a qualitative case study.

PubMed

Mwalabu, Gertrude; Evans, Catrin; Redsell, Sarah

2017-12-08

Young people living with perinatally-acquired HIV require age-appropriate support regarding sex and relationships as they progress towards adulthood. HIV affects both genders but evidence suggests that young women are particularly vulnerable to sexual abuse and more prone to engaging in sexual behaviours to meet their daily survival needs. This can result in poor sexual and reproductive health (SRH) outcomes. HIV services in Malawi provide support for young women's HIV-related clinical needs, but it is unclear whether there is sufficient provision for their SRH needs as they become adults. This paper explores the sex and relationship experiences of young women growing up with perinatally-acquired HIV in order to understand how to improve SRH care and associated outcomes. A qualitative case study approach was adopted in which each 'case' comprised a young woman (15-19 years) with perinatally acquired HIV, a nominated caregiver and service provider. Participants were purposively selected from three multidisciplinary centres providing specialised paediatric/adolescent HIV care in Malawi. Data was collected for 14 cases through in-depth interviews (i.e. a total of 42 participants) and analysed using within-case and cross-case approaches. The interviews with adolescents were based on an innovative visual method known as 'my story book' which encouraged open discussion on sensitive topics. Young women reported becoming sexually active at an early age for different reasons. Some sought a sense of intimacy, love, acceptance and belonging in these relationships, noting that they lacked this at home and/or within their peer groups. For others, their sexual activity was more functional - related to meeting survival needs. Young women reported having little control over negotiating safer sex or contraception. Their priority was preventing unwanted pregnancies yet several of the sample already had babies, and transfer to antenatal services created major disruptions in their HIV care. In contrast, caregivers and nurses regarded sexual activity from a clinical perspective, fearing onward transmission of HIV and advocating abstinence or condoms where possible. In addition, a cultural silence rooted in dominant religious and traditional norms closed down possibilities for discussion about sexual matters and prevented young women from accessing contraception. The study has shown how young women, caregivers and service providers have contrasting perspectives and priorities around SRH care. Illumination of these differences highlights a need for service improvement. It is suggested that young women themselves are involved in future service improvement initiatives to encourage the development of culturally and socially acceptable pathways of care.

An Assessment of Peri-Urban Groundwater Quality from Shallow Dug Wells, Mzuzu, Malawi

NASA Astrophysics Data System (ADS)

Holm, R.; Felsot, A.

2012-12-01

Throughout Malawi, governmental, non-governmental, religious and civic organizations are targeting the human need for water. Diarrheal diseases, often associated with unsafe drinking water, are a leading cause of mortality in children under five in Malawi with over 6,000 deaths per year (World Health Organization, 2010). From January to March 2012, a field study was undertaken in Malawi to study water quality and develop a public health risk communication strategy. The region studied, Area 1B, represents a comparatively new peri-urban area on the edge of Mzuzu city. Area 1B is serviced by a piped municipal water supply, but many shallow dug wells are also used for household water. Groundwater samples were collected from 30 shallow dug well sites and analyzed for nitrate, total coliform, Escherichia coli, total hardness, total alkalinity and pH. In addition to water quality analyses, a structured household questionnaire was administered to address water use, sanitation, health, consumption patterns, and socioeconomics. Results showed that more than half of the groundwater samples would be considered of unacceptable quality based on World Health Organization (WHO) standards for E. coli contamination. Low levels of nitrate were found in groundwater, but only one well exceeded WHO standards. The structured questionnaire revealed that some residents were still consuming groundwater despite the access to safer municipal water. In general, the widespread E. coli contamination was not statistically correlated with well depth, latrine proximity, or surface features. Similarly, nitrate concentrations were not significantly correlated with proximity to latrines. On the other hand, nitrate was correlated with well depth, which is expected given the high potential for leaching of anionic highly water soluble compounds. E. coli was significantly correlated with nitrate concentration. Projects targeting the need for clean water need to recognize that households with access to a safe piped municipal water service may still be consuming unsafe groundwater.

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 achievement of the health system goal of universal health coverage. Malawi, like majority of African countries, needs to invest more in strengthening R4H governance, developing and sustaining R4H resources, and producing and using research findings.

Cost-effectiveness and affordability of community mobilisation through women's groups and quality improvement in health facilities (MaiKhanda trial) in Malawi.

PubMed

Colbourn, Tim; Pulkki-Brännström, Anni-Maria; Nambiar, Bejoy; Kim, Sungwook; Bondo, Austin; Banda, Lumbani; Makwenda, Charles; Batura, Neha; Haghparast-Bidgoli, Hassan; Hunter, Rachael; Costello, Anthony; Baio, Gianluca; Skordis-Worrall, Jolene

2015-01-01

Understanding the cost-effectiveness and affordability of interventions to reduce maternal and newborn deaths is critical to persuading policymakers and donors to implement at scale. The effectiveness of community mobilisation through women's groups and health facility quality improvement, both aiming to reduce maternal and neonatal mortality, was assessed by a cluster randomised controlled trial conducted in rural Malawi in 2008-2010. In this paper, we calculate intervention cost-effectiveness and model the affordability of the interventions at scale. Bayesian methods are used to estimate the incremental cost-effectiveness of the community and facility interventions on their own (CI, FI), and together (FICI), compared to current practice in rural Malawi. Effects are estimated with Monte Carlo simulation using the combined full probability distributions of intervention effects on stillbirths, neonatal deaths and maternal deaths. Cost data was collected prospectively from a provider perspective using an ingredients approach and disaggregated at the intervention (not cluster or individual) level. Expected Incremental Benefit, Cost-effectiveness Acceptability Curves and Expected Value of Information (EVI) were calculated using a threshold of $780 per disability-adjusted life-year (DALY) averted, the per capita gross domestic product of Malawi in 2013 international $. The incremental cost-effectiveness of CI, FI, and combined FICI was $79, $281, and $146 per DALY averted respectively, compared to current practice. FI is dominated by CI and FICI. Taking into account uncertainty, both CI and combined FICI are highly likely to be cost effective (probability 98% and 93%, EVI $210,423 and $598,177 respectively). Combined FICI is incrementally cost effective compared to either intervention individually (probability 60%, ICER $292, EIB $9,334,580 compared to CI). Future scenarios also found FICI to be the optimal decision. Scaling-up to the whole of Malawi, CI is of greatest value for money, potentially averting 13.0% of remaining annual DALYs from stillbirths, neonatal and maternal deaths for the equivalent of 6.8% of current annual expenditure on maternal and neonatal health in Malawi. Community mobilisation through women's groups is a highly cost-effective and affordable strategy to reduce maternal and neonatal mortality in Malawi. Combining community mobilisation with health facility quality improvement is more effective, more costly, but also highly cost-effective and potentially affordable in this context.

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

Challenges for modelling spatio-temporal variations of malaria risk in Malawi

NASA Astrophysics Data System (ADS)

Lowe, R.; Chirombo, J.; Tompkins, A. M.

2012-04-01

Malaria is the leading cause of morbidity and mortality in Malawi with more than 6 million episodes reported each year. Malaria poses a huge economic burden to Malawi in terms of the direct cost of treating malaria patients and also indirect costs resulting from workdays lost in agriculture and industry and absenteeism from school. Malawi implements malaria control activities within the Roll Back Malaria framework, with the objective to provide those most at risk (i.e. children under five years, pregnant woman and individuals with suppressed immune systems) access to personal and community protective measures. However, at present there is no mechanism by which to target the most 'at risk' populations ahead of an impending epidemic. Malaria transmission is influenced by variations in meteorological conditions, which impact the biology of the mosquito and the availability of breeding sites, but also socio-economic conditions such as levels of urbanisation, poverty and education, which influence human vulnerability and vector habitat. The many potential drivers of malaria, both extrinsic, such as climate, and intrinsic, such as population immunity are often difficult to disentangle. This presents a challenge for modelling of malaria risk in space and time. Using an age-stratified spatio-temporal dataset of malaria cases at the district level from July 2004 - June 2011, we use a spatio-temporal modelling framework to model variations in malaria risk in Malawi. Climatic and topographic variations are accounted for using an interpolation method to relate gridded products to administrative districts. District level data is tested in the model to account for confounding factors, including the proportion of the population living in urban areas; residing in traditional housing; with no toilet facilities; who do not attend school, etc, the number of health facilities per population and yearly estimates of insecticide-treated mosquito net distribution. In order to account for the unobserved confounding factors that influence malaria, which are not accounted for using measured covariates, a negative binomial generalised linear mixed model (GLMM) is adopted, which includes structured and unstructured spatial and temporal random effects. The parameters in this spatio-temporal Bayesian hierarchical model are estimated using Markov Chain Monte Carlo (MCMC). This allows posterior predictive distributions for disease risk to be derived for each spatial location and time period. A novel visualisation technique is then used to display seasonal probabilistic forecasts of malaria risk, derived from the developed model using pre-defined risk category thresholds, on a map. This technique allows decision makers to identify areas where the model predicts with certainty a particular malaria risk category (high, medium or low); in order to effectively target limited resources to those districts most at risk for a given season.

An appraisal of public water supply and coverage in Mzuzu City, northern Malawi

NASA Astrophysics Data System (ADS)

Wanda, Elijah M. M.; Gulula, Lewis C.; Phiri, Gift

Literature on water supply and coverage is mixed about whether Malawi will achieve the MDGs by 2015. Mzuzu City is one of the most rapidly growing urban areas that is faced with public water supply and coverage challenges in Malawi. In view of this, an appraisal was done through documentation review, field visits and face to face interviews in order to evaluate problems of public water supply and coverage. It was observed that inequitable distribution of water points, unreliability of the water supply services and financial losses are some of the problems affecting public water supply in Mzuzu City. The financial losses were attributed to poor financial performance resulting from accrued debts by some individual customers and most government institutions, the board’s reliance on loans for expansion of services which has led into more revenue being spent servicing the loan and accrued interests, and high levels of unaccounted for water. This study found out that only 17% of the study population has piped water in their dwelling homes and yards. It was also observed that 51% of the population accesses the water from community stand pipes supplied by the NRWB. This means that only 68% of the study population in Mzuzu City (mostly those from planned settlements) is covered by NRWB and 32% is not covered and relies on boreholes (13.6%), unprotected wells (16.5%) and rivers (1.9%) as sources of water. The percentage composition of the population not covered by NRWB is of great concern and threat to public health and safety. The study recommends that NRWB should ensure that available funds, which would otherwise have been paid out in form of interest, are used on projects in phases to improve water supply and coverage in Mzuzu City. The study also recommends that the government of Malawi should consider converting the NRWB’s loans into grants in order to alleviate the NRWB’s financial losses. Furthermore, the study recommends that the NRWB should equitably increase its customer base.

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.

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.

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.

Adoption of formal HIV and AIDS workplace policies: an analysis of industry/sector variations.

PubMed

Bakuwa, Rhoda

2010-12-01

Addressing HIV and AIDS is the responsibility of many stakeholders including private sector companies. However, increasing evidence reveals that the majority of companies around the world are yet to acknowledge and respond to HIV and AIDS as a workplace issue. One factor that has been identified in the literature as playing a role in determining whether a company responds to HIV and AIDS, or not, is the industry/sector in which a company operates. This study therefore sought to empirically examine whether in the context of Malawi there were significant variations in the adoption of formal HIV and AIDS workplace policies based on the industry/sector in which a company was operating, as well as analyse the dynamics underlying such variations. Using survey data collected from 152 randomly selected private sector companies in Malawi, the results of this study revealed significant variations in the adoption of HIV and AIDS workplace policies among companies operating in various sectors. Companies in the service sector were leading the adoption compared to companies in other sectors such as the trading sector. Furthermore, the evidence from this study showed that differences in staff participation in the activities of HIV and AIDS institutions may explain the industry/sector variations. These results provide an important avenue to scale up company responses to HIV and AIDS by intensifying staff participation in the activities of HIV and AIDS institutions. Such institutions appear to play a vital role of providing up to date HIV-and AIDS-related information upon which companies are able to develop a business case for responding to the epidemic.

Empowering peer group leaders for HIV prevention in Malawi.

PubMed

McCreary, Linda L; Kaponda, Chrissie P N; Davis, Kristina; Kalengamaliro, Mary; Norr, Kathleen F

2013-09-01

Behavioral change interventions using peer group leaders are effective and widely used, but few studies have examined how being a peer group leader affects the leaders. This study describes how participants felt being a peer group leader affected their lives. This descriptive qualitative study interviewed 18 experienced peer group leaders who had conducted a multisession human immunodeficiency virus (HIV) prevention peer group intervention in rural Malawi. We used inductive content analysis and comparisons within and between cases. Three major themes were identified. All leaders said they experienced personal changes in their knowledge, attitudes, or HIV prevention behaviors. They described interacting with family, neighbors, and friends, and speaking at church or community meetings, to discuss HIV prevention issues. They increased their self-efficacy to engage others in sensitive HIV prevention issues, developed a self-identity as a change agent, and came to be recognized in their community as trustworthy advisors about HIV and acquired immunodeficiency syndrome. These three themes, taken together, form the meta-theme of psychological empowerment. Being a peer group leader empowered the leaders as change agents for HIV prevention and had impacts in the community after the intervention ended, potentially increasing the long-term effectiveness and cost effectiveness of peer group interventions. Healthcare workers and community volunteers who led HIV prevention sessions continued HIV prevention activities in the community and workplace after the program ended. Training health workers as volunteer HIV prevention leaders offers a strategy to bring HIV prevention to limited-resource settings, despite health worker shortages. © 2013 Sigma Theta Tau International.

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…

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…

Process Evaluation of HIV Prevention Peer Groups in Malawi: A Look inside the Black Box

ERIC Educational Resources Information Center

McCreary, Linda L.; Kaponda, Chrissie P. N.; Kafulafula, Ursula K.; Ngalande, Rebecca C.; Kumbani, Lily C.; Jere, Diana L. N.; Norr, James L.; Norr, Kathleen F.

2010-01-01

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10-12 participants by 85 trained volunteer peer…

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…

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…

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…

Ninetis russellsmithi n. sp., an unusual new pholcid spider species from Malawi (Araneae: Pholcidae)

PubMed Central

Huber, Bernhard A.

2002-01-01

A new species Ninetis russellsmithi n. sp. is described from Malawi. It lacks the most prominent autapomorphy of pholcid spiders, the retrolateral projection of the cymbium (procursus). Biogeographically this species marks the first record for the genus in a 3000 km gap between its African congeners in Namibia and Tanzania. PMID:15455038

Increasing Access of Female Students in Science Technology, Engineering and Mathematics (STEM), in the University of Malawi (UNIMA)

ERIC Educational Resources Information Center

Mbano, Nellie; Nolan, Kathleen

2017-01-01

In Malawi, in spite of a number of gender equity policies and initiatives that encourage females to pursue careers within the fields of science, technology, engineering, and mathematics (STEM), research indicates that they are under-represented in these fields. One initiative recommended to address the factors contributing to this…

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

Job satisfaction and retention of health-care providers in Afghanistan and Malawi.

PubMed

Fogarty, Linda; Kim, Young Mi; Juon, Hee-Soon; Tappis, Hannah; Noh, Jin Won; Zainullah, Partamin; Rozario, Aleisha

2014-02-17

This study describes job satisfaction and intention to stay on the job among primary health-care providers in countries with distinctly different human resources crises, Afghanistan and Malawi. Using a cross-sectional design, we enrolled 87 health-care providers in 32 primary health-care facilities in Afghanistan and 360 providers in 10 regional hospitals in Malawi. The study questionnaire was used to assess job satisfaction, intention to stay on the job and five features of the workplace environment: resources, performance recognition, financial compensation, training opportunities and safety. Descriptive analyses, exploratory factor analyses for scale development, bivariate correlation analyses and bivariate and multiple linear regression analyses were conducted. The multivariate model for Afghanistan, with demographic, background and work environment variables, explained 23.9% of variance in job satisfaction (F(9,73) = 5.08; P < 0.01). However, none of the work environment variables were significantly related to job satisfaction. The multivariate model for intention to stay for Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P < 0.01). Those with high scores for recognition were more likely to have higher intention to stay (β = 0.328, P < 0.05). However, being paid an appropriate salary was negatively related to intent to stay (β = -0.326, P < 0.01). For Malawi, the overall model explained only 9.8% of variance in job satisfaction (F(8,332) = 4.19; P < 0.01) and 9.1% of variance in intention to stay (F(10,330) = 3.57; P < 0.01). The construction of concepts of health-care worker satisfaction and intention to stay on the job are highly dependent on the local context. Although health-care workers in both Afghanistan and Malawi reported satisfaction with their jobs, the predictors of satisfaction, and the extent to which those predictors explained variations in job satisfaction and intention to stay on the job, differed substantially. These findings demonstrate the need for more detailed comparative human resources for health-care research, particularly regarding the relative importance of different determinants of job satisfaction and intention to stay in different contexts and the effectiveness of interventions designed to improve health-care worker performance and retention.

Job satisfaction and retention of health-care providers in Afghanistan and Malawi

PubMed Central

2014-01-01

Background This study describes job satisfaction and intention to stay on the job among primary health-care providers in countries with distinctly different human resources crises, Afghanistan and Malawi. Methods Using a cross-sectional design, we enrolled 87 health-care providers in 32 primary health-care facilities in Afghanistan and 360 providers in 10 regional hospitals in Malawi. The study questionnaire was used to assess job satisfaction, intention to stay on the job and five features of the workplace environment: resources, performance recognition, financial compensation, training opportunities and safety. Descriptive analyses, exploratory factor analyses for scale development, bivariate correlation analyses and bivariate and multiple linear regression analyses were conducted. Results The multivariate model for Afghanistan, with demographic, background and work environment variables, explained 23.9% of variance in job satisfaction (F(9,73) = 5.08; P < 0.01). However, none of the work environment variables were significantly related to job satisfaction. The multivariate model for intention to stay for Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P < 0.01). Those with high scores for recognition were more likely to have higher intention to stay (β = 0.328, P < 0.05). However, being paid an appropriate salary was negatively related to intent to stay (β = -0.326, P < 0.01). For Malawi, the overall model explained only 9.8% of variance in job satisfaction (F(8,332) = 4.19; P < 0.01) and 9.1% of variance in intention to stay (F(10,330) = 3.57; P < 0.01). Conclusions The construction of concepts of health-care worker satisfaction and intention to stay on the job are highly dependent on the local context. Although health-care workers in both Afghanistan and Malawi reported satisfaction with their jobs, the predictors of satisfaction, and the extent to which those predictors explained variations in job satisfaction and intention to stay on the job, differed substantially. These findings demonstrate the need for more detailed comparative human resources for health-care research, particularly regarding the relative importance of different determinants of job satisfaction and intention to stay in different contexts and the effectiveness of interventions designed to improve health-care worker performance and retention. PMID:24533615

Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals.

PubMed

Prust, Margaret L; Banda, Clement K; Nyirenda, Rose; Chimbwandira, Frank; Kalua, Thokozani; Jahn, Andreas; Eliya, Michael; Callahan, Katie; Ehrenkranz, Peter; Prescott, Marta R; McCarthy, Elizabeth A; Tagar, Elya; Gunda, Andrews

2017-07-21

In order to facilitate scale-up of antiretroviral therapy (ART) in Malawi, innovative and pragmatic models have been developed to optimize the efficiency of HIV service delivery. In particular, three models of differentiated care have emerged for stable patients: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where group members rotate in collecting medications at the facility for all members. This study aimed to assess the extent to which ART patients in Malawi are differentiated based on clinical stability and describe the characteristics and costs associated with the models of differentiated care offered. A mixed methods process evaluation was conducted from 30 purposefully selected ART facilities. Cross-sectional data for this evaluation was collected between February and May 2016. The following forms of data collection are reported here: structured surveys with 136 health care workers; reviews of 75,364 patient clinical records; 714 observations of visit time and flow; and 30 questionnaires on facility characteristics. Among ART patients, 77.5% (95% confidence interval [CI] 74.1-80.6) were eligible for differentiated models of care based on criteria for clinical stability from national guidelines. Across all facilities, 69% of patients were receiving MMS. In facilities offering FTRs and CAGs, 67% and 6% of patients were enrolled in the models, respectively. However, eligibility criteria were used inconsistently: 72.9% (95% CI 66.3-78.6) of eligible patients and 42.3% (95% CI 33.1-52.0) ineligible patients received MMS. Results indicated that patient travel and time costs were reduced by 67%, and the unit costs of ART service delivery through the MMS, FTR and CAG models were similar, representing a reduction of approximately 10% in the annual unit cost of providing care to stable patients that receive no model. MMS is being implemented nationally and has already generated cost savings and efficiencies in Malawi for patients and the health system, but could be improved by more accurate patient differentiation. While expanding FTRs and CAGs may not offer significant further cost savings in Malawi, future studies should investigate if such alternative models lead to improvements in patient satisfaction or clinical outcomes that might justify their implementation.

How do we know? An assessment of integrated community case management data quality in four districts of Malawi.

PubMed

Yourkavitch, Jennifer; Zalisk, Kirsten; Prosnitz, Debra; Luhanga, Misheck; Nsona, Humphreys

2016-11-01

The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) projects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, and to suggest ways to improve data quality. The first RAcE data quality assessment was conducted in Malawi in January 2014 and we present findings pertaining to data from the health management information system at the community, facility and other sub-national levels because RAcE grantees rely on that for most of their monitoring data. We randomly selected 10 health facilities (10% of eligible facilities) from the four RAcE project districts, and collected quantitative data with an adapted and comprehensive tool that included an assessment of Malawi's M&E system for iCCM data and a data verification exercise that traced selected indicators through the reporting system. We rated the iCCM M&E system across five function areas based on interviews and observations, and calculated verification ratios for each data reporting level. We also conducted key informant interviews with Health Surveillance Assistants and facility, district and central Ministry of Health staff. Scores show a high-functioning M&E system for iCCM with some deficiencies in data management processes. The system lacks quality controls, including data entry verification, a protocol for addressing errors, and written procedures for data collection, entry, analysis and management. Data availability was generally high except for supervision data. The data verification process identified gaps in completeness and consistency, particularly in Health Surveillance Assistants' record keeping. Staff at all levels would like more training in data management. This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality. © The Author 2016. 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.

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

PubMed Central

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

2015-01-01

Background 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. Methods 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. Results 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. Conclusions 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. PMID:26649176

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.

Prediction of Outcome From Adult Bacterial Meningitis in a High-HIV-Seroprevalence, Resource-Poor Setting Using the Malawi Adult Meningitis Score (MAMS).

PubMed

Wall, Emma C; Mukaka, Mavuto; Scarborough, Matthew; Ajdukiewicz, Katherine M A; Cartwright, Katharine E; Nyirenda, Mulinda; Denis, Brigitte; Allain, Theresa J; Faragher, Brian; Lalloo, David G; Heyderman, Robert S

2017-02-15

Acute bacterial meningitis (ABM) in adults residing in resource-poor countries is associated with mortality rates >50%. To improve outcome, interventional trials and standardized clinical algorithms are urgently required. To optimize these processes, we developed and validated an outcome prediction tool to identify ABM patients at greatest risk of death. We derived a nomogram using mortality predictors derived from a logistic regression model of a discovery database of adult Malawian patients with ABM (n = 523 [65%] cerebrospinal fluid [CSF] culture positive). We validated the nomogram internally using a bootstrap procedure and subsequently used the nomogram scores to further interpret the effects of adjunctive dexamethasone and glycerol using clinical trial data from Malawi. ABM mortality at 6-week follow-up was 54%. Five of 15 variables tested were strongly associated with poor outcome (CSF culture positivity, CSF white blood cell count, hemoglobin, Glasgow Coma Scale, and pulse rate), and were used in the derivation of the Malawi Adult Meningitis Score (MAMS) nomogram. The C-index (area under the curve) was 0.76 (95% confidence interval, .71-.80) and calibration was good (Hosmer-Lemeshow C-statistic = 5.48, df = 8, P = .705). Harmful effects of adjunctive glycerol were observed in groups with relatively low predicted risk of poor outcome (25%-50% risk): Case Fatality Rate of 21% in the placebo group and 52% in the glycerol group (P < .001). This effect was not seen with adjunctive dexamethasone. MAMS provides a novel tool for predicting prognosis and improving interpretation of ABM clinical trials by risk stratification in resource-poor settings. Whether MAMS can be applied to non-HIV-endemic countries requires further evaluation. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

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 findings point at clear gaps in coverage in the current Malawian health system and call for further investments to ensure adequate affordable care for people suffering from CNCDs.

HIV status, gender, and marriage dynamics among adults in Rural Malawi

PubMed Central

Anglewicz, Philip; Reniers, Georges

2014-01-01

Marriage and partnerships bring about non-negligible health risks in populations with generalized HIV epidemics, and concerns about the possible transmission of HIV thus often factor in the decision-making about partnership formation and dissolution. The awareness of and responses to HIV risk stemming from regular sexual partners have been well documented in African populations, but few studies have estimated the effects of observed HIV status on marriage decisions and outcomes. We study marriage dissolution and remarriage using longitudinal data with repeated HIV and marital status measurements from rural Malawi. Results indicate that HIV positive individuals face greater risks of union dissolution (both via widowhood and divorce) and lower remarriage rates. Modeling studies suggest that the exclusion of HIV positives from the marriage or partnerships market will decelerate the propagation of HIV. PMID:25469927

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

PubMed

Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

2017-05-22

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Applying a feminist approach to health and human rights research in Malawi: a study of violence in the lives of female domestic workers.

PubMed

Mkandawire-Valhmu, Lucy; Stevens, Patricia E

2007-01-01

In this study, we responded to the human rights challenges posed in Malawi by burgeoning poverty, rapid urbanization, lack of employment opportunity for women, and AIDS-related morbidity and mortality as they affect young women in domestic service. Through focus groups and individual interviews with 48 female domestic workers, we examined violence from a postcolonial feminist perspective. In this article, we tell the story of how we operationalized our feminist science and forged relationships with Malawian women to identify the jeopardy they face and make steps toward an emancipatory change. We highlight substantive findings, but direct our focus to methodology, theoretical grounding, and implications for nursing research undertaken with vulnerable populations in the Third World.

Shifting human resources for health in the context of ART provision: qualitative and quantitative findings from the Lablite baseline study.

PubMed

Nkhata, Misheck J; Muzambi, Margaret; Ford, Deborah; Chan, Adrienne K; Abongomera, George; Namata, Harriet; Mambule, Ivan; South, Annabelle; Revill, Paul; Grundy, Caroline; Mabugu, Travor; Chiwaula, Levison; Hakim, James; Kityo, Cissy; Reid, Andrew; Katabira, Elly; Sodhi, Sumeet; Gilks, Charles F; Gibb, Diana M; Seeley, Janet; Cataldo, Fabian

2016-11-16

Lablite is an implementation project supporting and studying decentralized antiretroviral therapy (ART) rollout to rural communities in Malawi, Uganda and Zimbabwe. Task shifting is one of the strategies to deal with shortage of health care workers (HCWs) in ART provision. Evaluating Human Resources for Health (HRH) optimization is essential for ensuring access to ART. The Lablite project started with a baseline survey whose aim was to describe and compare national and intercountry delivery of ART services including training, use of laboratories and clinical care. A cross-sectional survey was conducted between October 2011 and August 2012 in a sample of 81 health facilities representing different regions, facility levels and experience of ART provision in Malawi, Uganda and Zimbabwe. Using a questionnaire, data were collected on facility characteristics, human resources and service provision. Thirty three (33) focus group discussions were conducted with HCWs in a subset of facilities in Malawi and Zimbabwe. The survey results showed that in Malawi and Uganda, primary care facilities were run by non-physician clinical officers/medical assistants while in Zimbabwe, they were run by nurses/midwives. Across the three countries, turnover of staff was high especially among nurses. Between 10 and 20% of the facilities had at least one clinical officer/medical assistant leave in the 3 months prior to the study. Qualitative results show that HCWs in ART and non-ART facilities perceived a shortage of staff for all services, even prior to the introduction of ART provision. HCWs perceived the introduction of ART as having increased workload. In Malawi, the number of people on ART and hence the workload for HCWs has further increased following the introduction of Option B+ (ART initiation and life-long treatment for HIV positive pregnant and lactating women), resulting in extended working times and concerns that the quality of services have been affected. For some HCWs, perceived low salaries, extended working schedules, lack of training opportunities and inadequate infrastructure for service provision were linked to low job satisfaction and motivation. ART has been decentralized to lower level facilities in the context of an ongoing HRH crisis and staff shortage, which may compromise the provision of high-quality ART services. Task shifting interventions need adequate resources, relevant training opportunities, and innovative strategies to optimize the operationalization of new WHO treatment guidelines which continue to expand the number of people eligible for ART.

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 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

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…

The New Language of Instruction Policy in Malawi: A House Standing on a Shaky Foundation

ERIC Educational Resources Information Center

Kamwendo, Gregory Hankoni

2016-01-01

This research note is a critique of Malawi's new language of instruction (LOI) policy. The new policy stipulates English as the medium of instruction from the first year (Standard 1) of primary school in a country where English is not the dominant language of household communication. The children are now expected to learn (and that includes…

Recalibrating Baseline Evidence in Burundi, Malawi, Senegal and Uganda: Exploring the Potential of Multi-Site, National-Level Stakeholder Engagement in Participatory Evaluation

ERIC Educational Resources Information Center

Edge, Karen; Marphatia, Akanksha A.

2015-01-01

This paper details our collaborative work on the Improving Learning Outcomes in Primary Schools (ILOPS) project in Burundi, Malawi, Uganda and Senegal. ILOPS set out to establish an innovative template for multi-stakeholder, multinational participatory evaluation (PE) and examine the fundamental roles, relationships and evidence that underpin the…

Health promotion and risk reduction in Malawi, Africa, village women.

PubMed

Gennaro, S; Thyangathyanga, D; Kershbaumer, R; Thompson, J

2001-01-01

A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. Surveys were completed by trained data gatherers in the village setting. All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

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.

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

A job analysis of community health workers in the context of integrated nutrition and early child development.

PubMed

Phuka, John; Maleta, Kenneth; Thomas, Mavuto; Gladstone, Melisa

2014-01-01

Stunting and poor child development are major public health concerns in Malawi. Integrated nutrition and early child development (ECD) interventions have shown potential to reduce stunting, but it is not known how these integrated approaches can be implemented in Malawi. In this paper, we aimed to evaluate the current jobs status of community health workers and their potential to implement integrated approaches. This was accomplished by a desk review of nutrition and ECD policy documents, as well as interviews with key informants, community health workers, and community members. We found that Malawi has comprehensive policies and well-outlined coordination structures for nutrition and ECD that advocate for integrated approaches. Strong multidisciplinary interaction exists at central levels but not at the community level. Integration of community health workers from different sectors is limited by workload, logistics, and a lack of synchronized work schedules. Favorable, sound policies and well-outlined coordination structures alone are not enough for the establishment of integrated nutrition and ECD activities. Balanced bureaucratic structures, improved task allocation, and synchronization of work schedules across all relevant sectors are needed for integrated intervention in Malawi. © 2014 New York Academy of Sciences.

Wealth, education and urban-rural inequality and maternal healthcare service usage in Malawi.

PubMed

Yaya, Sanni; Bishwajit, Ghose; Shah, Vaibhav

2016-01-01

Malawi is among the 5 sub-Saharan African countries presenting with very high maternal mortality rates, which remain a challenge. This study aims to examine the impact of wealth inequality and area of residence (urban vs rural) and education on selected indicators of maternal healthcare services (MHS) usage in Malawi. This study was based on data from the 5th round of Multiple Indicator Cluster Surveys (MICS) conducted in 2013-2014 in Malawi. Study participants were 7572 mothers aged between 15 and 49 years. The outcome variable was usage status of maternal health services of the following types: antenatal care, skilled delivery assistance and postpartum care. Univariate, bivariate and multivariate methods were used to describe the pattern of MHS usage in the sample population. Association between household wealth status, education as well as the type of residence, whether urban or rural, as independent variables and usage of MHS as dependent variables were analysed using the generalised estimating equations (GEE) method. Mean age of the sample population was 26.88 (SD 6.68). Regarding the usage of MHS, 44.7% of women had at least 4 ANC visits, 87.8% used skilled delivery attendants and 82.2% of women had used postnatal care. Regarding the wealth index, about a quarter of the women were in the poorest wealth quintile (23.6%) while about 1/6 were in the highest wealth quintile (15%). Rate of usage for all 3 types of services was lowest among women belonging to the lowest wealth quintile. In terms of education, only 1/5 completed their secondary or a higher degree (20.1%) and nearly 1/10 of the population lives in urban areas (11.4%) whereas the remaining majority live in rural areas (88.6%). The rates of usage of MHS, although reasonable on an overall basis, were consistently lower in women with lower education and those residing in rural areas. Maternal health service usage in Malawi appears to be reasonable, yet the high maternal mortality rate is disturbing and calls for analysing factors hindering the achievement of maternal health-related Sustainable Development Goals (SDGs). The findings of this study underscore the need to minimise the wealth inequality, urban-rural divide and the low level of education among mothers to improve the usage of MHS. An equity-based policy approach considering the sociodemographic inequity in terms of wealth index, education and urban-rural divide might prove beneficial in further improving the MHS usage, as well as addressing the possible issues of quality gaps in MHS, which might be beneficial towards reducing maternal mortality. It should be noted that the study of quality gaps in MHS is beyond the scope of this paper and calls for further research in this arena.

Undergraduate physiotherapy education in Malawi--the views of students on disability.

PubMed

Amosun, S; Kambalametore, S; Maart, S; Ferguson, G

2013-06-01

The College of Medicine in Malawi offers an undergraduate physiotherapy programme which started in 2010. The programme aims at training competent physiotherapists who can address the needs of people with disabilities. Therefore it is important to ensure that the perceptions of physiotherapy students towards disability are appropriate. The study explored the views of the first cohort of physiotherapy students (n=19) in the pre-medical class in the College of Medicine, University of Malawi, on disability. An audit of the views of premedical physiotherapy students was carried out in 2010 using the Q methodology. Two independent factors emerged which captured the views of 19 students on disability. Most of the views expressed suggest that the students empathised with people with disabilities. Participants perceived that people with disabilities can have a good quality of life like everyone else, and are as intelligent as people without disabilities. However, some participants also expressed some discomfort when around people with disabilities. While there was consensus on some positive views, the negative viewpoints have the potential to act as a barrier to the rehabilitation of people with disabilities. The curriculum should ensure that the positive views are reinforced throughout the training programme, while the negative viewpoints are reversed.

Sex work and the construction of intimacies: meanings and work pragmatics in rural Malawi.

PubMed

Tavory, Iddo; Poulin, Michelle

2012-05-01

This article focuses on Malawian sex workers' understandings of exchange and intimacy, showing how multiple historically emergent categories and specific work pragmatics produce specific patterns of relational meanings. As we show, sex workers make sense of their relationships with clients through two categories. The first is sex work; the second is the chibwenzi , an intimate premarital relational category that emerged from pre-colonial transformations in courtship practices. These categories, in turn, are also shaped differently in different work settings. We use narratives from in-depth interviews with 45 sex workers and bar managers in southern Malawi to describe how the everyday pragmatics of two forms of sex work-performed by "bargirls" and "freelancers"-foster distinct understandings of relationships between them and men they have sex with. Bargirls, who work and live in bars, blurred the boundaries between "regulars" and chibwenzi; freelancers, who are not tethered to a specific work environment, often subverted the meanings of the chibwenzi , presenting these relationships as both intimate and emotionally distant. Through this comparison, we thus refine an approach to the study of the intimacy-exchange nexus, and use it to capture the complexities of gender relations in post-colonial Malawi.

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.

Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi.

PubMed

Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer

2013-01-01

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

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 possible supply chain performance and supply reliability. Establishing multi-level teams serves to connect HSAs with decision makers at higher levels of the health system, align objectives, clarify roles and promote trust and collaboration, thereby promoting country ownership and scalability of a cStock-like system.

Childhood disability in Malawi: a population based assessment using the key informant method.

PubMed

Tataryn, Myroslava; Polack, Sarah; Chokotho, Linda; Mulwafu, Wakisa; Kayange, Petros; Banks, Lena Morgon; Noe, Christiane; Lavy, Chris; Kuper, Hannah

2017-11-28

Epidemiological data on childhood disability are lacking in Low and Middle Income countries (LMICs) such as Malawi, hampering effective service planning and advocacy. The Key Informant Method (KIM) is an innovative, cost-effective method for generating population data on the prevalence and causes of impairment in children. The aim of this study was to use the Key Informant Method to estimate the prevalence of moderate/severe, hearing, vision and physical impairments, intellectual impairments and epilepsy in children in two districts in Malawi and to estimate the associated need for rehabilitation and other services. Five hundred key informants (KIs) were trained to identify children in their communities who may have the impairment types included in this study. Identified children were invited to attend a screening camp where they underwent assessment by medical professionals for moderate/severe hearing, vision and physical impairments, intellectual impairments and epilepsy. Approximately 15,000 children were identified by KIs as potentially having an impairment of whom 7220 (48%) attended a screening camp. The estimated prevalence of impairments/epilepsy was 17.3/1000 children (95% CI: 16.9-17.7). Physical impairment (39%) was the commonest impairment type followed by hearing impairment (27%), intellectual impairment (26%), epilepsy (22%) and vision impairment (4%). Approximately 2100 children per million population could benefit from physiotherapy and occupational therapy and 300 per million are in need of a wheelchair. An estimated 1800 children per million population have hearing impairment caused by conditions that could be prevented or treated through basic primary ear care. Corneal opacity was the leading cause of vision impairment. Only 50% of children with suspected epilepsy were receiving medication. The majority (73%) of children were attending school, but attendance varied by impairment type and was lowest among children with multiple impairments (38%). Using the KIM this study identified more than 2500 children with impairments in two districts of Malawi. As well as providing data on child disability, rehabilitation and referral service needs which can be used to plan and advocate for appropriate services and interventions, this method study also has an important capacity building and disability awareness raising component.

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 training and supervision of staff at CBOs for children affected by HIV, and the inclusion of CBOs in broader efforts to improve population mental health outcomes. PMID:24766642

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 cardiovascular) epidemic in this region. Our data will help inform the rationale for specific intervention studies and the development of appropriately targeted public health strategies to tackle this important and poverty-related global health problem.

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 disease and the emerging noncommunicable disease (especially respiratory and cardiovascular) epidemic in this region. Our data will help inform the rationale for specific intervention studies and the development of appropriately targeted public health strategies to tackle this important and poverty-related global health problem. PMID:24960156

National poverty reduction strategies and HIV/AIDS governance in Malawi: a preliminary study of shared health governance.

PubMed

Wachira, Catherine; Ruger, Jennifer Prah

2011-06-01

The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi's National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation? In 2007, we developed and conducted a survey of Malawian government ministries, United Nations agencies, members of the Country Coordination Mechanism, the Malawi National AIDS Commission (NAC), and NAC grantees (N = 125, 90% response rate), seeking survey respondents' retrospective perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi's PRSP process (2000-2004). We also assessed principle health sector and economic indicators and budget allocations for HIV/AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: (i) consensus among global, national, and sub-national actors on goals and measurable outcomes; (ii) mutual collective accountability; and (iii) enhancement of individual and group health agency. Indicators to assess these elements included: (i) goal alignment; (ii) adequate resource levels; (iii) agreement on key outcomes and indicators for evaluating those outcomes; (iv) meaningful inclusion and participation of groups and institutions; (v) special efforts to ensure participation of vulnerable groups; and (vi) effectiveness and efficiency measures. Results suggest that the PRSP process supported accountability for NSF resources. However, the process may have marginalized key stakeholders, potentially undercutting the implementation of HIV/AIDS Action Plans. Copyright © 2010. Published by Elsevier Ltd.

Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi

PubMed Central

Hundalani, Shilpa G; Richards-Kortum, Rebecca; Oden, Maria; Kawaza, Kondwani; Gest, Alfred; Molyneux, Elizabeth

2015-01-01

Background Low-cost bubble continuous positive airway pressure (bCPAP) systems have been shown to improve survival in neonates with respiratory distress, in developing countries including Malawi. District hospitals in Malawi implementing CPAP requested simple and reliable guidelines to enable healthcare workers with basic skills and minimal training to determine when treatment with CPAP is necessary. We developed and validated TRY (T: Tone is good, R: Respiratory Distress and Y=Yes) CPAP, a simple algorithm to identify neonates with respiratory distress who would benefit from CPAP. Objective To validate the TRY CPAP algorithm for neonates with respiratory distress in a low-resource setting. Methods We constructed an algorithm using a combination of vital signs, tone and birth weight to determine the need for CPAP in neonates with respiratory distress. Neonates admitted to the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi, were assessed in a prospective, cross-sectional study. Nurses and paediatricians-in-training assessed neonates to determine whether they required CPAP using the TRY CPAP algorithm. To establish the accuracy of the TRY CPAP algorithm in evaluating the need for CPAP, their assessment was compared with the decision of a neonatologist blinded to the TRY CPAP algorithm findings. Results 325 neonates were evaluated over a 2-month period; 13% were deemed to require CPAP by the neonatologist. The inter-rater reliability with the algorithm was 0.90 for nurses and 0.97 for paediatricians-in-training using the neonatologist's assessment as the reference standard. Conclusions The TRY CPAP algorithm has the potential to be a simple and reliable tool to assist nurses and clinicians in identifying neonates who require treatment with CPAP in low-resource settings. PMID:25877290

Patterns and determinants of small-quantity LNS utilization in rural Malawi and Mozambique: considerations for interventions with specialized nutritious foods.

PubMed

Kodish, Stephen R; Aburto, Nancy J; Nseluke Hambayi, Mutinta; Dibari, Filippo; Gittelsohn, Joel

2017-01-01

Small-quantity, lipid-based nutrient supplements (SQ-LNS) show promise to improve the quality of maternal and child diets, particularly during the first 1000 days of life. The potential of SQ-LNS to impact positively upon nutritional status relies on numerous factors, including complementary dietary intake, disease prevalence and dynamics of household utilization, including sharing practices. Therefore, this study sought to elucidate the patterns and determinants of SQ-LNS utilization among children 6-23 months and potential sharing practices of other household members prior to intervention development. In Ntchisi, Malawi and Cabo Delgado, Mozambique, both rural, agricultural settings, we conducted two home-feeding trials of 8 and 6 weeks, respectively, nested within a larger multi-phase, emergent formative research design. Multiple methods, including in-depth interviews (n = 38), direct meal observations (n = 80), full-day child observations (n = 38) and spot checks of SQ-LNS supply (n = 23), were conducted with households (n = 35 in Malawi; n = 24 in Mozambique). Overall, the SQ-LNS was utilized contrary to its recommended use, with 50% of households in Malawi reporting running out of stock too early and 87% of households in Mozambique either overusing or underusing the product. Utilization of SQ-LNS was manifested in four patterns of overuse and two of underuse and was determined by factors at multiple levels of influence. Maternal and child health efforts need to consider the reasons behind choices by households to overuse or underuse SQ-LNS and design intervention strategies to increase the likelihood of its appropriate utilization. © 2016 John Wiley & Sons Ltd.

Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi

PubMed Central

Orlando, Stefano; Diamond, Samantha; Palombi, Leonardo; Sundaram, Maaya; Shear Zinner, Lauren; Marazzi, Maria Cristina; Mancinelli, Sandro; Liotta, Giuseppe

2016-01-01

Abstract The aim of this study is to assess the cost-effectiveness of a holistic, comprehensive human immunodeficiency virus (HIV) treatment Program in Malawi. Comprehensive cost data for the year 2010 have been collected at 30 facilities from the public network of health centers providing antiretroviral treatment (ART) throughout the country; two of these facilities were operated by the Disease Relief through Excellent and Advanced Means (DREAM) program. The outcomes analysis was carried out over five years comparing two cohorts of patients on treatment: 1) 2387 patients who started ART in the two DREAM centers during 2008, 2) patients who started ART in Malawi in the same year under the Ministry of Health program. Assuming the 2010 cost as constant over the five years the cost-effective analysis was undertaken from a health sector and national perspective; a sensitivity analysis included two hypothesis of ART impact on patients’ income. The total cost per patient per year (PPPY) was $314.5 for the DREAM protocol and $188.8 for the other Malawi ART sites, with 737 disability adjusted life years (DALY) saved among the DREAM program patients compared with the others. The Incremental Cost-Effectiveness Ratio was $1640 per DALY saved; it ranged between $896–1268 for national and health sector perspective respectively. The cost per DALY saved remained under $2154 that is the AFR-E-WHO regional gross domestic product per capita threshold for a program to be considered very cost-effective. HIV/acquired immune deficiency syndrome comprehensive treatment program that joins ART with laboratory monitoring, treatment adherence reinforcing and Malnutrition control can be very cost-effective in the sub-Saharan African setting. PMID:27227921

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

Maternal and Neonatal Risk Factors Associated with Vertical Transmission of Ophthalmia Neonatorum in Neonates Receiving Health Care in Blantyre, Malawi

PubMed Central

Ranjit, Roshni; Menezes, Lynette; Drucker, Mitchell; Msukwa, Gerald; Batumba, Nkume

2014-01-01

Context: Neonatal conjunctivitis is associated with poor prenatal care worldwide. Purpose: Data on neonatal conjunctivitis is scarce in Malawi. This study describes risk factors associated with conjunctivitis in neonates born in a large tertiary care hospital in Blantyre, Malawi. Materials and Methods: Medical records of a retrospective cohort of 231 neonates diagnosed with conjunctivitis from January 2006 to December 2009 at a large tertiary hospital in Malawi were reviewed. All subjects were clinically diagnosed with ophthalmia neonatorum. Data were collected on patient demographics and clinical features. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers as well as the treatments administered. Results: Mean age of the mother was 23.45 years (range, 15-40 years), and the mean number of previous deliveries was 2.3 (range, 1-7) children. Nearly, 80% of mothers delivered preterm infants via spontaneous vaginal delivery. The mean birth weight of neonates was 2869.6 grams (1100-5000 grams). Among mothers, premature rupture of membranes was the leading risk factor (24%) followed by sepsis during labor (9%), and history of sexually transmitted infections (STI) (7%). Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. Tetracycline with a saline eyewash was used frequently (34%) compared with combinations of benzyl penicillin and gentamicin. Conclusions: Improving prenatal care to reduce sepsis, traumatic deliveries, and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population. PMID:25100909

Qualitative analysis of a psychological supportive counseling group for burn survivors and families in Malawi.

PubMed

Barnett, Brian S; Mulenga, Macjellings; Kiser, Michelle M; Charles, Anthony G

2017-05-01

While psychological care, including supportive group therapy, is a mainstay of burn treatment in the developed world, few reports of support groups for burn survivors and their caregivers in the developing world exist. This study records the findings of a support group in Malawi and provides a qualitative analysis of thematic content discussed by burn survivors and caregivers. We established a support group for burn survivors and caregivers from February-May 2012 in the burn unit at Kamuzu Central Hospital in Lilongwe, Malawi. Sessions were held weekly for twelve weeks and led by a Malawian counselor. The group leader compiled transcripts of each session and these transcripts were qualitatively analyzed for thematic information. Thematic analysis demonstrated a variety of psychological issues discussed by both survivors and caregivers. Caregivers discussed themes of guilt and self-blame for their children's injuries, worries about emotional distance now created between caregiver and survivor, fears that hospital admission meant likely patient death and concerns about their child's future and burn associated stigma. Burn survivors discussed frustration with long hospitalization courses, hope created through interactions with hospital staff, the association between mental and physical health, rumination about their injuries and how this would affect their future, decreased self-value, increased focus on their own mortality and family interpersonal difficulties. The establishment of a support group in our burn unit provided a venue for burn survivors and their families to discuss subjective experiences, as well as the dissemination of various coping techniques. Burn survivors and their caregivers in Malawi would benefit from the establishment of similar groups in the future to help address the psychological sequelae of burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The use of specialty training to retain doctors in Malawi: A discrete choice experiment.

PubMed

Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylène; Muula, Adamson S; Dzowela, Titha; Hanson, Kara

2016-11-01

Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi. Despite evidence that specialty training is highly sought after, Malawian junior doctors would not accept all types of training. Doctors preferred timely training outside of Malawi in core specialties (internal medicine, general surgery, paediatrics, obstetrics & gynaecology). Specialty preferences are particularly strong, with most junior doctors requiring nearly double their monthly salary to accept training all in Malawi and over six-fold to accept training in ophthalmology (representing a bundle of unpopular but priority specialties). In contrast, the location of work before training did not significantly influence most doctors' choices when guaranteed specialty training. Using a latent class model, we identified four subgroups of junior doctors with distinct preferences. Policy simulations showed that these preferences could be leveraged by policymakers to improve retention in exchange for guaranteed specialty training, however incentivising the uptake of training in priority specialties will only be effective in those with more flexible preferences. These results indicate that indiscriminate expansion of postgraduate training to slow emigration of doctors from sub-Saharan African countries may not be effective unless doctors' preferences are taken into account. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Role of the Precambrian Mughese Shear Zone on Cenozoic faulting along the Rukwa-Malawi Rift segment of the East African Rift System

NASA Astrophysics Data System (ADS)

Heilman, E.; Kolawole, F.; Mayle, M.; Atekwana, E. A.; Abdelsalam, M. G.

2017-12-01

We address the longstanding question of the role of long-lived basement structures in strain accommodation within active rift systems. Studies have highlighted the influence of pre-existing zones of lithospheric weakness in modulating faulting and fault kinematics. Here, we investigate the role of the Neoproterozoic Mughese Shear Zone (MSZ) in Cenozoic rifting along the Rukwa-Malawi rift segment of the East African Rift System (EARS). Detailed analyses of Shuttle Radar Topography Mission (SRTM) DEM and filtered aeromagnetic data allowed us to determine the relationship between rift-related basement-rooted normal faults and the MSZ fabric extending along the southern boundary of the Rukwa-Malawi Rift North Basin. Our results show that the magnetic lineaments defining the MSZ coincide with the collinear Rukwa Rift border fault (Ufipa Fault), a dextral strike-slip fault (Mughese Fault), and the North Basin hinge-zone fault (Mbiri Fault). Fault-scarp and minimum fault-throw analyses reveal that within the Rukwa Rift, the Ufipa Border Fault has been accommodating significant displacement relative to the Lupa Border Fault, which represents the northeastern border fault of the Rukwa Rift. Our analysis also shows that within the North Basin half-graben, the Mbiri Fault has accommodated the most vertical displacement relative to other faults along the half-graben hinge zone. We propose that the Cenozoic reactivation along the MSZ facilitated significant normal slip displacement along the Ufipa Border Fault and the Mbiri Fault, and minor dextral strike-slip between the two faults. We suggest that the fault kinematics along the Rukwa-Malawi Rift is the result of reactivation of the MSZ through regional oblique extension.

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.

Urinary schistosomiasis among preschool children in Malengachanzi, Nkhotakota District, Malawi: Prevalence and risk factors.

PubMed

Moyo, V B; Changadeya, W; Chiotha, S; Sikawa, D

2016-03-01

This study was designed to determine the prevalence of and risk factors for schistosomiasis among a group of preschool children in Malawi. Schistosomiasis burden among preschoolers in Malawi is not well documented in the literature. This study used field research (in the form of a snail survey), laboratory work (urinalysis and microscopy for parasite identification), and questionnaire-guided interviews to determine the prevalence of and risk factors for urinary schistosomiasis among children, aged between 6 and 60 months, in Malengachanzi, Nkhotakota District, Malawi. Urinary schistosomiasis prevalence among preschool children was 13%. Of the factors evaluated, only age (P = 0.027) was statistically significantly associated with urinary schistosomiasis risk. Four-year-old preschool children were five times more likely to contract urinary schistosomiasis than twoyear-old children (odds ratio [OR] = 5.255; 95% confidence interval [CI] = 1.014-27.237; P = 0.048). Increased contact with infested water among older children likely explains much of their increased risk. Infestation was evidenced by the presence of infected Bulinus globosus snails in the water contact points surveyed. Multiple regression analysis showed that visiting water contact sites daily (OR = 0.898, 95% CI = 0.185-4.350, P = 0.894), bathing in these sites (OR = 9.462, 95% CI = 0.036-0.00, P = 0.430) and lack of knowledge, among caregivers, regarding the causes of urinary schistosomiasis (OR = 0.235, 95% CI = 0.005-1.102, P = 0.066) posed statistically insignificant risk increases for preschoolers contracting urinary schistosomiasis. Urinary schistosomiasis was prevalent among preschool children in Malengachanzi, Nkhotakota District. Contact with infested water puts these children and the general population at risk of infection and reinfection. Inclusion of preschool children in treatment programmes should be considered imperative, along with safe treatment guidelines. To prevent infection, the population in the area should be provided with health education and safe alternative water sources.

Changing Patterns of Access to Basic Education in Malawi: A Story of a Mixed Bag?

ERIC Educational Resources Information Center

Chimombo, Joseph

2009-01-01

Malawi was the first sub-Saharan African country to take a bold decision and declare free primary education after the Jomtien conference in 1990. Fourteen years after the policy was first implemented no serious attempt has been made to find out what has happened to the influx of pupils joining the system. Using secondary sources of data, this…

From Early Childhood Development Policy to Sustainability: The Fragility of Community-Based Childcare Services in Malawi

ERIC Educational Resources Information Center

Neuman, Michelle J.; McConnell, Christin; Kholowa, Foster

2014-01-01

Over the past 20 years, more than 6,000 community-based childcare centers (CBCCs) have been created in mostly rural areas of Malawi. Although the original purpose of these CBCCs was to meet the care needs of orphans and vulnerable children affected by the HIV/AIDS pandemic, the services have since expanded their mandate to provide early…

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 for data storage and analysis with unprecedented speed and efficient computing by making use of Google's computing infrastructure.

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

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.

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 hominins and suids occurred in both landscapes, pointing to distinct habitat flexibility and also nutritional versatility. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Local to global: Working together to meet the needs of vulnerable communities.

PubMed

Dressel, Anne; Mkandawire-Valhmu, Lucy; Dietrich, Ann; Chirwa, Ellen; Mgawadere, Florence; Kambalametore, Sylvia; Kako, Peninnah

2017-09-01

Since 2012, the University of Wisconsin-Milwaukee (UWM) faculty from nursing and physical therapy (PT) have been working together towards a common goal: to meet the healthcare needs of vulnerable populations in Malawi and Milwaukee. Sharing valuable knowledge and understanding one another's professions have allowed us to develop interprofessional education (IPE) learning experiences for students to help identify how quality of life could be improved or enhanced for children and their families across two different geographic spaces, one in rural Malawi and the other in urban Milwaukee. IPE learning modules were implemented in UWM's community health-focused short-term study abroad programmes to Malawi. IPE learning modules were also piloted at one of UWM's nurse-managed community health centres, located in a low-income, African American community in the inner city of Milwaukee, Wisconsin. Based on survey data collected from 10 participating IPE students in Milwaukee, from nursing, occupational therapy, PT, and speech and language pathology, a pilot study yielded a statistically significant change in a positive direction for increased understanding of three interprofessional collaborative practice core competencies: values and ethics, roles and responsibilities, and teams and teamwork. In this article, we discuss the processes used to develop, implement, and evaluate IPE experiences for UWM students, which may enable other professionals to envision the various projects they can embark upon from an interprofessional perspective.

Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

PubMed Central

Dasgupta, Aisha Nandini Zoe; Zaba, Basia; Crampin, Amelia C.

2018-01-01

Context Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance. Methods A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women’s cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence. Results The contraceptive point prevalence of 35% was slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable—the most widely used modern method—received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence. Conclusions Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened. PMID:26600568

School Socioeconomic Composition and Adolescent Sexual Initiation in Malawi.

PubMed

Kim, Jinho

2015-09-01

Numerous studies have documented the determinants of sexual behavior among adolescents in less-developed countries, yet relatively little is known about the influence of social contexts such as school and neighborhood. Using two waves of data from a school-based longitudinal survey conducted in Malawi from 2011-13, this study advances our understanding of the relationship between school-level socioeconomic contexts and adolescents' sexual activity. The results from two-level multinomial logistic regression models suggest that high socioeconomic composition of the student body in school decreases the odds of initiation of sexual activity, independent of other important features of schools and individual-level characteristics. This study also finds that the association between school socioeconomic composition and sexual activity is statistically significant among male adolescents but not female adolescents, suggesting that schools' socioeconomic contexts may be more relevant to male adolescents' initiation of sexual activity. © 2015 The Population Council, Inc.

School socioeconomic composition and adolescent sexual initiation in Malawi

PubMed Central

Kim, Jinho

2015-01-01

While numerous studies have documented the determinants of sexual behavior among adolescents in less developed countries, relatively little is known about the influence of social contexts such as school and neighborhood. Using two waves of data from a school-based longitudinal survey conducted in Malawi from 2011 to 2013, this study advances our understanding of the relationship between school-level socioeconomic contexts and adolescents’ sexual activity. The results from two-level multinomial logistic regression models suggest that high socioeconomic composition of the student body in school decreases the odds of initiating sexual activity, independently of other important features of schools as well as individual-level characteristics. This study also finds that the association between school socioeconomic composition and sexual activity is statistically significant only among males, but not females, suggesting that school’s socioeconomic contexts may be more relevant to male adolescents’ initiation of sexual activity. PMID:26347090

Motivational factors for participation in biomedical research: evidence from a qualitative study of biomedical research participation in Blantyre District, Malawi.

PubMed

Mfutso-Bengo, Joseph; Manda-Taylor, Lucinda; Masiye, Francis

2015-02-01

Obtaining effective informed consent from research participants is a prerequisite to the conduct of an ethically sound research. Yet it is believed that obtaining quality informed consent is generally difficult in settings with low socioeconomic status. This is so because of the alleged undue inducements and therapeutic misconception among participants. However, there is a dearth of data on factors that motivate research participants to take part in research. Hence, this study was aimed at filling this gap in the Malawian context. We conducted 18 focus group discussions with community members in urban and rural communities of Blantyre in Malawi. Most participants reported that they accepted the invitation to participate in research because of better quality treatment during study also known as ancillary care, monetary and material incentives given to participants, and thorough medical diagnosis. © The Author(s) 2014.

Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.

PubMed

Amouzou, Agbessi; Kanyuka, Mercy; Hazel, Elizabeth; Heidkamp, Rebecca; Marsh, Andrew; Mleme, Tiope; Munthali, Spy; Park, Lois; Banda, Benjamin; Moulton, Lawrence H; Black, Robert E; Hill, Kenneth; Perin, Jamie; Victora, Cesar G; Bryce, Jennifer

2016-03-01

We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. "Dose" variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. "Response" variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2-59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to "hard-to-reach" areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered. © The American Society of Tropical Medicine and Hygiene.

High Maternal Body Mass Index Is Associated with an Early-Onset of Overweight/Obesity in Pre-School-Aged Children in Malawi. A Multilevel Analysis of the 2015-16 Malawi Demographic and Health Survey.

PubMed

Ntenda, Peter Austin Morton; Mhone, Thomas Gabriel; Nkoka, Owen

2018-05-25

Overweight/obesity in young children is one of the most serious public health issues globally. We examined whether individual- and community-level maternal nutritional status is associated with an early onset of overweight/obesity in pre-school-aged children in Malawi. Data were obtained from the 2015-16 Malawi Demographic and Health Survey (MDHS). The maternal nutritional status as body mass index and childhood overweight/obesity status was assessed by using the World Health Organization (WHO) recommendations. To examine whether the maternal nutritional status is associated with overweight/obesity in pre-school-aged children, two-level multilevel logistic regression models were constructed on 4023 children of age less than five years dwelling in 850 different communities. The multilevel regression analysis showed that children born to overweight/obese mothers had increased odds of being overweight/obese [adjusted odds ratio (aOR) = 3.11; 95% confidence interval (CI): 1.13-8.54]. At the community level, children born to mothers from the middle (aOR: 1.68; 95% CI: 1.02-2.78) and high (aOR: 1.69; 95% CI: 1.00-2.90) percentage of overweight/obese women had increased odds of being overweight/obese. In addition, there were significant variations in the odds of childhood overweight/obesity in the communities. Strategies aimed at reducing childhood overweight/obesity in Malawi should address not only women and their children but also their communities. Appropriate choices of nutrition, diet and physical activity patterns should be emphasized upon in overweight/obese women of childbearing age throughout pregnancy and beyond.

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.

Lessons Learned From Option B+ in the Evolution Toward "Test and Start" From Malawi, Cameroon, and the United Republic of Tanzania.

PubMed

Kalua, Thokozani; Tippett Barr, Beth A; van Oosterhout, Joep J; Mbori-Ngacha, Dorothy; Schouten, Erik J; Gupta, Sundeep; Sande, Amakobe; Zomba, Gerald; Tweya, Hannock; Lungu, Edgar; Kajoka, Deborah; Tih, Pius; Jahn, Andreas

2017-05-01

The acceleration of prevention of mother-to-child transmission (PMTCT) activities, coupled with the rollout of 2010 World Health Organization (WHO) guidelines, led to important discussions and innovations at global and country levels. One paradigm-shifting innovation was Option B+ in Malawi. It was later included in WHO guidelines and eventually adopted by all 22 Global Plan priority countries. This article presents Malawi's experience with designing and implementing Option B+ and provides complementary narratives from Cameroon and Tanzania. Malawi's HIV program started in 2002, but by 2009, the PMTCT program was lagging far behind the antiretroviral therapy (ART) program because of numerous health system challenges. When WHO recommended Option A and Option B for PMTCT in 2010, it was clear that Malawi's HIV program would not be able to successfully implement either option without increasing existing barriers to PMTCT services and potentially decreasing women's access to care. Subsequent stakeholder discussions led to the development of Option B+. Operationalizing Option B+ required several critical considerations, including the complete integration of ART and PMTCT programs, systematic reduction of barriers to facilitate doubling the number of ART sites in less than a year, building consensus with stakeholders, and securing additional resources for the new program. During the planning and implementation process, several lessons were learned which are considerations for countries transitioning to "treat-all": Comprehensive change requires effective government leadership and coordination; national clinical guidelines must accommodate health system limitations; ART services and commodities should be decentralized within facilities; the general public should be well informed about major changes in the national HIV program; and patients should be educated on clinic processes to improve program monitoring.

Pigeon Pea and Cowpea-Based Cropping Systems Improve Vesicular Arbuscular Mycorrhizal Fungal Colonisation of Subsequent Maize on the Alfisols in Central Malawi

PubMed Central

Semu, Ernest; Mrema, Jerome P.; Nalivata, Patson C.

2017-01-01

Mycorrhizal associations contribute to the sustainability of crop production systems through their roles in nutrient cycling and other benefits in the soil-plant ecosystems. A two-year study was conducted on the Alfisols of Lilongwe and Dowa districts, Central Malawi, to assess the vesicular-arbuscular mycorrhizal (VAM) fungal colonisation levels in pigeon pea, cowpea, and maize grown in sole cropping, legume-cereal, and legume-legume intercropping systems and in the maize grown in short rotation (year 2) as influenced by the previous cropping systems and N fertilizer application. The gridline intersect method was used to assess the VAM fungal colonisation levels. Results showed that all treatments that included legumes whether grown as sole crop, in legume-cereal or in legume-legume cropping systems in the previous year, had significantly higher (P < 0.05) VAM fungal colonisation of the rotational maize crop roots by a range 39% to 50% and 19% to 47% than those in maize supplied and not supplied with N fertilizer, respectively, in a maize-maize short rotation, at the Lilongwe site. A similar trend was reported for the Dowa site. Furthermore, there were positive correlations between VAM fungal colonisation and the plant P content, dry matter yield, and nodule numbers. Further studies may help to assess the diversity of VAM fungal species in Malawi soils and identify more adaptive ones for inoculation studies. PMID:28584528

Pigeon Pea and Cowpea-Based Cropping Systems Improve Vesicular Arbuscular Mycorrhizal Fungal Colonisation of Subsequent Maize on the Alfisols in Central Malawi.

PubMed

Njira, Keston O W; Semu, Ernest; Mrema, Jerome P; Nalivata, Patson C

2017-01-01

Mycorrhizal associations contribute to the sustainability of crop production systems through their roles in nutrient cycling and other benefits in the soil-plant ecosystems. A two-year study was conducted on the Alfisols of Lilongwe and Dowa districts, Central Malawi, to assess the vesicular-arbuscular mycorrhizal (VAM) fungal colonisation levels in pigeon pea, cowpea, and maize grown in sole cropping, legume-cereal, and legume-legume intercropping systems and in the maize grown in short rotation (year 2) as influenced by the previous cropping systems and N fertilizer application. The gridline intersect method was used to assess the VAM fungal colonisation levels. Results showed that all treatments that included legumes whether grown as sole crop, in legume-cereal or in legume-legume cropping systems in the previous year, had significantly higher ( P < 0.05) VAM fungal colonisation of the rotational maize crop roots by a range 39% to 50% and 19% to 47% than those in maize supplied and not supplied with N fertilizer, respectively, in a maize-maize short rotation, at the Lilongwe site. A similar trend was reported for the Dowa site. Furthermore, there were positive correlations between VAM fungal colonisation and the plant P content, dry matter yield, and nodule numbers. Further studies may help to assess the diversity of VAM fungal species in Malawi soils and identify more adaptive ones for inoculation studies.

Quality of care for patients with non-communicable diseases in the Dedza District, Malawi

PubMed Central

Wood, Rachel; Der Merwe, Lisa Van; Mash, Robert

2015-01-01

Introduction In Malawi, non-communicable diseases (NCDs) are thought to cause 28% of deaths in adults. The aim of this study was to establish the extent of primary care morbidity related to NCDs, as well as to audit the quality of care, in the primary care setting of Dedza District, central Malawi. Methods This study was a baseline audit using clinic registers and a questionnaire survey of senior health workers at 5 clinics, focusing on care for hypertension, diabetes, asthma and epilepsy Results A total of 82 581 consultations were recorded, of which 2489 (3.0%) were for the selected NCDs. Only 5 out of 32 structural criteria were met at all 5 clinics and 9 out of 29 process criteria were never performed at any clinic. The only process criteria performed at all five clinics was measurement of blood pressure. The staff's knowledge on NCDs was basic and the main barriers to providing quality care were lack of medication and essential equipment, inadequate knowledge and guidelines, fee-for-service at two clinics, geographic inaccessibility and lack of confidence in the primary health care system by patients. Conclusion Primary care morbidity from NCDs is currently low, although other studies suggest a significant burden of disease. This most likely represents a lack of utilisation, recognition, diagnosis and ability to manage patients with NCDs. Quality of care is poor due to a lack of essential resources, guidelines, and training. PMID:26245609

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.

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.

Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study.

PubMed

Stanton, Michelle C; Yamauchi, Masato; Mkwanda, Square Z; Ndhlovu, Paul; Matipula, Dorothy Emmie; Mackenzie, Charles; Kelly-Hope, Louise A

2017-04-03

Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi. A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 cases-control pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period. Cases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = -0.06, 95% CI = (-0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = -0.61, 95% CI = (-0.79, -0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km 2 , controls = 2.10 km 2 , P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare. Those affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.

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 temporally and spatially. None of the stations have stable monthly rainfall regimes (mean PCI of less than 10). Stations with the highest mean rainfall were found to have a lower interannual variability. The rainfall stations showed low spatial correlations for annual, monthly as well as seasonal timescales indicating that the data may not be suitable for spatial interpolation. However, some structure (i.e. lower correlation with distance) could be observed when aggregating the data at 50 mile intervals. The annual and seasonal rainfall series were dominated by negative trends. The spatial distribution of the trends can be described as heterogeneous, although most of the stations in the southern region have negative trends. At the monthly timescale, 37 of the stations show a negative trend with four of the stations, all in the south, showing significant negative trends. On the other hand, only 5 stations show positive trends with only one significant trend in the south. Keywords: Malawi, rainfall trends, spatial variation

Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.

PubMed

Gopinathan, Unni; Lewin, Simon; Glenton, Claire

2014-12-01

To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout. © 2014 John Wiley & Sons Ltd.

Does a ban on informal health providers save lives? Evidence from Malawi

PubMed Central

Godlonton, Susan; Okeke, Edward N.

2015-01-01

Informal health providers ranging from drug vendors to traditional healers account for a large fraction of health care provision in developing countries. They are, however, largely unlicensed and unregulated leading to concern that they provide ineffective and, in some cases, even harmful care. A new and controversial policy tool that has been proposed to alter household health seeking behavior is an outright ban on these informal providers. The theoretical effects of such a ban are ambiguous. In this paper, we study the effect of a ban on informal (traditional) birth attendants imposed by the Malawi government in 2007. To measure the effect of the ban, we use a difference-in-difference strategy exploiting variation across time and space in the intensity of exposure to the ban. Our most conservative estimates suggest that the ban decreased use of traditional attendants by about 15 percentage points. Approximately three quarters of this decline can be attributed to an increase in use of the formal sector and the remainder is accounted for by an increase in relative/friend-attended births. Despite the rather large shift from the informal to the formal sector, we do not find any evidence of a statistically significant reduction in newborn mortality on average. The results are robust to a triple difference specification using young children as a control group. We examine several explanations for this result and find evidence consistent with quality of formal care acting as a constraint on improvements in newborn health. PMID:26681821

Report to UNESCO on Eleven Weeks as Consultant to the Governments of Kenya, Tanzania, Zambia and Malawi on Aspects of Biology Teaching, February to April, 1971.

ERIC Educational Resources Information Center

Meyer, Rex

This report describes the activities of a UNESCO consultant who visited Kenya, Tanzania, Zambia and Malawi for the purpose of assisting local education agencies in the Biology Teaching Pilot Project. The consultant's report briefly summarizes the status of the School Science Project (SSP) in these East African countries. Also listed are the…

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

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

PubMed Central

Lazzerini, Marzia; Seward, Nadine; Lufesi, Norman; Banda, Rosina; Sinyeka, Sophie; Masache, Gibson; Nambiar, Bejoy; Makwenda, Charles; Costello, Anthony; McCollum, Eric D; Colbourn, Tim

2017-01-01

Summary Background Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Methods Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models. Findings Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; ptrend<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11.8%), severe undernutrition (15.4%), severe acute malnutrition (34.8%), and symptom duration of more than 21 days (9.0%). Interpretation Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi. PMID:26718810

Barriers and Facilitators to HPV Vaccination: Perspectives from Malawian Women

PubMed Central

Ports, Katie A.; Reddy, Diane M.; Rameshbabu, Anjali

2014-01-01

The aim of this research was to elucidate potential barriers and facilitators to human papillomavirus (HPV) vaccination in Malawi, a sub-Saharan country. In Malawi, approximately 31 out of every 100,000 women develop cervical cancer annually, and 80% of those affected die from this malignancy. HPV vaccination may provide a feasible strategy for cervical cancer prevention in Malawi. However, important questions and concerns regarding cervical cancer and HPV vaccination acceptance among individuals and their communities must be considered prior to vaccine delivery. Qualitative interviews were conducted with 30 Malawian mothers aged 18–49 years from Chiradzulu District. Women’s knowledge and beliefs about HPV, cervical cancer, and vaccination, and their social-ecological contexts were explored in-depth. Thematic analyses revealed that despite women’s limited knowledge, cervical cancer was perceived to be a serious disease. Participants believed that as women, they were responsible for their children’s health. Women unanimously reported that they would vaccinate their children against HPV, especially if a health professional recommended it. Malawi’s health care infrastructure could present challenges to HPV vaccine programs; however, participants did not typically report this to be a barrier to vaccination. These data shed light on factors that may influence HPV vaccination acceptance and uptake in Malawi. PMID:23937733

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

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 in children with SAM, indicating a lack of sensitive behaviour in social interactions. Conclusions Children with SAM have severe developmental delays after a hospital admission. Our results indicate that there might be a significant difference in developmental attainment between children with kwashiorkor and with marasmus. Future studies exploring longer–term outcomes and testing possible intervention strategies are urgently needed. PMID:29302321

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 to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks. PMID:24884788

Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study.

PubMed

Bailey, Nicola; Mandeville, Kate L; Rhodes, Tim; Mipando, Mwapatsa; Muula, Adamson S

2012-09-14

In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation. Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach. Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector. Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors.

Crustal and mantle structure and anisotropy beneath the incipient segments of the East African Rift System: Preliminary results from the ongoing SAFARI

NASA Astrophysics Data System (ADS)

Yu, Y.; Reed, C. A.; Gao, S. S.; Liu, K. H.; Massinque, B.; Mdala, H. S.; moidaki, M.; Mutamina, D. M.; Atekwana, E. A.; Ingate, S. F.; Reusch, A.; Barstow, N.

2013-12-01

Despite the vast wealth of research conducted toward understanding processes associated with continental rifting, the extent of our knowledge is derived primarily from studies focused on mature rift systems, such as the well-developed portions of the East African Rift System (EARS) north of Lake Malawi. To explore the dynamics of early rift evolution, the SAFARI (Seismic Arrays for African Rift Initiation) team deployed 50 PASSCAL broadband seismic stations across the Malawi, Luangwa, and Okavango rifts of the EARS during the summer of 2012. The cumulative length of the profiles is about 2500 km and the planned recording duration is 2 years. Here we present the preliminary results of systematic analyses of data obtained from the first year of acquisition for all 50 stations. A total of 446 high-quality shear-wave splitting measurements using PKS, SKKS, and SKS phases from 84 teleseismic events were used to constrain fast polarization directions and splitting times throughout the region. The Malawi and Okavango rifts are characterized by mostly NE trending fast directions with a mean splitting time of about 1 s. The fast directions on the west side of the Luangwa Rift Zone are parallel to the rift valley, and those on the east side are more N-S oriented. Stacking of approximately 1900 radial receiver functions reveals significant spatial variations of both crustal thickness and the ratio of crustal P and S wave velocities, as well as the thickness of the mantle transition zone. Stations situated within the Malawi rift demonstrate a southward increase in observed crustal thickness, which is consistent with the hypothesis that the Malawi rift originated at the northern end of the rift system and propagated southward. Both the Okavango and Luangwa rifts are associated with thinned crust and increased Vp/Vs, although additional data is required at some stations to enhance the reliability of the observations. Teleseismic P-wave travel-time residuals show a delay of about 1 s at stations in the Okavango rift relative to the Limpopo belt. The study region is characterized by a relatively average mantle transition zone thickness of 250 km except for stations located within and to the immediate NW of the Okavango rift, where it is probably abnormally thin. Additional seismological techniques will be applied to the data set, and the preliminary results from the above initial analyses will be confirmed or modified by data from the SAFARI stations in the second year.

Assessing the feasibility of mobile phones for follow-up of acutely unwell children presenting to village clinics in rural northern Malawi.

PubMed

Hardy, Victoria; Hsieh, Jenny; Chirambo, Baxter; Wu, Tsung-Shu Joseph; O'Donoghue, John; Muula, Adamson S; Thompson, Matthew

2017-03-01

Patient follow-up is a routine component of clinical practice and valuable for evaluating the effectiveness of interventions, but because of the broad dispersion of health facilities and lack of standardised medical reporting in Malawi, collecting patient outcome data can be challenging. Increasing accessibility and affordability of mobile technology in resource-poor settings may facilitate patient follow-up in the community. The objective of this study was to evaluate the potential utility of mobile phones for collecting follow-up clinical data from parents or caregivers of acutely unwell under-5 children, for intervention evaluation purposes. Parents' or caregivers' mobile phone numbers were obtained by health surveillance assistants (HSAs) during study enrollment. Guardians who provided a telephone number were contacted by the study team to establish re-consultations or hospitalisations of their child(ren) within 14 days of recruitment. Health records at village clinics and higher-level health facilities were hand-searched to identify or confirm presentations and abstract clinical data. 87 out of 149 (58.4%) guardians provided a mobile telephone number, of whom the study team could contact 44 (29.5%). Seven guardians stated they took their child for further treatment: three of these returned to village clinics and four presented to secondary care facilities; attendance could only be confirmed from health records for one child. With continued expansion of cellular network coverage and mobile ownership in Malawi, mobile phones may facilitate collection of patient outcomes for intervention evaluation purposes. Future consideration should also be given to integrating mobile technologies into HSA clinical practice.

Sex work and the construction of intimacies: meanings and work pragmatics in rural Malawi

PubMed Central

Tavory, Iddo; Poulin, Michelle

2017-01-01

This article focuses on Malawian sex workers’ understandings of exchange and intimacy, showing how multiple historically emergent categories and specific work pragmatics produce specific patterns of relational meanings. As we show, sex workers make sense of their relationships with clients through two categories. The first is sex work; the second is the chibwenzi, an intimate premarital relational category that emerged from pre-colonial transformations in courtship practices. These categories, in turn, are also shaped differently in different work settings. We use narratives from in-depth interviews with 45 sex workers and bar managers in southern Malawi to describe how the everyday pragmatics of two forms of sex work—performed by “bargirls” and “freelancers”—foster distinct understandings of relationships between them and men they have sex with. Bargirls, who work and live in bars, blurred the boundaries between “regulars” and chibwenzi; freelancers, who are not tethered to a specific work environment, often subverted the meanings of the chibwenzi, presenting these relationships as both intimate and emotionally distant. Through this comparison, we thus refine an approach to the study of the intimacy-exchange nexus, and use it to capture the complexities of gender relations in post-colonial Malawi. PMID:28936026

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

Agroecology and sustainable food systems: Participatory research to improve food security among HIV-affected households in northern Malawi.

PubMed

Nyantakyi-Frimpong, Hanson; Mambulu, Faith Nankasa; Bezner Kerr, Rachel; Luginaah, Isaac; Lupafya, Esther

2016-09-01

This article shares results from a long-term participatory agroecological research project in northern Malawi. Drawing upon a political ecology of health conceptual framework, the paper explores whether and how participatory agroecological farming can improve food security and nutrition among HIV-affected households. In-depth interviews were conducted with 27 farmers in HIV-affected households in the area near Ekwendeni Trading Centre in northern Malawi. The results show that participatory agroecological farming has a strong potential to meet the food, dietary, labour and income needs of HIV-affected households, whilst helping them to manage natural resources sustainably. As well, the findings reveal that place-based politics, especially gendered power imbalances, are imperative for understanding the human impacts of the HIV/AIDS epidemic. Overall, the study adds valuable insights into the literature on the human-environment dimensions of health. It demonstrates that the onset of disease can radically transform the social relations governing access to and control over resources (e.g., land, labour, and capital), and that these altered social relations in turn affect sustainable disease management. The conclusion highlights how the promotion of sustainable agroecology could help to partly address the socio-ecological challenges associated with HIV/AIDS. Copyright © 2016 Elsevier Ltd. All rights reserved.

Kangaroo Mother Care: A review of mothers׳'experiences at Bwaila hospital and Zomba Central hospital (Malawi).

PubMed

Chisenga, Jayne Z; Chalanda, Marcia; Ngwale, Mathews

2015-02-01

Kangaroo Mother Care is an intervention that can help reduce neonatal mortality rate in Malawi but it has not been rolled out to all health facilities. Understanding the mothers׳ experience would help strategise when scaling-up this intervention. to review experiences of mothers Kangaroo Mother Care at two hospitals of Bwaila and Zomba. quantitative, descriptive using open interviews. two central hospitals in Malawi. 113 mothers that were in the Kangaroo Mother Care unit and those that had come for follow-up two weeks after discharge before the study took place. mothers had high level of knowledge about the significant benefits of Kangaroo Mother Care but 84% were not aware of the services prior to their hospitalisation. 18.6% (n=19) were not counselled prior to KMC practice. Mothers preferred KMC to incubator care. There were factors affecting compliance and continuation of KMC, which were lack of support, culture, lack of assistance with skin-to-skin contact, multiple roles of the mother and stigma. mothers had a positive attitude towards KMC once fully aware of its benefits. there is need for awareness campaigns on KMC services, provision of counselling, support and assistance which can help motivate mothers and their families to comply with the guidelines of KMC services. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social Studies in African Education.

ERIC Educational Resources Information Center

Adeyemi, Michael B., Ed.

This collection of essays is organized into two sections: Section 1 deals with general issues in social studies, while Section 2 examines social studies education in Botswana, Ethiopia, Ghana, Kenya, Malawi, Namibia, Nigeria, Tanzania, and Zambia. Essays in Section One are: (1) "The Historical Context of Education in British Colonial…

Associations between maternal experiences of intimate partner violence and child nutrition and mortality: findings from Demographic and Health Surveys in Egypt, Honduras, Kenya, Malawi and Rwanda.

PubMed

Rico, Emily; Fenn, Bridget; Abramsky, Tanya; Watts, Charlotte

2011-04-01

If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (<-2 Z-score height-for-age and <-3 Z-score height-for-age) in 6-59-month-old children. Analyses were adjusted for potential confounders, and the role of mediating factors was explored. The prevalence of physical and/or sexual IPV since the age of 15 years ranged from 15.5% (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study's objectives, and further explore the causal framework of this relationship using more advanced statistical analysis.

Preliminary Studies of the Performance of Quinoa (Chenopodium quinoa Willd.) Genotypes under Irrigated and Rainfed Conditions of Central Malawi.

PubMed

Maliro, Moses F A; Guwela, Veronica F; Nyaika, Jacinta; Murphy, Kevin M

2017-01-01

The goal of sustainable intensification of agriculture in Malawi has led to the evaluation of innovative, regionally novel or under-utilized crop species. Quinoa ( Chenopodium quinoa Willd.) has the potential to provide a drought tolerant, nutritious alternative to maize. We evaluated 11 diverse varieties of quinoa for their yield and agronomic performance at two locations, Bunda and Bembeke, in Malawi. The varieties originated from Ecuador, Chile and Bolivia in South America; the United States and Canada in North America; and, Denmark in Europe, and were chosen based on their variation in morphological and agronomic traits, and their potential for adaptation to the climate of Malawi. Plant height, panicle length, days to maturity, harvest index, and seed yield were recorded for each variety under irrigation at Bunda and Bembeke, and under rainfed conditions at Bunda. Plant height was significantly influenced by both genotype and environment. There were also significant differences between the two locations for panicle length whereas genotype and genotype × environment (G × E) interaction were not significantly different. Differences were found for genotype and G × E interaction for harvest index. Notably, differences for genotype, environment and G × E were found for grain yield. Seed yield was higher at Bunda (237-3019 kg/ha) than Bembeke (62-692 kg/ha) under irrigated conditions. The highest yielding genotype at Bunda was Titicaca (3019 kg/ha) whereas Multi-Hued was the highest (692 kg/ha) at Bembeke. Strong positive correlations between seed yield and (1) plant height ( r = 0.74), (2) days to maturity ( r = 0.76), and (3) biomass ( r = 0.87) were found under irrigated conditions. The rainfed evaluations at Bunda revealed significant differences in seed yield, plant biomass, and seed size among the genotypes. The highest yielding genotype was Black Seeded (2050 kg/ha) followed by Multi-Hued (1603 kg/ha) and Bio-Bio (1446 kg/ha). Ecuadorian (257 kg/ha) was the lowest yielding genotype. In general the seed yields of the genotypes were lower under rainfed conditions than under irrigated conditions at Bunda. The results also highlight the need to continue evaluating a diverse number of cultivars to select for genotypes adapted to specific agro-ecological areas and across seasons in Malawi.

Preliminary Studies of the Performance of Quinoa (Chenopodium quinoa Willd.) Genotypes under Irrigated and Rainfed Conditions of Central Malawi

PubMed Central

Maliro, Moses F. A.; Guwela, Veronica F.; Nyaika, Jacinta; Murphy, Kevin M.

2017-01-01

The goal of sustainable intensification of agriculture in Malawi has led to the evaluation of innovative, regionally novel or under-utilized crop species. Quinoa (Chenopodium quinoa Willd.) has the potential to provide a drought tolerant, nutritious alternative to maize. We evaluated 11 diverse varieties of quinoa for their yield and agronomic performance at two locations, Bunda and Bembeke, in Malawi. The varieties originated from Ecuador, Chile and Bolivia in South America; the United States and Canada in North America; and, Denmark in Europe, and were chosen based on their variation in morphological and agronomic traits, and their potential for adaptation to the climate of Malawi. Plant height, panicle length, days to maturity, harvest index, and seed yield were recorded for each variety under irrigation at Bunda and Bembeke, and under rainfed conditions at Bunda. Plant height was significantly influenced by both genotype and environment. There were also significant differences between the two locations for panicle length whereas genotype and genotype × environment (G × E) interaction were not significantly different. Differences were found for genotype and G × E interaction for harvest index. Notably, differences for genotype, environment and G × E were found for grain yield. Seed yield was higher at Bunda (237–3019 kg/ha) than Bembeke (62–692 kg/ha) under irrigated conditions. The highest yielding genotype at Bunda was Titicaca (3019 kg/ha) whereas Multi-Hued was the highest (692 kg/ha) at Bembeke. Strong positive correlations between seed yield and (1) plant height (r = 0.74), (2) days to maturity (r = 0.76), and (3) biomass (r = 0.87) were found under irrigated conditions. The rainfed evaluations at Bunda revealed significant differences in seed yield, plant biomass, and seed size among the genotypes. The highest yielding genotype was Black Seeded (2050 kg/ha) followed by Multi-Hued (1603 kg/ha) and Bio-Bio (1446 kg/ha). Ecuadorian (257 kg/ha) was the lowest yielding genotype. In general the seed yields of the genotypes were lower under rainfed conditions than under irrigated conditions at Bunda. The results also highlight the need to continue evaluating a diverse number of cultivars to select for genotypes adapted to specific agro-ecological areas and across seasons in Malawi. PMID:28289421

Study protocol: the effects of air pollution exposure and chronic respiratory disease on pneumonia risk in urban Malawian adults--the Acute Infection of the Respiratory Tract Study (The AIR Study).

PubMed

Jary, Hannah; Mallewa, Jane; Nyirenda, Mulinda; Faragher, Brian; Heyderman, Robert; Peterson, Ingrid; Gordon, Stephen; Mortimer, Kevin

2015-08-20

Pneumonia is the 2nd leading cause of years of life lost worldwide and is a common cause of adult admissions to hospital in sub-Saharan Africa. Risk factors for adult pneumonia are well characterised in developed countries, but are less well described in sub-Saharan Africa where HIV is a major contributing factor. Exposure to indoor and outdoor air pollution is high, and tobacco smoking prevalence is increasing in sub-Saharan Africa, yet the contribution of these factors to the burden of chronic respiratory diseases in sub-Saharan Africa remains poorly understood. Furthermore, the extent to which the presence of chronic respiratory diseases and exposure to air pollution contribute to the burden of pneumonia is not known. The Acute Infection of the Respiratory Tract Study (The AIR Study) is a case-control study to identify preventable risk factors for adult pneumonia in the city of Blantyre, Malawi. Cases will be adults admitted with pneumonia, recruited from Queen Elizabeth Central Hospital, the largest teaching hospital in Malawi. Controls will be adults without pneumonia, recruited from the community. The AIR Study will recruit subjects and analyse data within strata defined by positive and negative HIV infection status. All participants will undergo thorough assessment for a range of potential preventable risk factors, with an emphasis on exposure to air pollution and the presence of chronic respiratory diseases. This will include collection of questionnaire data, clinical samples (blood, urine, sputum and breath samples), lung function data and air pollution monitoring in their home. Multivariate analysis will be used to identify the important risk factors contributing to the pneumonia burden in this setting. Identification of preventable risk factors will justify research into the effectiveness of targeted interventions to address this burden in the future. The AIR Study is the first study of radiologically confirmed pneumonia in which air pollution exposure measurements have been undertaken in this setting, and will contribute important new information about exposure to air pollution in urban SSA. Through identification of preventable risk factors, the AIR Study aims to facilitate future research and implementation of targeted interventions to reduce the high burden of pneumonia in SSA.

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

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.

Prevalence of HIV Drug Resistance Before and 1 Year After Treatment Initiation in 4 Sites in the Malawi Antiretroviral Treatment Program

PubMed Central

Bennett, Diane; van Oosterhout, Joep J.; Moyo, Kundai; Hosseinipour, Mina; DeVos, Josh; Zhou, Zhiyong; Aberle-Grasse, John; Warne, Thomas R.; Mtika, Clement; Chilima, Ben; Banda, Richard; Pasulani, Olesi; Porter, Carol; Phiri, Sam; Jahn, Andreas; Kamwendo, Debbie; Jordan, Michael R.; Kabuluzi, Storn; Chimbwandira, Frank; Kagoli, Mathew; Matatiyo, Blackson; Demby, Austin; Yang, Chunfu

2012-01-01

Since 2004, the Malawi antiretroviral treatment (ART) program has provided a public health–focused system based on World Health Organization clinical staging, standardized first-line ART regimens, limited laboratory monitoring, and no patient-level monitoring of human immunodeficiency virus drug resistance (HIVDR). The Malawi Ministry of Health conducts periodic evaluations of HIVDR development in prospective cohorts at sentinel clinics. We evaluated viral load suppression, HIVDR, and factors associated with HIVDR in 4 ART sites at 12–15 months after ART initiation. More than 70% of patients initiating ART had viral suppression at 12 months. HIVDR prevalence (6.1%) after 12 months of ART was low and largely associated with baseline HIVDR. Better follow-up, removal of barriers to on-time drug pickups, and adherence education for patients 16–24 years of age may further prevent HIVDR. PMID:22544204

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

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.

Cancer and Palliative Care in the United States, Turkey, and Malawi: Developing Global Collaborations

PubMed Central

Walker, Deborah Kirk; Edwards, Rebecca L.; Bagcivan, Gulcan; Bakitas, Marie A.

2017-01-01

As the global cancer burden grows, so too will global inequities in access to cancer and palliative care increase. This paper will describe the cancer and palliative care landscape relative to nursing practice, education, and research, and emerging global collaborations in the United States (U.S.), Turkey, and Malawi. It is imperative that nurses lead efforts to advance health and strengthen education in these high-need areas. Leaders within the University of Alabama at Birmingham School of Nursing, through a Pan American Health Organization/World Health Organization Nursing Collaborating Center, have initiated collaborative projects in cancer and palliative care between the U.S., Turkey, and Malawi to strengthen initiatives that can ultimately transform practice. These collaborations will lay a foundation to empower nurses to lead efforts to reduce the global inequities for those with cancer and other serious and life-limiting illnesses. PMID:28695167

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

Making products available among community health workers: Evidence for improving community health supply chains from Ethiopia, Malawi, and Rwanda

PubMed Central

Chandani, Yasmin; Andersson, Sarah; Heaton, Alexis; Noel, Megan; Shieshia, Mildred; Mwirotsi, Amanda; Krudwig, Kirstin; Nsona, Humphreys; Felling, Barbara

2014-01-01

Background A UNICEF review of the challenges to scaling up integrated community case management (iCCM) found that drug shortages were a common bottleneck. In many settings, little thought has gone into the design of supply chains to the community level and limited evidence exists for how to address these unique challenges. SC4CCM’s purpose was to conduct intervention research to identify proven, simple, affordable solutions that address the unique supply chain challenges faced by CHWs and to demonstrate that supply chain constraints at the community level can be overcome. Methods SC4CCM selected three countries to implement supply chain innovations and developed a theory of change (TOC) framework for the learning phase, which identified the main drivers of product availability and was used for baseline assessments, design, implementation and evaluation of interventions in Ethiopia, Malawi, and Rwanda. Interventions were developed in each country and tested over 12–24 months. Mixed–method follow up assessments were conducted in each country in 2012–2013. The Supply Chain for Community Case Management (SC4CCM) Project then simplified the TOC into a Community Health Supply Chain (CHSC) framework to enable cross country analysis Results The findings from interventions in the three countries suggest that the greatest supply chain benefits are realized when all three CHSC framework elements (data flow, product flow, and effective people) are in place and working together. The synergistic effect of these three elements on supply chain performance was most effectively demonstrated by results from the Enhanced Management and Quality Collaborative interventions in Malawi and Rwanda, respectively, which were characterized by lower mean stockout rates and higher in stock rates on day of visit, when compared to other interventions. Conclusions Many conditions are necessary to ensure continuous product availability at the community level, however a supply chain works best when three key elements (product flow, data flow, and effective people) are deliberately included as an integral part of the system design. Although these elements may be designed differently in different settings, streamlining and synchronizing them while ensuring inclusion of all components for each element improves supply chain performance and promotes product availability at the community level. PMID:25520795

Feasibility and acceptability of oral cholera vaccine mass vaccination campaign in response to an outbreak and floods in Malawi.

PubMed

Msyamboza, Kelias Phiri; M'bang'ombe, Maurice; Hausi, Hannah; Chijuwa, Alexander; Nkukumila, Veronica; Kubwalo, Hudson Wenji; Desai, Sachin; Pezzoli, Lorenzo; Legros, Dominique

2016-01-01

Despite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015. This was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak. During the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign. This documentation has demonstrated that it was feasible, acceptable by the community to conduct a large-scale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi.

Feasibility and acceptability of oral cholera vaccine mass vaccination campaign in response to an outbreak and floods in Malawi

PubMed Central

Msyamboza, Kelias Phiri; M'bang'ombe, Maurice; Hausi, Hannah; Chijuwa, Alexander; Nkukumila, Veronica; Kubwalo, Hudson Wenji; Desai, Sachin; Pezzoli, Lorenzo; Legros, Dominique

2016-01-01

Introduction Despite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015. Methods This was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak. Results During the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign. Conclusion This documentation has demonstrated that it was feasible, acceptable by the community to conduct a large-scale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi. PMID:27347292

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.

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.

Experiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth Central Hospital, Malawi: A descriptive qualitative study.

PubMed

Gondwe, Mtisunge Joshua; Gombachika, Belinda; Majamanda, Maureen D

2017-03-01

An innovative, low-cost bubble continuous positive airway pressure (bCPAP) device has recently been introduced in Malawi for the treatment of respiratory distress in infants. While this novel bCPAP system has been shown to be safe and effective in reducing infant mortality, caregivers' experiences have not been investigated. The purpose of this study was to explore experiences of parents and guardians of infants who had been on bCPAP at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. This was a descriptive phenomenological study that was carried out at the Chatinkha nursery unit and the paediatric nursery ward at QECH, from January to February 2015. Purposive sampling was used to select participants for in-depth interviews. Data saturation was reached with 12 caregivers. Data were analysed using Colaizzi's framework. Caregivers received inadequate, inconsistent, and sporadic information about bCPAP. Student nurses and doctors were best able to answer caregivers' questions and concerns. When their infants were on bCPAP, caregivers felt anxious and fearful. However, upon implementation of bCPAP treatment for their children, the caregivers were satisfied with it. The main sources of psychological stress were limited parent-child interaction and the constraints of prescribed visiting hours. Family, friends, and caregiver involvement in the care of infants provided some psychological comfort. The results show gaps in the information and psychological support that mothers of infants on bCPAP receive in hospital. We recommend that psychological support be given to the mothers of infants on bCPAP at QECH.

The Effect of School Status and Academic Skills on the Reporting of Premarital Sexual Behavior: Evidence from a Longitudinal Study in Rural Malawi

PubMed Central

Soler-Hampejsek, Erica; Grant, Monica J.; Mensch, Barbara S.; Hewett, Paul C.; Rankin, Johanna

2013-01-01

Purpose Reliable data on sexual behavior are needed to identify adolescents at risk of acquiring HIV or other sexually transmitted diseases, as well as unintended pregnancies. This study aims to investigate whether schooling status and literacy and numeracy skills affect adolescents’ reports of premarital sex collected using audio computer-assisted self-interviews (ACASI). Methods Data on 2320 participants in the first three rounds of the Malawi Schooling and Adolescent Study were analyzed to estimate the level of inconsistency in reporting premarital sex among rural Malawian adolescents. Multivariate logistic regressions were used to examine the relationships between school status and academic skills and premarital sexual behavior reports. Results Males were more likely than females to report premarital sex at baseline while females were more likely than males to report sex inconsistently within and across rounds. School-going females and males were more likely to report never having had sex at baseline and to “retract” reports of ever having sex across rounds than their peers who had recently left school. School-going females were also more likely to report sex inconsistently at baseline. Literate and numerate respondents were less likely to report sex inconsistently at baseline; however, they were more likely to retract sex reports across rounds. Conclusions The level of inconsistency both within a survey round and across rounds reflects the difficulties in collecting reliable sexual behavior data from young people in settings such as rural Malawi, where education levels are low, and sex among school-going females is not socially accepted. PMID:23688856

Identifying potential recommendation domains for conservation agriculture in Ethiopia, Kenya, and Malawi.

PubMed

Tesfaye, Kindie; Jaleta, Moti; Jena, Pradyot; Mutenje, Munyaradzi

2015-02-01

Conservation agriculture (CA) is being promoted as an option for reducing soil degradation, conserving water, enhancing crop productivity, and maintaining yield stability. However, CA is a knowledge- and technology-intensive practice, and may not be feasible or may not perform better than conventional agriculture under all conditions and farming systems. Using high resolution (≈1 km(2)) biophysical and socioeconomic geospatial data, this study identified potential recommendation domains (RDs) for CA in Ethiopia, Kenya, and Malawi. The biophysical variables used were soil texture, surface slope, and rainfall while the socioeconomic variables were market access and human and livestock population densities. Based on feasibility and comparative performance of CA over conventional agriculture, the biophysical and socioeconomic factors were first used to classify cultivated areas into three biophysical and three socioeconomic potential domains, respectively. Combinations of biophysical and socioeconomic domains were then used to develop potential RDs for CA based on adoption potential within the cultivated areas. About 39, 12, and 5% of the cultivated areas showed high biophysical and socioeconomic potential while 50, 39, and 21% of the cultivated areas showed high biophysical and medium socioeconomic potential for CA in Malawi, Kenya, and Ethiopia, respectively. The results indicate considerable acreages of land with high CA adoption potential in the mixed crop-livestock systems of the studied countries. However, there are large differences among countries depending on biophysical and socio-economic conditions. The information generated in this study could be used for targeting CA and prioritizing CA-related agricultural research and investment priorities in the three countries.

Identifying Potential Recommendation Domains for Conservation Agriculture in Ethiopia, Kenya, and Malawi

NASA Astrophysics Data System (ADS)

Tesfaye, Kindie; Jaleta, Moti; Jena, Pradyot; Mutenje, Munyaradzi

2015-02-01

Conservation agriculture (CA) is being promoted as an option for reducing soil degradation, conserving water, enhancing crop productivity, and maintaining yield stability. However, CA is a knowledge- and technology-intensive practice, and may not be feasible or may not perform better than conventional agriculture under all conditions and farming systems. Using high resolution (≈1 km2) biophysical and socioeconomic geospatial data, this study identified potential recommendation domains (RDs) for CA in Ethiopia, Kenya, and Malawi. The biophysical variables used were soil texture, surface slope, and rainfall while the socioeconomic variables were market access and human and livestock population densities. Based on feasibility and comparative performance of CA over conventional agriculture, the biophysical and socioeconomic factors were first used to classify cultivated areas into three biophysical and three socioeconomic potential domains, respectively. Combinations of biophysical and socioeconomic domains were then used to develop potential RDs for CA based on adoption potential within the cultivated areas. About 39, 12, and 5 % of the cultivated areas showed high biophysical and socioeconomic potential while 50, 39, and 21 % of the cultivated areas showed high biophysical and medium socioeconomic potential for CA in Malawi, Kenya, and Ethiopia, respectively. The results indicate considerable acreages of land with high CA adoption potential in the mixed crop-livestock systems of the studied countries. However, there are large differences among countries depending on biophysical and socio-economic conditions. The information generated in this study could be used for targeting CA and prioritizing CA-related agricultural research and investment priorities in the three countries.

Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV

PubMed Central

2011-01-01

Background In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. Discussion District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. Summary Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not. PMID:21794154

Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi.

PubMed

Bennett, Sarah D; Lowther, Sara A; Chingoli, Felix; Chilima, Benson; Kabuluzi, Storn; Ayers, Tracy L; Warne, Thomas A; Mintz, Eric

2018-01-01

On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.

Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi

PubMed Central

Lowther, Sara A.; Chingoli, Felix; Chilima, Benson; Kabuluzi, Storn; Ayers, Tracy L.; Warne, Thomas A.; Mintz, Eric

2018-01-01

On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered. PMID:29474394

Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project): a process evaluation

PubMed Central

Ellard, David R; Chimwaza, Wanangwa; Davies, David; O'Hare, Joseph Paul; Kamwendo, Francis; Quenby, Siobhan; Griffiths, Frances

2014-01-01

Objectives The ‘enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa’ (ETATMBA) project is training emergency obstetric and new-born care (EmONC) non-physician clinicians (NPCs) as advanced clinical leaders. Our objectives were to evaluate the implementation and changes to practice. Design A mixed methods process evaluation with the predominate methodology being qualitative. Setting Rural and urban hospitals in 8 of the 14 districts of northern and central Malawi. Participants 54 EmONC NPCs with 3 years’ plus experience. Intervention Training designed and delivered by clinicians from the UK and Malawi; it is a 2-year plus package of training (classroom, mentorship and assignments). Results We conducted 79 trainee interviews over three time points during the training, as well as a convenience sample of 10 colleagues, 7 district officers and 2 UK obstetricians. Trainees worked in a context of substantial variation in the rates of maternal and neonatal deaths between districts. Training reached trainees working across the target regions. For 46 trainees (8 dropped out of the course), dose delivered in terms of attendance was high and all 46 spent time working alongside an obstetrician. In early interviews trainees recalled course content unprompted indicating training had been received. Colleagues and district officers reported cascading of knowledge and initial changes in practice indicating early implementation. By asking trainees to describe actual cases we found they had implemented new knowledge and skills. These included life-saving interventions for postpartum haemorrhage and eclampsia. Trainees identified the leadership training as enabling them to confidently change their own practice and initiate change in their health facility. Conclusions This process evaluation suggests that trainees have made positive changes in their practice. Clear impacts on maternal and perinatal mortality are yet to be elucidated. PMID:25116455

Do Malawian women critically assess the quality of care? A qualitative study on women's perceptions of perinatal care at a district hospital in Malawi.

PubMed

Kumbani, Lily C; Chirwa, Ellen; Malata, Address; Odland, Jon Øyvind; Bjune, Gunnar

2012-11-16

Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women's perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women's perceptions on perinatal care among the women delivered at a district hospital. A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women's perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers' attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.

Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi.

PubMed

Makombe, Simon D; Hochgesang, Mindy; Jahn, Andreas; Tweya, Hannock; Hedt, Bethany; Chuka, Stuart; Yu, Joseph Kwong-Leung; Aberle-Grasse, John; Pasulani, Olesi; Bailey, Christopher; Kamoto, Kelita; Schouten, Erik J; Harries, Anthony D

2008-04-01

As national antiretroviral treatment (ART) programmes scale-up, it is essential that information is complete, timely and accurate for site monitoring and national planning. The accuracy and completeness of reports independently compiled by ART facilities, however, is often not known. This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities ("site report") as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team ("supervision report"). Completeness and accuracy of key case registration and outcome variables were compared. Data were considered inaccurate if variables from the site reports were missing or differed by more than 5% from the supervision reports. Additionally, we compared the national summaries obtained from the two data sources. Monitoring and evaluation of Malawi's national ART programme is based on WHO's recommended tools for ART monitoring. It includes one master card for each ART patient and one patient register at each ART facility. Each quarter, sites complete cumulative cohort analyses and teams from the Ministry of Health conduct supervisory visits to all public sector ART sites to ensure the quality of reported data. Most sites had complete case registration and outcome data; however many sites did not report accurate data for several critical data fields, including reason for starting, outcome and regimen. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. Several facility-level characteristics were associated with data quality. While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.

Exploring Crustal Structure and Mantle Seismic Anisotropy Associated with the Incipient Southern and Southwestern Branches of the East African Rift System

NASA Astrophysics Data System (ADS)

Yu, Y.; Reed, C. A.; Gao, S. S.; Liu, K. H.; Massinque, B.; Mdala, H. S.; Chindandali, P. R. N.; Moidaki, M.; Mutamina, D. M.

2014-12-01

In spite of numerous geoscientific studies, the mechanisms responsible for the initiation and development of continental rifts are still poorly understood. The key information required to constrain various geodynamic models on rift initiation can be derived from the crust/mantle structure and anisotropy beneath incipient rifts such as the Southern and Southwestern branches of the East African Rift System. As part of a National Science Foundation funded interdisciplinary project, 50 PASSCAL broadband seismic stations were deployed across the Malawi, Luangwa, and Okavango rift zones from the summer of 2012 to the summer of 2014. Preliminary results from these 50 SAFARI (Seismic Arrays for African Rift Initiation) and adjacent stations are presented utilizing shear-wave splitting (SWS) and P-S receiver function techniques. 1109 pairs of high-quality SWS measurements, consisting of fast polarization orientations and splitting times, have been obtained from a total of 361 seismic events. The results demonstrate dominantly NE-SW fast orientations throughout Botswana as well as along the northwestern flank of the Luangwa rift valley. Meanwhile, fast orientations beneath the eastern Luangwa rift flank rotate from NNW to NNE along the western border of the Malawi rift. Stations located alongside the western Malawi rift border faults yield ENE fast orientations, with stations situated in Mozambique exhibiting more E-W orientations. In the northern extent of the study region, fast orientations parallel the trend of the Rukwa and Usangu rift basins. Receiver function results reveal that, relative to the adjacent Pan-African mobile belts, the Luangwa rift zone has a thin (30 to 35 km) crust. The crustal thickness within the Okavango rift basin is highly variable. Preliminary findings indicate a northeastward thinning along the southeast Okavango border fault system congruent with decreasing extension toward the southwest. The Vp/Vs measurements in the Okavango basin are roughly 1.75 on average, suggesting an unmodified crustal composition, while those of the Luangwa and southern Malawi rift zones are relatively high, probably suggesting ancient or ongoing magmatic emplacement. The Pan-African mobile belts enveloping the rift zones are mostly characterized by more felsic and thicker crust.

Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi.

PubMed

Bradley, Susan; Kamwendo, Francis; Chipeta, Effie; Chimwaza, Wanangwa; de Pinho, Helen; McAuliffe, Eilish

2015-03-21

Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi's efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers' perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi's women. A qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants' experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions (a) in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software. Eighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care. This study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi.

Development and validation of a Malawian version of the primary care assessment tool.

PubMed

Dullie, Luckson; Meland, Eivind; Hetlevik, Øystein; Mildestvedt, Thomas; Gjesdal, Sturla

2018-05-16

Malawi does not have validated tools for assessing primary care performance from patients' experience. The aim of this study was to develop a Malawian version of Primary Care Assessment Tool (PCAT-Mw) and to evaluate its reliability and validity in the assessment of the core primary care dimensions from adult patients' perspective in Malawi. A team of experts assessed the South African version of the primary care assessment tool (ZA-PCAT) for face and content validity. The adapted questionnaire underwent forward and backward translation and a pilot study. The tool was then used in an interviewer administered cross-sectional survey in Neno district, Malawi, to test validity and reliability. Exploratory factor analysis was performed on a random half of the sample to evaluate internal consistency, reliability and construct validity of items and scales. The identified constructs were then tested with confirmatory factor analysis. Likert scale assumption testing and descriptive statistics were done on the final factor structure. The PCAT-Mw was further tested for intra-rater and inter-rater reliability. From the responses of 631 patients, a 29-item PCAT-Mw was constructed comprising seven multi-item scales, representing five primary care dimensions (first contact, continuity, comprehensiveness, coordination and community orientation). All the seven scales achieved good internal consistency, item-total correlations and construct validity. Cronbach's alpha coefficient ranged from 0.66 to 0.91. A satisfactory goodness of fit model was achieved (GFI = 0.90, CFI = 0.91, RMSEA = 0.05, PCLOSE = 0.65). The full range of possible scores was observed for all scales. Scaling assumptions tests were achieved for all except the two comprehensiveness scales. Intra-class correlation coefficient (ICC) was 0.90 (n = 44, 95% CI 0.81-0.94, p < 0.001) for intra-rater reliability and 0.84 (n = 42, 95% CI 0.71-0.96, p < 0.001) for inter-rater reliability. Comprehensive metric analyses supported the reliability and validity of PCAT-Mw in assessing the core concepts of primary care from adult patients' experience. This tool could be used for health service research in primary care in Malawi.

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

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 in contracts with pharmaceutical companies to ensure the timely supply of vaccines, and developing well-defined guidelines to address vaccination delays, refusals and coverage.

Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey.

PubMed

Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer

2014-01-01

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

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.

Task-shifting of orthopaedic surgery to non-physician clinicians in Malawi: effective and safe?

PubMed

Wilhelm, Torsten J; Dzimbiri, Kondwani; Sembereka, Victoria; Gumeni, Martin; Bach, Olaf; Mothes, Henning

2017-10-01

There is a shortage of orthopaedic surgeons in Malawi. Orthopaedic clinical officers (OCOs) treat trauma patients and occasionally perform major orthopaedic surgery. No studies have assessed the efficacy and safety of their work. The aim of this study was to evaluate their contribution to major orthopaedic surgery at Zomba Central Hospital. Data about orthopaedic procedures during 2006-2010 were collected from theatre books. We selected major amputations and open reductions and plating for outcome analysis and collected details from files. We compared patients operated by OCOs alone ('OCOs alone' group) and by surgeons or OCOs assisted by surgeons ('Surgeon present' group). OCOs performed 463/1010 major (45.8%) and 1600/1765 minor operations (90.7%) alone. There was no difference in perioperative outcome between both groups. OCOs carry out a large proportion of orthopaedic procedures with good clinical results. Shifting of clinical tasks including major orthopaedic surgery can be safe. Further prospective studies are recommended.

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

The Relationship between Partners' Family-Size Preferences in Southern Malawi.

PubMed

Yeatman, Sara; Sennott, Christie

2014-09-01

Studies of the relative influence of partners' fertility preferences on behaviors tend to treat preferences as fixed, largely independent traits despite existing theoretical arguments and empirical evidence suggesting that they are moving targets that may be jointly developed within relationships. In this study, we use couple-level panel data from married and unmarried young adults in southern Malawi to examine the relationship between partners' family-size preferences. We find evidence of assortative mating: young Malawians are more likely to partner with individuals who have similar family-size goals. Additionally, although partners' family-size preferences do not perfectly converge, changes among men's and women's preferences are significantly more likely to be "toward" than "away from" those of their partner. Our findings point to a need for studies regarding the relative influence of partners on reproductive outcomes to consider the interdependence of partners' preferences and the varied ways in which partners can influence shared reproductive behaviors. © 2014 The Population Council, Inc.

The Relationship between Partners’ Family-Size Preferences in Southern Malawi

PubMed Central

Yeatman, Sara; Sennott, Christie

2015-01-01

Studies of the relative influence of partners’ fertility preferences on behaviors tend to treat preferences as fixed, largely independent traits despite existing theoretical arguments and empirical evidence suggesting that they are moving targets that may be jointly developed within relationships. In this study, we use couple-level panel data from married and unmarried young adults in southern Malawi to examine the relationship between partners’ family-size preferences. We find evidence of assortative mating: young Malawians are more likely to partner with individuals who have similar family-size goals. Additionally, although partners’ family-size preferences do not perfectly converge, changes among men’s and women’s preferences are significantly more likely to be “toward” than “away from” those of their partner. Our findings point to a need for studies regarding the relative influence of partners on reproductive outcomes to consider the interdependence of partners’ preferences and the varied ways in which partners can influence shared reproductive behaviors. PMID:25207497

Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi.

PubMed

Grimason, Anthony Martin; Masangwi, Salule Joseph; Morse, Tracy Dawn; Jabu, George Christopher; Beattie, Tara Kate; Taulo, Steven Elias; Lungu, Kingsley

2014-01-01

A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children's hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools.

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.

An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi.

PubMed

Kaplan, Julika Ayla; Kandodo, Jonathan; Sclafani, Joseph; Raine, Susan; Blumenthal-Barby, Jennifer; Norris, Alison; Norris-Turner, Abigail; Chemey, Elly; Beckham, John Michael; Khan, Zara; Chunda, Reginald

2017-06-19

Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women's autonomy and fistula risk undergo further investigation.

Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

PubMed

Lungu, Edgar Arnold; Biesma, Regien; Chirwa, Maureen; Darker, Catherine

2018-06-01

In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, full childhood immunization, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health programming. Efforts should be dedicated towards addressing determinants of child health in both urban and rural areas.

Readiness of hospitals to provide Kangaroo Mother Care (KMC) and documentation of KMC service delivery: Analysis of Malawi 2014 Emergency Obstetric and Newborn Care (EmONC) survey data.

PubMed

Chavula, Kondwani; Likomwa, Dyson; Valsangkar, Bina; Luhanga, Richard; Chimtembo, Lydia; Dube, Queen; Gobezie, Wasihun Andualem; Guenther, Tanya

2017-12-01

Malawi introduced Kangaroo Mother Care (KMC) in 1999 as part of its efforts to address newborn morbidity and mortality and has continued to expand KMC services across the country. Yet, data on availability of KMC services and routine service provision are limited. Data from the 2014 Emergency Obstetric Newborn Care (EmONC) survey, which was a census of all 87 hospitals in Malawi, were analyzed. The WHO service availability and readiness domains were used to generate indicators for KMC service readiness and an additional domain for documentation of KMC services was included. Levels of KMC service delivery were quantified using data extracted from a 12-month register review and a KMC initiation rate was calculated for each facility by dividing the reported number of babies initiated on KMC by the number of live births at facility. We defined three levels of KMC readiness and two levels of KMC operational status. 79% of hospitals (69/87) reported providing inpatient KMC services. More than half of the hospitals (62%; 54/87) met the most basic definition of readiness (staff, space for KMC and functional weighing scale) and 35% (30/87) met an expanded definition of readiness (guidelines, staff, space, scale and register in use). Only 15 % (13/87) of hospitals had all KMC tracer items. Less than half of the hospitals (43%; 37/87) met criteria for KMC operational status at minimum levels (≥1/100 live births), and just 16% (14/87) met criteria for KMC operational status at routine levels (≥5/100 live births). Our study found large differences between reported levels of KMC services and documented levels of KMC readiness and service provision among hospitals in Malawi. It is recommended that facility assessments of services such as KMC include record reviews to better estimate service availability and delivery. Further efforts to strengthen the capacity of Malawian hospitals to deliver KMC are needed.

Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi.

PubMed

Hundalani, Shilpa G; Richards-Kortum, Rebecca; Oden, Maria; Kawaza, Kondwani; Gest, Alfred; Molyneux, Elizabeth

2015-07-01

Low-cost bubble continuous positive airway pressure (bCPAP) systems have been shown to improve survival in neonates with respiratory distress, in developing countries including Malawi. District hospitals in Malawi implementing CPAP requested simple and reliable guidelines to enable healthcare workers with basic skills and minimal training to determine when treatment with CPAP is necessary. We developed and validated TRY (T: Tone is good, R: Respiratory Distress and Y=Yes) CPAP, a simple algorithm to identify neonates with respiratory distress who would benefit from CPAP. To validate the TRY CPAP algorithm for neonates with respiratory distress in a low-resource setting. We constructed an algorithm using a combination of vital signs, tone and birth weight to determine the need for CPAP in neonates with respiratory distress. Neonates admitted to the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi, were assessed in a prospective, cross-sectional study. Nurses and paediatricians-in-training assessed neonates to determine whether they required CPAP using the TRY CPAP algorithm. To establish the accuracy of the TRY CPAP algorithm in evaluating the need for CPAP, their assessment was compared with the decision of a neonatologist blinded to the TRY CPAP algorithm findings. 325 neonates were evaluated over a 2-month period; 13% were deemed to require CPAP by the neonatologist. The inter-rater reliability with the algorithm was 0.90 for nurses and 0.97 for paediatricians-in-training using the neonatologist's assessment as the reference standard. The TRY CPAP algorithm has the potential to be a simple and reliable tool to assist nurses and clinicians in identifying neonates who require treatment with CPAP in low-resource settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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.

Impact of pharmacy worker training and deployment on access to essential medicines and health outcomes in Malawi: protocol for a cluster quasi-experimental evaluation.

PubMed

Lubinga, Solomon J; Jenny, Alisa M; Larsen-Cooper, Erin; Crawford, Jessica; Matemba, Charles; Stergachis, Andy; Babigumira, Joseph B

2014-10-11

Access to essential medicines is core to saving lives and improving health outcomes of people worldwide, particularly in the low- and middle-income countries. Having a trained pharmacy workforce to manage the supply chain and safely dispense medicines is critical to ensuring timely access to quality pharmaceuticals and improving child health outcomes. This study measures the impact of an innovative pharmacy assistant training program in the low-income country of Malawi on access to medicines and health outcomes. We employ a cluster quasi-experimental design with pre-and post-samples and decision analytic modeling to examine access to and the use of medicines for malaria, pneumonia, and diarrhea for children less than 5 years of age. Two intervention districts, with newly trained and deployed pharmacy assistants, and two usual care comparison districts, matched on socio-economic, geographic, and health-care utilization indicators, were selected for the study. A baseline household survey was conducted in March 2014, prior to the deployment of pharmacy assistants to the intervention district health centers. Follow-up surveys are planned at 12- and 24-months post-deployment. In addition, interviews are planned with caregivers, and time-motion studies will be conducted with health-care providers at the health centers to estimate costs and resources use. This impact evaluation is designed to provide data on the effects of a novel pharmacy assistant program on pharmaceutical systems performance, and morbidity and mortality for the most common causes of death for children under five. The results of this study should contribute to policy decisions about whether and how to scale up the health systems strengthening workforce development program to have the greatest impact on the supply chain and health outcomes in Malawi.

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.

Surveillance of tuberculosis in Malawian prisons

PubMed Central

Banda, R. P.; Gausi, F.; Salaniponi, F. M.; Harries, A. D.; Mpunga, J.; Banda, H. M.; Munthali, C.; Ndindi, H.

2012-01-01

Setting: The Malawi National Tuberculosis Programme (NTP) has collaborated with the Prison Health Services (PHS) on tuberculosis (TB) control in prisons since 1996. Information on case finding and treatment outcomes is routinely collected, but there has not been any recent countrywide review of these prison data. Objectives: To determine 1) the number of prisoners registered for TB in 2007, 2) TB treatment outcomes in 2006 and 3) training of prison health care staff in all Malawian prisons. Design: Descriptive study involving a review of 2006 and 2007 data collected by the NTP during surveillance in 2008. Results: In 2007, 278 TB patients were registered in Malawian prisons, representing a TB case notification rate of 835 per 100 000 (higher than that in the general population, at 346/100 000). The treatment success rate for new smear-positive TB cases for 2006 was 73%, lower than the national average of 78%. In all, 52 prison health care staff had received 1 week of training in TB management, usually just after starting work in the prison. Conclusions: TB case notifications in Malawian prisons were higher than in the general population and treatment outcomes less favourable. The NTP and PHS need better collaboration to improve TB control in Malawian prisons. PMID:26392938

Inequalities in microbial contamination of drinking water supplies in urban areas: the case of Lilongwe, Malawi.

PubMed

Boakye-Ansah, Akosua Sarpong; Ferrero, Giuliana; Rusca, Maria; van der Zaag, Pieter

2016-10-01

Over past decades strategies for improving access to drinking water in cities of the Global South have mainly focused on increasing coverage, while water quality has often been overlooked. This paper focuses on drinking water quality in the centralized water supply network of Lilongwe, the capital of Malawi. It shows how microbial contamination of drinking water is unequally distributed to consumers in low-income (unplanned areas) and higher-income neighbourhoods (planned areas). Microbial contamination and residual disinfectant concentration were measured in 170 water samples collected from in-house taps in high-income areas and from kiosks and water storage facilities in low-income areas between November 2014 and January 2015. Faecal contamination (Escherichia coli) was detected in 10% of the 40 samples collected from planned areas, in 59% of the 64 samples collected from kiosks in the unplanned areas and in 75% of the 32 samples of water stored at household level. Differences in water quality in planned and unplanned areas were found to be statistically significant at p < 0.05. Finally, the paper shows how the inequalities in microbial contamination of drinking water are produced by decisions both on the development of the water supply infrastructure and on how this is operated and maintained.

Insight, psychopathology and global functioning in schizophrenia in urban Malawi.

PubMed

Crumlish, Niall; Samalani, Prince; Sefasi, Anthony; Kinsella, Anthony; O'Callaghan, Eadbhard; Chilale, Harris

2007-09-01

Insight, psychopathology and functioning are related in schizophrenia, but it is unclear whether insight relates independently to functioning after controlling for psychopathology. Equally, any such relationship may vary culturally. We investigated the relationship between insight, psychopathology and functioning in 60 patients with schizophrenia in Mzuzu, a town in Malawi. After controlling for psychopathology, functioning was associated with the ;symptom relabelling' dimension of insight (P=0.01). This preliminary finding suggests that symptom-focused psychoeducation might be appropriate for African patients with schizophrenia.

Informal alcohol in Malawi: stakeholder perceptions and policy recommendations.

PubMed

Limaye, Rupali J; Rutkow, Lainie; Rimal, Rajiv N; Jernigan, David H

2014-02-01

Through the eyes of those involved in the alcohol policy-making process in Malawi, we explored the role of informal (non-commercial) alcohol in rural communities, its harmful effects, and implications for appropriate national policy. Harms included early drinking initiation, violence, and sexual risk exposure. Informants suggested that policy should address informal alcohol's content, selling times, and easy access. Because most informal alcohol producers are women who rely upon sales for subsistence, policies must avoid limiting women's economic opportunities while protecting community health.

Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi.

PubMed Central

Clear, A S; Chirambo, M C; Hutt, M S

1979-01-01

The histological features of 234 conjunctival biopsies from Africans in Malawi have been re-examined. The appearances of solar keratosis, pinguecula, and pterygium are presented as part of a continuous spectrum of the same pathological process and aetiology, which may lead to carcinomatous change. The results are discussed with regard to the specific geographical distribution of such lesions found by other workers, with particular emphasis on ultraviolet radiation as the main aetiological factor. Images PMID:427069

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.

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.

From Lake Malawi Drilling: East African Climate May Have Caused Major Evolutionary Turnover in Mammalian Species During MIS 14

NASA Astrophysics Data System (ADS)

Johnson, Thomas; Werne, Josef

2016-04-01

Hominin evolution underwent important changes in the last 1.3 million years, including the extinction of Paranthropus at about 1.2 Ma, leaving Homo as the sole hominin genus. Our genus experienced a major increase in cranial capacity at about 500 ka, and our species, H. sapiens, first appeared at ~200 ka. There was a major turnover in mammalian species in East Africa between 540 and 400 ka, favoring descendants of smaller size and less specialized diet. An understanding of what drove evolution in these directions is fundamental to understanding the development of modern H. sapiens. Climate certainly played a role, for it is the principal factor that influences the distribution of vegetation and habitability on the landscape. We present a 1.3 million year record of temperature and hydroclimate in the basin of Lake Malawi, the second deepest lake in Africa, derived from a 380 m sediment sequence taken from a water depth of 590 m by the Lake Malawi Drilling Project. Seismic reflection profiles used to select the site portray an undisturbed sedimentary section that was not impacted by erosion, turbidity currents or mass wasting events. Sediment samples were analyzed to produce records of temperature (TEX86) and aridity (Ca content and leaf wax δ13C). The temperature record displays progressively larger amplitude glacial-interglacial variations from MIS 13 (~500 ka) to MIS 5 (~125 ka). Intervals of low Ca abundance, which reflect lake high stands, correlate with times of depleted δ13Cwax and relatively warm temperatures. The Malawi basin experienced warm, wet interglacials and cooler (by about 2 - 4°C), dry glacial periods, with roughly a 100 ky periodicity since the Mid-Pleistocene Transition (MPT), about 900 ka. The paleoclimate record from Lake Malawi sediments portrays a transition from a highly variable and predominantly arid climate prior to 900 ka to a progressively more humid environment after the MPT dominated by 100 ky cycles consisting of warm, wet interglacial periods alternating with relatively cool, dry glacial periods. One of the coldest, and most prolonged dry periods of the last million years in the Malawi basin occurred around 540 ka (MIS 14). This perturbation in the climate may have been a factor in the substantial mammalian extinctions and increased cranial capacity of Homo that occurred during this time. As more long-term, high-resolution histories of climate are recovered from the other great lakes of East Africa, we will be able to address key questions raised by the Malawi record, e.g., the extent of the rift valley that shifted to wetter conditions over the past million years, and whether MIS 14 was an unusually cold ice age throughout the region. Future drilling campaigns on the East African Great Lakes will offer unique opportunities to understand the changing landscape where our ancestors evolved, migrated, and advanced their cultures.

Marriage, not religion, is associated with HIV infection among women in rural Malawi.

PubMed

Muula, Adamson S

2010-02-01

Despite the fact that religious affiliation is almost universal in Malawi, and religious denomination could potentially influence HIV-risk behaviors, limited data exist on its role of in HIV infection in this setting. This study was conducted to assess whether religious denominational affiliation, religiosity or place of residence were associated with sexual behaviors and HIV infection among Christian women. A total of 63 of 939 women with HIV test results (6.7%) were HIV infected. There was no association between religion or frequency of church attendance and HIV infection or condom use within the current or most recent marriage. Compared to women who lived in a village which was neither the husband's village nor her own village, women living with spouse in her own village or living in a husband's village were less likely to be HIV infected.

Analyzing spatial clustering and the spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of Malawi, 1994-2010.

PubMed

Zulu, Leo C; Kalipeni, Ezekiel; Johannes, Eliza

2014-05-23

Although local spatiotemporal analysis can improve understanding of geographic variation of the HIV epidemic, its drivers, and the search for targeted interventions, it is limited in sub-Saharan Africa. Despite recent declines, Malawi's estimated 10.0% HIV prevalence (2011) remained among the highest globally. Using data on pregnant women in Malawi, this study 1) examines spatiotemporal trends in HIV prevalence 1994-2010, and 2) for 2010, identifies and maps the spatial variation/clustering of factors associated with HIV prevalence at district level. Inverse distance weighting was used within ArcGIS Geographic Information Systems (GIS) software to generate continuous surfaces of HIV prevalence from point data (1994, 1996, 1999, 2001, 2003, 2005, 2007, and 2010) obtained from surveillance antenatal clinics. From the surfaces prevalence estimates were extracted at district level and the results mapped nationally. Spatial dependency (autocorrelation) and clustering of HIV prevalence were also analyzed. Correlation and multiple regression analyses were used to identify factors associated with HIV prevalence for 2010 and their spatial variation/clustering mapped and compared to HIV clustering. Analysis revealed wide spatial variation in HIV prevalence at regional, urban/rural, district and sub-district levels. However, prevalence was spatially leveling out within and across 'sub-epidemics' while declining significantly after 1999. Prevalence exhibited statistically significant spatial dependence nationally following initial (1995-1999) localized, patchy low/high patterns as the epidemic spread rapidly. Locally, HIV "hotspots" clustered among eleven southern districts/cities while a "coldspot" captured configurations of six central region districts. Preliminary multiple regression of 2010 HIV prevalence produced a model with four significant explanatory factors (adjusted R2 = 0.688): mean distance to main roads, mean travel time to nearest transport, percentage that had taken an HIV test ever, and percentage attaining a senior primary education. Spatial clustering linked some factors to particular subsets of high HIV-prevalence districts. Spatial analysis enhanced understanding of local spatiotemporal variation in HIV prevalence, possible underlying factors, and potential for differentiated spatial targeting of interventions. Findings suggest that intervention strategies should also emphasize improved access to health/HIV services, basic education, and syphilis management, particularly in rural hotspot districts, as further research is done on drivers at finer scale.

Attitudes and Perceptions Towards Access and Use of the Formal Healthcare Sector in Northern Malawi.

PubMed

Fisher, Emily; Lazarus, Rebecca; Asgary, Ramin

2017-01-01

We evaluated community attitudes, perceptions, and experiences regarding access and use of health care systems in Northern Malawi. Through a qualitative descriptive approach, 12 focus group discussions were conducted in 2014 with community members (n=71) in Mzimba North, Malawi. Data were transcribed and analyzed for major themes. Both formal health care systems and traditional medicine were widely used as complementary. Health care-seeking behavior was governed by previous treatment history and by whether a disease was believed to be biological or spiritual in nature, the latter being best treated with traditional medicine. Barriers to using formal health care included cost, hospital resources/environment, socio-cultural beliefs, and transportation. Transportation was a significant barrier, often linked to increased mortality. Support of local strategies to address transportation, structural approaches to improve hospital capabilities and environment, and community education reconciling traditional beliefs and modern medicine may mitigate access issues and improve use of the health care system.

The “Empty Chairs” Approach to Learning: Simulation-Based Train the Trainer Program in Mzuzu, Malawi

PubMed Central

Sigalet, Elaine; Wishart, Ian; Lufesi, Norman; Haji, Faizal

2017-01-01

Together, a group of Canadian colleagues from St. John's, Newfoundland, Calgary, Alberta (some via Doha) and London, Ontario introduced the first Train the Trainer in Simulation-Based Learning (TTT-SBL) program in Mzuzu Central Hospital and Mzuzu University in Malawi. The team led by Elaine Sigalet (Doha) and consisting of Ian Wishart (Calgary), Faizal Haji (London) and Adam Dubrowski (St. John's) was invited to Malawi by Norman Lufesi to conduct a two-day TTT-SBL course for facilitators who teach an Emergency Triage, Assessment and Treatment (ETAT) plus Trauma course. The following technical report describes this course.  All trainees-facilitators who took part in the first iteration of the TTT-SBL course were asked to participate in teaching an ETAT course and modify it to include elements of simulation. The new format of ETAT resulted in a reduction of time necessary to conduct the course from four days (based on historical data) to 2.5 days. PMID:28580202

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

Influence of Lake Malawi on regional climate from a double-nested regional climate model experiment

NASA Astrophysics Data System (ADS)

Diallo, Ismaïla; Giorgi, Filippo; Stordal, Frode

2017-07-01

We evaluate the performance of the regional climate model (RCM) RegCM4 coupled to a one dimensional lake model for Lake Malawi (also known as Lake Nyasa in Tanzania and Lago Niassa in Mozambique) in simulating the main characteristics of rainfall and near surface air temperature patterns over the region. We further investigate the impact of the lake on the simulated regional climate. Two RCM simulations, one with and one without Lake Malawi, are performed for the period 1992-2008 at a grid spacing of 10 km by nesting the model within a corresponding 25 km resolution run ("mother domain") encompassing all Southern Africa. The performance of the model in simulating the mean seasonal patterns of near surface air temperature and precipitation is good compared with previous applications of this model. The temperature biases are generally less than 2.5 °C, while the seasonal cycle of precipitation over the region matches observations well. Moreover, the one-dimensional lake model reproduces fairly well the geographical pattern of observed (from satellite measurements) lake surface temperature as well as its mean month-to-month evolution. The Malawi Lake-effects on the moisture and atmospheric circulation of the surrounding region result in an increase of water vapor mixing ratio due to increased evaporation in the presence of the lake, which combines with enhanced rising motions and low-level moisture convergence to yield a significant precipitation increase over the lake and neighboring areas during the whole austral summer rainy season.

Potential Barriers to Healthcare in Malawi for Under-five Children with Cough and Fever: A National Household Survey

PubMed Central

Ngwira, Bagrey; Stockman, Lauren J.; Deming, Michael; Nyasulu, Peter; Bowie, Cameron; Msyamboza, Kelias; Meyrowitsch, Dan W.; Cunliffe, Nigel A.; Bresee, Joseph; Fischer, Thea K.

2014-01-01

Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p=0.02) and children aged >12 months (p=0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p<0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p<0.001) and higher direct costs (p<0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi. PMID:24847595

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

Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi.

PubMed

McCauley, Mary; Madaj, Barbara; White, Sarah A; Dickinson, Fiona; Bar-Zev, Sarah; Aminu, Mamuda; Godia, Pamela; Mittal, Pratima; Zafar, Shamsa; van den Broek, Nynke

2018-01-01

For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low-resource settings. We sought to assess the extent and types of maternal morbidity. Descriptive observational cross-sectional study at primary-level and secondary-level healthcare facilities in India, Pakistan, Kenya and Malawi to assess physical, psychological and social morbidity during and after pregnancy. Sociodemographic factors, education, socioeconomic status (SES), quality of life, satisfaction with health, reported symptoms, clinical examination and laboratory investigations were assessed. Relationships between morbidity and maternal characteristics were investigated using multivariable logistic regression analysis. 11 454 women were assessed in India (2099), Malawi (2923), Kenya (3145), and Pakistan (3287). Almost 3 out of 4 women had ≥1 symptoms (73.5%), abnormalities on clinical examination (71.3%) or laboratory investigation (73.5%). In total, 36% of women had infectious morbidity of which 9.0% had an identified infectious disease (HIV, malaria, syphilis, chest infection or tuberculosis) and an additional 32.5% had signs of early infection. HIV-positive status was highest in Malawi (14.5%) as was malaria (10.4%). Overall, 47.9% of women were anaemic, 11.5% had other medical or obstetric conditions, 25.1% reported psychological morbidity and 36.6% reported social morbidity (domestic violence and/or substance misuse). Infectious morbidity was highest in Malawi (56.5%) and Kenya (40.4%), psychological and social morbidity was highest in Pakistan (47.3%, 60.2%). Maternal morbidity was not limited to a core at-risk group; only 1.2% had all four morbidities. The likelihood of medical or obstetric, psychological or social morbidity decreased with increased education; adjusted OR (95% CI) for each additional level of education ranged from 0.79 (0.75 to 0.83) for psychological morbidity to 0.91 (0.87 to 0.95) for infectious morbidity. Each additional level of SES was associated with increased psychological morbidity (OR 1.15 (95% CI 1.10 to 1.21)) and social morbidity (OR 1.05 (95% CI 1.01 to 1.10)), but there was no difference regarding medical or obstetric morbidity. However, for each morbidity association was heterogeneous between countries. Women suffer significant ill-health which is still largely unrecognised. Current antenatal and postnatal care packages require adaptation if they are to meet the identified health needs of women.

Characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding in Option B+ in Malawi.

PubMed

Landes, M; Sodhi, S; Matengeni, A; Meaney, C; van Lettow, M; Chan, A K; van Oosterhout, J J

2016-08-04

Malawi adopted the PMTCT strategy 'Option B+' in 2011, providing life-long ART for all HIV-infected pregnant and breastfeeding women. We explored differences in characteristics and outcomes of women initiating ART during pregnancy versus breastfeeding. We conducted a retrospective cohort analysis of women in Zomba District, southern Malawi, from January 2012- September 2013. Data were extracted from the Zomba District Observational Cohort Study, a surveillance project collecting data from standardized Ministry of Health ART monitoring tools. 1986 (67.2 %) women initiated ART during pregnancy and 969 (32.8 %) during breastfeeding. Women initiating ART in breastfeeding were more likely to be > 30 years (aOR = 1.33, 95 % CI1.11-1.59, p = 0.003) and have WHO Stage 3/4 (aOR = 2.74, 95 % CI1.94-3.87, p < 0.001). Eighteen (0.6 %) deaths occurred and 942 (31.9 %) women defaulted ART. 'Early' death (< 30 days) occurred in 3 (0.1 %) women and 449 (16.4 %) women defaulted early. Death/default < 30 days was more likely among women initiating ART during pregnancy (aOR 1.62, 95 % CI1.28-2.05, p < 0.001) or < 30 years old (aOR 1.27, 95 % CI 1.02-1.57, p = 0.03) and was less likely among those with WHO Stage 3/4 (aOR 0.30, 95 % CI 0.15-0.60, p < 0.001). Using Kaplan-Meier estimators to investigate time to death/default, we showed a sharp drop in death/default-free survival probability at time zero, yet survival probability decreased in a nearly linear manner after this initial period of high default. Women under 30 years had increased rates of death/default over time (log rank test: p < 0.001), however no significant differences were observed in death/default over time associated with timing of ART initiation, documented clinical stage at initiation, health clinic size or adherence rates. Many women in Malawi started ART during breastfeeding within Option B+ and were older and had more advanced WHO Clinical Staging. This represents a missed PMTCT opportunity to initiate treatment early in pregnancy. Early defaulting is identified as a challenge within Option B+, and was more likely among younger women and those initiating ART in pregnancy. Targeted research to understand factors associated with uptake of ART during pregnancy and retention in care could improve the efficacy of Option B+ in Malawi.

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

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.

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.

Inpatient mortality rates during an era of increased access to HIV testing and ART: A prospective observational study in Lilongwe, Malawi.

PubMed

Matoga, Mitch M; Rosenberg, Nora E; Stanley, Christopher C; LaCourse, Sylvia; Munthali, Charles K; Nsona, Dominic P; Haac, Bryce; Hoffman, Irving; Hosseinipour, Mina C

2018-01-01

In the era of increased access to HIV testing and antiretroviral treatment (ART), the impact of HIV and ART status on inpatient mortality in Malawi is unknown. We prospectively followed adult inpatients at Kamuzu Central Hospital medical wards in Lilongwe, Malawi, between 2011 and 2012, to evaluate causes of mortality, and the impact of HIV and ART status on mortality. We divided the study population into five categories: HIV-negative, new HIV-positive, ART-naïve patients, new ART-initiators, and ART-experienced. We used multivariate binomial regression models to compare risk of death between categories. Among 2911 admitted patients the mean age was 38.5 years, and 50% were women. Eighty-one percent (81%) of patients had a known HIV status at the time of discharge or death. Mortality was 19.4% and varied between 13.9% (HIV-negative patients) and 32.9% (HIV-positive patients on ART ≤1 year). In multivariable analyses adjusted for age, sex and leading causes of mortality, being new HIV-positive (RR = 1.64 95% CI: 1.16-2.32), ART-naive (RR = 2.28 95% CI: 1.66-2.32) or being a new ART-initiator (RR = 2.41 95% CI: 1.85-3.14) were associated with elevated risk of mortality compared to HIV-negative patients. ART-experienced patients had comparable mortality (RR = 1.33 95% CI: 0.94-1.88) to HIV-negative patients. HIV related mortality remains high among medical inpatients, especially among HIV-positive patients who recently initiated ART or have not started ART yet.

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.

The effect of school status and academic skills on the reporting of premarital sexual behavior: evidence from a longitudinal study in rural Malawi.

PubMed

Soler-Hampejsek, Erica; Grant, Monica J; Mensch, Barbara S; Hewett, Paul C; Rankin, Johanna

2013-08-01

Reliable data on sexual behavior are needed to identify adolescents at risk of acquiring human immunodeficiency virus or other sexually transmitted diseases, as well as unintended pregnancies. This study aimed to investigate whether schooling status and literacy and numeracy skills affect adolescents' reports of premarital sex, collected using audio computer-assisted self-interviews. We analyzed data on 2,320 participants in the first three rounds of the Malawi Schooling and Adolescent Study to estimate the level of inconsistency in reporting premarital sex among rural Malawian adolescents. We used multivariate logistic regressions to examine the relationships between school status and academic skills and premarital sexual behavior reports. Males were more likely than females to report premarital sex at baseline, whereas females were more likely than males to report sex inconsistently within and across rounds. School-going females and males were more likely to report never having had sex at baseline and to retract reports of ever having sex across rounds than were their peers who had recently left school. School-going females were also more likely to report sex inconsistently at baseline. Literate and numerate respondents were less likely to report sex inconsistently at baseline; however, they were more likely to retract sex reports across rounds. The level of inconsistency both within a survey round and across rounds reflects the difficulties in collecting reliable sexual behavior data from young people in settings such as rural Malawi, where education levels are low and sex among school-going females is not socially accepted. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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

Water supply dynamics and quality of alternative water sources in low-income areas of Lilongwe City, Malawi

NASA Astrophysics Data System (ADS)

Chidya, Russel C. G.; Mulwafu, Wapulumuka O.; Banda, Sembeyawo C. T.

2016-06-01

Recent studies in many developing countries have shown that Small Scale Independent Providers (SSIPs) in low-income areas (LIAs) are practical alternatives to water utilities. This study explored supply dynamics and quality of alternative water sources in four LIAs of Lilongwe City in Malawi using qualitative and quantitative methods. Household-level surveys (n = 120) and transect walks were employed to determine the socio-economic activities in the areas. One-on-one discussions were made with water source owners (SSIPs) (n = 24). Data on policy and institutional frameworks was collected through desktop study and Key Informant Interviews (n = 25). Quality of the water sources (shallow wells and boreholes) was determined by collecting grab samples (n = 24) in triplicate using 500 mL bottles. Selected physico-chemical and microbiological parameters were measured: pH, EC, TDS, turbidity, water temperature, salinity, K, Na, Ca, Mg, Cl-, F-, NO3-, alkalinity, water hardness, Fecal coliform (FC) and Faecal Streptococci (FS) bacteria. Water quality data was compared with Malawi Bureau of Standards (MBS) and World Health Organization (WHO) guidelines for drinking water. Shallow wells were reported (65%, n = 120) to be the main source of water for household use in all areas. Some policies like prohibition of boreholes and shallow wells in City locations were in conflict with other provisions of water supply, sanitation and housing. High levels of FC (0-2100 cfu/100 mL) and FS (0-1490 cfu/100 mL) at several sites (>90%, n = 24) suggest water contamination likely to impact on human health. This calls for upgrading and recognition of the water sources for improved water service delivery.

The Mwanje Project: Engaging Preservice Teachers in Global Service Learning

ERIC Educational Resources Information Center

Doppen, Frans H.; Tesar, Jennifer

2012-01-01

This article reports the findings of a study that engaged preservice social studies teachers at two institutions of higher education in Ohio and West Virginia in a service learning to benefit the Mwanje school in Malawi. The findings suggest that despite some initial levels of apprehension the project enhanced the student teachers' global…

Unemployed Youth: Alternative Approaches to an African Crisis.

ERIC Educational Resources Information Center

Livingstone, Ian

1989-01-01

This article draws on the findings of seven country studies of youth employment programs in Africa (Botswana, Somalia, Zambia, Malawi, Kenya, Ethiopia, and Mauritius). Considered are public service/public works programs, agricultural development, employable skills development and vocationalization of education, and national youth services. (SK)

Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study.

PubMed

Taulo, Frank; Berry, Mark; Tsui, Amy; Makanani, Bonus; Kafulafula, George; Li, Qing; Nkhoma, Chiwawa; Kumwenda, Johnstone J; Kumwenda, Newton; Taha, Taha E

2009-06-01

This study aimed to determine changes in fertility intentions of HIV-1 infected and uninfected reproductive age women in Blantyre, Malawi. Participants were asked about their fertility intentions at baseline and at 3-month visits for 1 year. Time-to-event statistical models were used to determine factors associated with changes in fertility intentions. Overall, 842 HIV uninfected and 844 HIV infected women were enrolled. The hazard of changing from wanting no more children at baseline to wanting more children at follow-up was 61% lower among HIV infected women compared to HIV uninfected women (P < 0.01) after adjusting for other factors, while HIV infected women were approximately 3 times more likely to change to wanting no more children. The overall pregnancy rate after 12 months was 14.9 per 100 person-years and did not differ among 102 HIV uninfected and 100 infected women who became pregnant. HIV infection is a significant predictor of fertility intentions over time.

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

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.

Metaphors We Love By: Conceptualizations of Sex among Young People in Malawi

PubMed Central

Undie, Chi-Chi; Crichton, Joanna; Zulu, Eliya

2008-01-01

This paper explores how young people in Malawi conceptualize sex and sexual relations through an analysis of their personal narratives about these phenomena. Eleven focus group discussions were conducted with 114 youth aged 14–19 years. Participants were asked to describe behaviors, attitudes, and motivations to reduce unplanned pregnancies and the spread of HIV/AIDS, with appropriate probes to illuminate their sexual world-views. The various metaphors that emanated from the discussions suggest that young people in this study take a utilitarian approach to sex, and conceive it as a natural and routine activity of which pleasure and passion are essential components. Future research and prevention efforts (around sexuality education in particular) would do well to incorporate adolescents’ language in programming as this can enhance understanding of the world of young people as well as the effectiveness of interventions addressing problems related to early sexual behavior. PMID:18458743