Malawi is located in southeastern Africa with Mozambique, Tanzania and Zambia as its neighboring countries. The country's climate is subtropical, conducive to the tobacco, tea, coffee and sugar grown there. The population of Malawi is predominantly rural with 90% of the population engaging in subsistence farming. Most of the people are of Bantu origin. There is no visa requirement for those travelling in Malawi, but there are conditions to be aware of for the visitor to Malawi. The government bans the wearing of slacks or shorts by women and hair below the nape of the neck for men. Malaria is endemic and tsetse flies and the risk of encephalitis are present. The water, however, is potable and telecommunications within Malawi are good. The political structure of the country is headed by an elected present and a presidentially appointed cabinet. There are 118 seats in the country's unicameral National Assembly. Although Malawi has traditionally been self-sufficient, it suffered from the world commodity price recession in the 1980s. However, Malawi has continued to grow economically at a slower rate. The United States and Malawi enjoy good diplomatic relations and have an open exchange program. As well, relations with neighboring countries, particularly Mozambique, have improved greatly.
An analysis of Malawi\\'s publication productivity. ... Background: Publications productivity, the number of scientific articles published, is a measure of a country's scientific output. If measured ... 20.9% of the authors were of Malawian origin and Tropical Doctor was the journal that had the most articles originating from Malawi.
Kanyuka, Mercy; Ndawala, Jameson; Mleme, Tiope; Chisesa, Lusungu; Makwemba, Medson; Amouzou, Agbessi; Borghi, Josephine; Daire, Judith; Ferrabee, Rufus; Hazel, Elizabeth; Heidkamp, Rebecca; Hill, Kenneth; Martínez Álvarez, Melisa; Mgalula, Leslie; Munthali, Spy; Nambiar, Bejoy; Nsona, Humphreys; Park, Lois; Walker, Neff; Daelmans, Bernadette; Bryce, Jennifer; Colbourn, Tim
Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280,000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external
Otañez, Martin G; Mamudu, Hadii M; Glantz, Stanton A
Transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it. We analyze tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organizations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC.
Grantee: Sokoine University of. Agriculture, Tanzania. Malnutrition is a serious problem in Malawi: 46% of children under five are stunted and. 14% of newborns are underweight. The. University of Malawi is working with Tanzanian researchers in selected communities in both countries to survey nutritional status, main.
Mhone, C S
Hastings Banda ruled Malawi for three decades until 1993. During that period, it was considered taboo to publicly discuss sexual matters. Efforts to prevent and control the spread of HIV/AIDS therefore got fully underway only after the end of Banda's autocratic regime. There are now an estimated 225,000 cases of AIDS in Malawi. The Ministry of Health estimates that 33% of urban adults and 17% of rural adults are HIV positive, approximately 10% of the total population. In some urban areas, 33% of women attending antenatal clinics and 70-98% of prostitutes are HIV positive. The high prevalence of sexually transmitted diseases and the practice of dry sex are thought to be major cofactors in bringing about such high rates of HIV infection. Several surveys do, however, indicate that the rate of growth of the HIV epidemic may be slowing. Even if the projected decrease in the incidence of new infections actually occurs, the cumulative HIV prevalence will continue to increase. Malawi, one of the world's poorest nations, with a per capita income of $140 and a literacy rate of 47%, cannot afford the overwhelming burden of providing comprehensive care to the segment of its population which suffers with AIDS. The author stresses the need for AIDS education in primary schools, especially since many students drop out prior to secondary school.
Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead
Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.
Full Text Available BACKGROUND: Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. METHODS & FINDINGS: In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment. CONCLUSIONS: This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.
Full Text Available This study examines struggles to bring people back into protected forests to enhance sustainable forest management and livelihoods using insights emerging from a co-management project in Malawi. It uses mixed social science methods and a process-based conceptualization of co-management to analyze experiences, and theory of reciprocal altruism to explain major findings of continuing local forest-user commitment to co-management despite six years of conservation burdens largely for minimal financial benefits. It argues that overemphasis on cash incentives as the motivation for “self-interested” users to participate in co-management overlooks locally significant non-cash motivations, inflates local expectations, and creates perverse incentives that undermine socio-ecological goals. Some non-cash incentives outweighed cash-driven ones. Findings support broadening of incentives mechanisms, including via nested cross-scale institutional arrangements for holistic management that integrates adjacent forests into forest-reserve co-management. Strengthened institutions, improving community/government and intra-community trust, improved village forests easing pressure on the reserve, measures minimizing elite capture, and impetus from an external threat, enhanced forest condition. Generous forest rights and appropriate community licensing and benefit-sharing systems also helped. Bureaucratic/donor inefficiencies, wood-extraction challenges, poor forest-based enterprise development, and low resource value undermined performance. Insights on forest-management planning, fair cost-sharing, targeting the poor, and need for social learning are highlighted.
Fiona R Parrott
Full Text Available BACKGROUND: Treatment seeking delays among people living with HIV have adverse consequences for outcome. Gender differences in treatment outcomes have been observed in sub-Saharan Africa. OBJECTIVE: To better understand antiretroviral treatment (ART seeking behaviour in HIV-infected adults in rural Malawi. METHODS: Qualitative interviews with male and female participants in an ART cohort study at a treatment site in rural northern Malawi triangulated with analysis of baseline clinical and demographic data for 365 individuals attending sequentially for ART screening between January 2008 and September 2009. RESULTS: 43% of the cohort presented with late stage HIV disease classified as WHO stage 3/4. Respondents reported that women's frequency of testing, health awareness and commitment to children led to earlier ART uptake and that men's commitment to wider social networks of influence, masculine ideals of strength, and success with sexual and marital partners led them to refuse treatment until they were sick. Quantitative analysis of the screening cohort provided supporting evidence for these expressed views. Overall, male gender (adjusted OR 2.3, 95% CI1.3-3.9 and never being married (adjusted OR 4.1, 95% CI1.5-11.5 were risk factors for late presentation, whereas having ≥3 dependent children was associated with earlier presentation (adjusted OR 0.31, 95% CI0.15-0.63, compared to those with no dependent children. CONCLUSION: Gender-specific barriers and facilitators operate throughout the whole process of seeking care. Further efforts to enrol men into care earlier should focus on the masculine characteristics that they value, and the risks to these of severe health decline. Our results emphasise the value of exploring as well as identifying behavioural correlates of late presentation.
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.
funded awards for doctoral thesis research. At the University of Malawi's Bunda College of Agriculture, 12 African students are carrying out research in aquaculture and fisheries. July 2010. About Canada's International Development Research Centre. IDRC supports research in developing countries to promote growth and ...
How has the lack of support for Music in schools and colleges affect- ed school going boys and girls in the country? ..... Malawi must educationally empower her African child to demonstrate human, cultur- al, and national identity as well as mental .... It helps them to develop the entire personal- ity, wisdom and emotions.
Cole, Donald C; Nyirenda, Lot Jata; Fazal, Nadia; Bates, Imelda
National health research for development (R4D) platforms in lower income countries (LICs) are few. The Health Research Capacity Strengthening Initiative (HRCSI, 2008-2013) was a national systems-strengthening programme in Malawi involved in national priority setting, decision-making on funding, and health research actor mobilization. We adopted a retrospective mixed-methods evaluation approach, starting with information gleaned from reports (HRCSI and Malawian) and databases (HRCSI). A framework of a health research system (actors and components) guided report review and interview guide development. From a list of 173 individuals involved in HRCSI, 30 interviewees were selected within categories of stakeholders. Interviews were conducted face-to-face or via telephone/Skype over 1 month, documented with extensive notes. Analysis of emerging themes was iterative among co-evaluators, with synthesis according to the implementation stage. Major HRCSI outputs included (1) National research priority-setting: through the production of themed background papers by Malawian health researchers and broad consultation, HRCSI led the development of a National Health Research Agenda (2012-2016), widely regarded as one of HRCSI's foremost achievements. (2) Institutional research capacity: there was an overwhelming view that HRCSI had produced a step-change in the number of high calibre scientists in Malawi and in fostering research interest among young Malawians, providing support for around 56 MSc and PhD students, and over 400 undergraduate health-related projects. (3) Knowledge sharing: HRCSI supported research dissemination through national and institutional meetings by sponsoring attendance at conferences and through close relationships with individuals in the print media for disseminating information. (4) Sustainability: From 2011-2013, HRCSI significantly improved research systems, processes and leadership in Malawi, but further strengthening was needed for HRCSI to be
Laidlaw, Rebecca; Dixon, Diane; Morse, Tracy; Beattie, Tara K; Kumwenda, Save; Mpemberera, Grant
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.
Nina A. Uspenskaya
Full Text Available The article describes the problems of higher education in the Arab countries from the time of caliphate in the 7th century to present time. The Arab caliphate had a number of scientific centres based on the principles of ancient Greek science and culture. The author stresses the role of interpreters and translators in the development of science, preservation and development of the ancient school of knowledge. Many of ancient scientific books appeared in Europe only in Arabic translation. That means that science and education in the Arab countries was mostly based on ancient science. One of great problems of education in the Arab countries is the recession of its quality and backwardness as compared to European education. The reason is lack of finances and unstable situation in the region. The author illustrates the article with the situation in educational institutions of Egypt. Egypt has one of the oldest and most individual systems of education in the Arab countries. The article shows secular universities as well as one of the most influential religion universities, Al-Azhar. Today, religion education in oriental countries is gaining more and more importance. Religion penetrates all spheres of society. The financial streams in the Arab countries are controlled by Muslim circles.
Department of Community Health, University of Malawi College of Medicine Private Bag 360,. Chichiri .... household parent. At least one relative sleeps in the household under a net. 159(35.0%). 245 (54.0%). 50(11.0%). Not applicable. Parents sleep under net ... level of sanitation and social deprivation in this area.
Makaula, Peter; Sadalaki, John R.; Muula, Adamson S.
and Google Scholar using th keywords: "schistosomiasis", "Bilharzia", "Bulinus" and "Biomphalaria" in combination with "Malawi". These searche were supplemented by iterative reviews of reference lists for relevant publications in peer reviewed internationa scientific journals or other media. The recovered......Introduction: Schistosomiasis remains an important public health problem that undermines social and economi development in tropical regions of the world, mainly Sub-Saharan Africa. We are not aware of any systematic revie of the literature of the epidemiology and transmission of schistosomiasis...... in Malawi since 1985. Therefore, w reviewed the current state of knowledge of schistosomiasis epidemiology and transmission in this country an identified knowledge gaps and relevant areas for future research and research governance Methods: We conducted computer-Aided literature searches of Medline, SCOPUS...
Hardy, Victoria; Hsieh, Jenny; Chirambo, Baxter; Wu, Tsung-Shu Joseph; O'Donoghue, John; Muula, Adamson S; Thompson, Matthew
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.
Білошицький, В. І.
In the article essence history and specific of becoming of civil-military relations is in countries NATO, modern state of civil-military relations in these countries. Importance of their further optimization is underline by the aim of acquisition by countries NATO stable system of civil-military relations.
Items 1 - 50 of 71 ... Malawi Medical Journal. ... PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING AJOL · RESOURCES. Archives: Malawi Medical Journal. Journal Home > Archives: Malawi Medical Journal. Log in or Register to get access to full ...
The Malawi Medical Journal is a peer reviewed publication of scientific medical research and serves as a forum for the dissemination of findings of health-related research undertaken in Malawi to health workers in Malawi. It incorporates original research studies, policy analysis, case reports, literature reviews and ...
Polis, Chelsea B; Mhango, Chisale; Philbin, Jesse; Chimwaza, Wanangwa; Chipeta, Effie; Msusa, Ausbert
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
Kambewa, E.; Nagoli, J.
The contribution of smallholders to the economic growth in developing countries and Malawi in particular may be a well know fact. Malawi's economy is agro-based where the agriculture sector contributes 42% of national GDP. Despite the smallholder agriculture's contribution to the economy (30% of
Setting: 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. Subjects: Researchers interviewed Malawi's central immunisation manager, three zonal immunisation officers, ...
The paper examines trends in the proximate determinants of fertility (nuptiality or marriage, contraception and post-partum infecundability) in Malawi during the twelve-year period 1992-2004, with a view to explaining the factors responsible for fertility decline in the country. The study uses the Malawi Demographic and ...
Cundale, Katie; Wroe, Emily; Matanje-Mwagomba, Beatrice L; Muula, Adamson S; Gupta, Neil; Berman, Josh; Kasomekera, Noel; Masiye, Jones
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.
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 ... deaths and disabilities related to NCDIs, and the National. Commission posits that ... multiple sources, including domestic violence and road traffic injuries.2 With ...
Otañez, Marty G; Mamudu, Hadii; Glantz, Stanton A
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
for Malawi's language-in-education policies to be successfully implemented, there is need for the involvement of ... system and as a subject of study throughout Malawi's entire education system in the 1969/70 academic ...... Sibayan's (1999:42) comments on the Singapore experiences where similar assumptions led to the ...
Agarwal, Sanjay; Aklilu, Petros
The World Bank supported three phases Malawi Social Action Fund (MASAF) project was first approved in 1996. Malawi, with a population of 13 million, is a low income country with one of the lowest per capita incomes in Sub-Saharan Africa. Malawi continues to face a variety of social, economic, political and administrative challenges including high inflation, low salaries/pensions of public ...
design farming practices that can improve food security and withstand climate change. □ Farmers coping with HIV/AIDS and climate change. Funding: $566,860. Duration: 2009–2014. Grantees: University of Malawi and. Ekwendeni Hospital, Malawi, and. University of Western Ontario, Canada. Poor Malawian farmers, ...
Monique van Lettow
Full Text Available In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART. We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy.A prospective cohort study was conducted in Malawi, investigating mortality in relation to ART uptake, microbiological findings and treatment of opportunistic infection (OIs, 6 months after meeting ART eligibility criteria.Of 469 consecutive adults eligible for ART, 74(16% died within 6 months of enrolment, at a median of 41 days (IQR 20-81. 370(79% started ART at a median time of 18 days (IQR 7-40 after enrolment. Six-month case-fatality rates were higher in patients with OIs; 25/121(21% in confirmed/clinical TB and 10/50(20% with blood stream infection (BSI compared to 41/308(13% in patients with no infection identified. Median TB treatment start was 27 days (IQR 17-65 after enrolment and mortality [8 deaths (44%] was significantly higher among 18 culture-positive patients with delayed TB diagnosis compared to patients diagnosed clinically and treated promptly with subsequent culture confirmation [6/34 (18%;p = 0.04]. Adjusted multivariable analysis, excluding deaths in the first 21 days, showed weight loss >10%, low CD4 count, severe anemia, laboratory-only TB diagnosis, and not initiating ART to be independently associated with increased risk of death.Mortality remains high among chronically ill patients eligible for ART. Prompt initiation of ART is vital: more than half of deaths were among patients who never started ART. Diagnostic and treatment delay for TB was strongly associated with risk of death. More than half of deaths occurred without identification of a specific infection. ART programmes need access to rapid point-of-care-diagnostic tools for OIs. The role of early empiric OI treatment in this population
Maseko Fresier C
Full Text Available Abstract 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
This paper presents the characterization of global solar radiation (GSR) for Malawi using NASA's SSE model. The mean monthly daily GSR monthly variation in the three regions of Malawi has been investigated. It has been found that there is a general gradient in GSR in the north-south direction. This gradient correlates ...
Background: Malawi has the highest age standardised rate of cervical cancer in the world. This study describes the presentation, management and short-term outcomes of patients with newly diagnosed cervical cancer at Queen Elizabeth Central Hospital (QECH), in Southern Malawi. Methods: All patients with a new ...
J. P. Grundling
Full Text Available Purpose of the study: The purpose this paper is to identify and describe the characteristics and influences of the cotton farming pipeline in Malawi and South Africa. Problem investigated: A broad based approach was followed to investigate the cotton farming pipeline to identify the major driving forces of the cotton pipeline in each of the respective countries. Research approach: A qualitative field research approach was followed to compile data on cotton farming in Malawi and South Africa. Data was compiled upstream from input suppliers, downstream from ginners, cotton transport conveyors, cotton marketing managers and agricultural government officials as well as from farmers and agricultural organizations. Findings: In Malawi a family farming model is followed versus an industrial model of production in South Africa. Despite the differences in approach, the farmers in both countries are faced with similar problems. In this regard, an urgent rethinking of the technological conditions of production and the possibilities of technological change is needed. Recommendations: The research proposes that these countries can benefit from establishing institutions like agricultural co-operatives and mechanisms like the development of a free traffic mechanism of seed-cotton. Conclusion: The present research may assist in developing first layer managerial recommendations that could enhance the sustainability and co-existence of cotton farming in the two countries.
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Colbourn, Tim; Lewycka, Sonia; Nambiar, Bejoy; Anwar, Iqbal; Phoya, Ann; Mhango, Chisale
Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality. We reviewed the literature for population-based studies that provide estimates of the maternal mortality ratio (MMR) in Malawi, and for studies that list and justify variables potentially associated with trends in MMR. We used all population-based estimates of MMR representative of the whole of Malawi to construct a best-fit trend-line for the range of years with available data, calculated the proportion attributable to HIV and qualitatively analysed trends and evidence related to other covariates to logically assess likely candidate drivers of the observed trend in MMR. 14 suitable estimates of MMR were found, covering the years 1977-2010. The resulting best-fit line predicted MMR in Malawi to have increased from 317 maternal deaths/100 000 live-births in 1980 to 748 in 1990, before peaking at 971 in 1999, and falling to 846 in 2005 and 484 in 2010. Concurrent deteriorations and improvements in HIV and health system investment and provisions are the most plausible explanations for the trend. Female literacy and education, family planning and poverty reduction could play more of a role if thresholds are passed in the coming years. The decrease in MMR in Malawi is encouraging as it appears that recent efforts to control HIV and improve the health system are bearing fruit. Sustained efforts to prevent and treat maternal complications are required if Malawi is to attain the MDG 5 target and save the lives of more of its mothers in years to come.
Kamanga, Tamara; Chisenga, Chikondi; Katonda, Vincent
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
Kalanda, Boniface Francis
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…
Lupafya, Phindile Chitsulo; Mwagomba, Beatrice L. Matanje; Hosig, Kathy; Maseko, Lucy M.; Chimbali, Henry
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…
A principal objective of the Malawi government is to provide public health services that reach poor men and women. This paper assesses to what extent the Government has been successful in achieving this. Malawi was also found to be more successful than other countries in Africa at providing health services that reach ...
sectional qualitative research project involving focus groups, semi-structured interviews and questionnaires given to students and recent graduates of the University of. Malawi, College of Medicine. The results we present are based on material from 4 ...
health service of Malawi began - not in the com~ munity or in the hospital, .... comes home they may keep him at a distance and half-expect him to .... So a good service often begins in a blaze of publicity, with local leaders and villagers invited to a meeting, performances from health education bands and drama groups, and ...
very important that midwives be available for the well being of these women. However, mere presence of ... nurse-midwives in working towards safe motherhood in Malawi and some recommendations in an attempt ... hospitals, the working conditions worsen for the remaining nurs- es and as a result they are also tempted to ...
Mar 14, 2013 ... A secondary analysis of the Malawi School-Based Student Health. Survey (2009) ... reporting be bullied compared to non-smokers (AOR=3.97; 955. CI [3.83 ... academic performance. Methods ... health,College of Medicine, .
As Malawi continues to suffer from a large burden of noncommunicable diseases (NCDs), models for NCD screening need to be developed that do not overload a ... Focusing on hypertension and diabetes, we screened all adults 30 years and above for hypertension using a single blood pressure cut-off of 160/110 mmHg, ...
Dulanya, Zuze; Morales-Simfors, Nury; Sivertun, Åke
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.
Full Text Available The demographic study of nuptiality in African countries is not very developed and often of secondary interest in a discussion of the proximate determinants of fertility. This paper uses unusual marriage history data to examine divorce and remarriage in rural Malawi. Life table probabilities of divorce range from 40 to 65 percent and are among the highest on the continent. An investigation into the determinants of marital instability using proportional hazards models confirms the importance of kinship systems and female empowerment, but the mechanism underlying the high divorce rates in Malawi seems to be more complicated than that. This is, for example, illustrated in the effect of the polygyny variables. Marriage, divorce, and remarriage are further considered as empowering strategies that women deploy throughout their lives.
Namoto, M.; Likoswe, M.G.
This study of 42 case studies of nurseries was made as part of a major sample survey of 360 nurseries in 6 districts in Malawi. The purpose of the study was to let the small nurseries in the country explain in their own words how they source seed, how and for whom they produce seedlings......, and to explain about their problems and opportunities in the nursery business. The assessment was made within the framework of Improved Seed Supply for Agroforestry in African Countries (ISSAAC), a Danida supported programme implemented in cooperation between Forest & Landscape Denmark and World Agroforestry...
J. E., Chisi, BSc (Hons), MBBS, PhD, Senior Lecturer, H. Misiri, BSc, MSc, Lecturer, Y. Zverev, MBBS, PhD, Associate Professor, College of Medicine,. University of Malawi, Private Bag 360, Blantyre 3, Malawi, A. Nkhoma, Diploma in Clinical Medicine, Nkhotakota District Hospital and J. M. Sternberg,. BSc, MSc, Senior ...
Domestic smoke exposure and early HIV infection are critical but unseen risk factors for pneumonia. This paper reviews how recent research in Malawi and elsewhere contributes to an understanding of the possible immunological mechanisms underlying these risks. [Malawi Med J, Vol.15(2) 2003: 68-71] ...
Spatially diverse trends in population growth, climate change, industrialization, urbanization and economic development are expected to change future food supply and demand. These changes may affect the suitability of land for food production, implying elevated risks especially for resource constrained, food-importing countries. We present the evolution of biophysical redundancy for agricultural production at country level, from 1992 to 2012. Biophysical redundancy, defined as unused biotic and abiotic environmental resources, is represented by the potential food production of 'spare land', available water resources (i.e., not already used for human activities), as well as production increases through yield gap closure on cultivated areas and potential agricultural areas. In 2012, the biophysical redundancy of 75 (48) countries, mainly in North Africa, Western Europe, the Middle East and Asia, was insufficient to produce the caloric nutritional needs for at least 50% (25%) of their population during a year. Biophysical redundancy has decreased in the last two decades in 102 out of 155 countries, 11 of these went from high to limited redundancy, and nine of these from limited to very low redundancy. Although the variability of the drivers of change across different countries is high, improvements in yield and population growth have a clear impact on the decreases of redundancy towards the very low redundancy category. We took a more detailed look at countries classified as 'Low Income Economies (LIEs)' since they are particularly vulnerable to domestic or external food supply changes, due to their limited capacity to offset for food supply decreases with higher purchasing power on the international market. Currently, nine LIEs have limited or very low biophysical redundancy. Many of these showed a decrease in redundancy over the last two decades, which is not always linked with improvements in per capita food availability.
Background: Depression is one of the leading contributors to the global burden of disease and often has an onset during adolescence. While effective treatments are available, many low-income countries, such as Malawi, lack appropriately trained health providers in community health settings, and this limits access to ...
Milledge, J.; Calis, J. C. J.; Graham, S. M.; Phiri, A.; Wilson, L. K.; Soko, D.; Mbvwinji, M.; Walsh, A. L.; Rogerson, S. R.; Molyneux, M. E.; Molyneux, E. M.
The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi. All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected
'The rise of cancer in less affluent countries is an impending disaster' Malawi Medical Journal Vol. 20 (4) 2008: pp. 108-108. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v20i4.10978 · AJOL African Journals Online. HOW TO ...
This article investigates the historical evolution of tourism development in Malawi from its colonial origins to the current phase in which national government is seeking to scale up the tourism sector. The shifting policy challenges of tourism development in the country and of government responses are highlighted.
This review paper covers the issues of pit latrine emptying national policies and regulations with a focus on Malawi and Zambia. With 2.4 billion people worldwide still lacking improved sanitation facilities, developing countries need to look at policy, regulation and practice for household sanitation service provision with a ...
Grant, Monica; Lloyd, Cynthia; Mensch, Barbara
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…
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
Onaji, P.B.; Siemons, R.V.
The feasibility of charcoal production from cotton stalks in Malawi was studied based on experience from Sudan. The country relies considerably on biomass fuels. Of the total energy consumption in Malawi of 2.376 MTOE in 1989, 92% was met by biomass (fuelwood: 83.6% and charcoal: 8.3% Petroleum
Zijlstra, E E
The migration of physicians out of developing nations to rich, western countries contributes heavily to the healthcare problems in Africa. African physicians emigrate primarily to the USA, UK and Canada. In their land of origin, there is often a severe shortage of physicians, while the need for physicians has increased due to HIV/AIDS and the introduction of antiretroviral therapy. Training capacity in Africa is limited. Of the 256 physicians who have graduated from the College of Medicine in Malawi, 60% reside in Malawi; most work in the public sector. Of those who moved abroad, 59% are obtaining specialised postgraduate training. The problem of brain drain in Malawi appears to be limited at this time. However, given the severe shortage of physicians, training capacity should be increased and career prospects, remuneration and working conditions should be improved.
efficient energy use. The paper presents a study on the energy consumption of the most common household appliances in Malawi and prescribes the various steps ... The total installed capacity in Malawi grid is only 375. MW . This will not be enough if access to electricity were to be increased. The World Bank reports that.
Hou, Xiaolin; Olsson, Mattias; Togneri, Laura
Radiochemical analysis plays a critical role in the determination of pure beta and alpha emitting radionuclides for environmental monitoring, radioecology, decommissioning, nuclear forensics and geological dating. A remarkable development on radiochemical analysis has been achieved in the past...... decades to meet the increased requirement. In the recent years, mass spectrometric techniques have been considerably improved and are widely employed for measurement of radionuclides. Analytical methods for rapid, automated and simultaneous determination of radionuclides have been extensively developed...... for emergency analysis. In Nordic countries, many laboratories are involved in the determination of radionuclides for various purposes, and a series of radiochemical analytical methods have been developed and applied. This article presents the present status and progress on radiochemical analysis...
Full Text Available Background and Aim. New diagnostic or therapeutic methods in endoscopy have been used. Current clinical application of these procedures is not well known. The aim of this study is to investigate the present situation on endoscopic diagnosis and treatment of gastrointestinal disorders in East Asian countries. Method. A representative member from the International Gastrointestinal Consensus Symposium Committee provided a questionnaire to physicians in China, Indonesia, Japan, Korea, the Philippines, and Thailand. Results. In total, 514 physicians including gastroenterologists, surgeons, and general practitioners enrolled. The most frequently occurring disorder as the origin of upper gastrointestinal bleeding is gastric ulcer. Capsule endoscopy is selected as the first choice for the diagnosis of small intestine bleeding. The second choice was double-balloon endoscopy or angiography. For patients with gastric adenoma, the number of physicians who choose endoscopic mucosal resection is larger than those selecting endoscopic submucosal dissection (ESD in China, Indonesia, the Philippines, and Thailand. ESD is chosen first in Japan and Korea. Conclusion. New instruments or techniques on endoscopy have not come into wide use yet, and there is diversity in the situation on it in Asian countries. We should unify the endoscopic diagnostic criteria or treated strategy in patients with GI disease.
Full Text Available Dengue is a common cause of infection in adults in tropical countries. Sepsis is a syndrome of systemic manifestations induced by infection of any organisms; including bacterial, fungal and viral agents. Here, we investigated the diagnosis, management and outcomes of dengue patients presenting with sepsis in a prospective study of community-acquired sepsis in Thailand.From June to December 2015, 874 adult patients (age≥18 years with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were evaluated. Serum was stored and later tested for dengue PCR assays.A total of 126 patients had dengue PCR assays positive (2 DENV-1, 12 DENV-2, 24 DENV-3 and 88 DENV-4, and 5 of them (4% died. We found that attending physicians suspected dengue infection on admission in 84 patients (67%, and recorded dengue infection as the final diagnosis in 96 patients (76%. Four of five fatal cases were diagnosed and treated as septic shock not due to dengue. In multivariable analysis, there was a trend showing that age≥60 years, hypoxemia and misdiagnosis of dengue by attending physicians were associated with 28-day mortality.A number of adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical features alone is difficult. Rapid diagnostic tests for dengue may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.
Yeganeh-Arani, Erfan; Chandratilake, Mudawa; Muula, Adamson S
The shortage of doctors in all specialties in Malawi is particularly severe in rural areas. Contributory factors are the low number of students graduating each year, migration of doctors, and the preference of new graduates for practising in urban areas. Attempts to increase the output from Malawi's only medical school are insufficient to meet the country's healthcare needs. We studied the factors influencing career choices of medical undergraduates of the College of Medicine in Blantyre, Malawi, who were surveyed by means of a self-administered questionnaire (N=205) and individual interviews (N=17). Most respondents (89.4%) indicated that they intend to specialise abroad, predominantly to study in 'better institutions' and to get the 'experience' of a different country; 87.0% indicated that they intend to live in Malawi long term. Although, in general, the rural lifestyle was unattractive to medical students, respondents from rural areas and small towns, and whose parents were 'non-professionals', were more likely to intend working in rural areas and small towns, and to settle in Malawi, than students from urban and professional families. The College of Medicine should consider increasing its intake of students with lower socio-economic backgrounds and from rural areas/small towns to increase the number of doctors working in rural areas and settling in Malawi. However, the Ministry of Health may need a multipronged approach to reduce the mismatch between doctors' career expectations and the country's healthcare needs.
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.
Hassan A. Al-Thani
Full Text Available To describe prevalence and impact of peripheral arterial disease (PAD in patients with acute coronary syndrome (ACS, data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD. Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI, patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P=0.028. After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P=0.01. Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death.
Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O’byrne, Thomasena; Heyderman, Robert; Desmond, Nicola
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
Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O'byrne, Thomasena; Heyderman, Robert; Desmond, Nicola
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.
Hurst, Rachel; Siyame, Edwin W P; Young, Scott D; Chilimba, Allan D C; Joy, Edward J M; Black, Colin R; Ander, E Louise; Watts, Michael J; Chilima, Benson; Gondwe, Jellita; Kang'ombe, Dalitso; Stein, Alexander J; Fairweather-Tait, Susan J; Gibson, Rosalind S; Kalimbira, Alexander A; Broadley, Martin R
Selenium (Se) is an essential human micronutrient with critical roles in immune functioning and antioxidant defence. Estimates of dietary Se intakes and status are scarce for Africa although crop surveys indicate deficiency is probably widespread in Malawi. Here we show that Se deficiency is likely endemic in Malawi based on the Se status of adults consuming food from contrasting soil types. These data are consistent with food balance sheets and composition tables revealing that >80% of the Malawi population is at risk of dietary Se inadequacy. Risk of dietary Se inadequacy is >60% in seven other countries in Southern Africa, and 22% across Africa as a whole. Given that most Malawi soils cannot supply sufficient Se to crops for adequate human nutrition, the cost and benefits of interventions to alleviate Se deficiency should be determined; for example, Se-enriched nitrogen fertilisers could be adopted as in Finland.
Kulik, Margarete C; Bialous, Stella Aguinaga; Munthali, Spy; Max, Wendy
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.
Musharrafieh, Umayya; Rahi, Amal C; Taha, Assaad; Shamseddine, Wael; Steitieh, Suzanne; Jamali, Faek; Tamim, Hala
In most developing countries including Lebanon, trauma research is lacking and warranted. Objectives of the current study were to describe trauma patients referred to a tertiary care center during one year and identify outcomes and patterns of injury. Review of hospital charts of every 12th consecutive patient presenting to the emergency unit (ED) after a traumatic event during the year 2001-2002. Data collected include: demographics, injury description, and hospital data. A total of 736 patients were included, 212 pediatric, 455 young, and 62 geriatric patients. The most common body regions injured were the extremities followed by the face. The most encountered mechanism of injury was fall from less than 15 feet (38.2%) followed by penetrating/gunshot injury (14.8%), and road traffic accidents (11.8%). The rates of hospital admission and surgical intervention were highest among geriatric patients (p = 0.03 and p < 0.001). Most injuries occurred during the evening shift and the average time spent in the ED was 86 minutes. The police was informed in 6.6% of the cases. Falls represent a worrisome mechanism across all age groups. This may be an indication for unaddressed occupational hazards for the working young and lack of awareness about the need for more children supervision. More rigorous investigation of intentional and unintentional firearm injuries, and their predisposing factors are needed.
Full Text Available BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSION: 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
Ehelepola, N D B; Ranasinghe, T I D M; Prashanthi, B; Bandara, H M P A G S
Patients often, but not always, present with features that allow easy differentiation between traumatic brain injury and a stroke. Early diagnosis and appropriate treatment are crucial for a good outcome in both. Millions of people worldwide climb coconut and other trees without any protective gear. We present a case of a coconut tree climber found unconscious after a fall, initially misdiagnosed as a traumatic brain injury but later proven to be a hemorrhagic stroke. We discuss how to prevent such incidents and why that deserves more attention. There is a severe paucity of such case reports and discussion of related issues in medical literature. A 65 year old, previously healthy Sinhalese man had fallen from a coconut tree and was found unconscious with wounds on his limbs on the right side of his body. He was taken to the closest hospital. After being given primary care, he was transferred to the Kandy teaching hospital for neurosurgical management. Physical examination findings suggested a stroke but not the medical history. We could not exclude a head and cervical spine injury clinically. A computed tomography scan of the brain and cervical spine showed a left thalamic hemorrhage but no other injuries that could be attributed to trauma, therefore we confirmed it was a hemorrhagic stroke presenting as a traumatic brain injury. Since strokes are very common and rising in prevalence, being more aware of uncommon presentations like this can be useful to all health care workers working in acute medical settings especially in developing countries. Computed tomography scans of the brain plays a critical role in accurate diagnosis of both strokes and traumatic brain injuries; but many people in the developing world do not have prompt access to computed tomography scanners. Providing early access to a computed tomography scan of the brain to a wider population after a head injury or a stroke may contribute to reducing morbidity and mortality. Developing and promoting
Background: Preterm birth is a major cause of neonatal death, and has an incidence in industrialised countries of 7%. There are still very limited data from developing countries. Methods: Cohort study of 512 unselected pregnant women in rural communities in Malawi. All had ultrasound foetal measurements before 24 ...
The paper presents finding on a qualitative study which carried out to determine the suitability of the national sexual and reproductive health and rights [SRHR] in mitigating challenges in cervical cancer control and prevention. Methods: a desk review of the Malawi National Sexual and Reproductive Health and Rights ...
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…
consistent findings of medical socialization research truly inherent in medical education itself, evidence of ... groups and interviews, a procedure that draws on grounded theory methodology.7. The results presented ... the University of Malawi College of Medicine Research and. Ethics Committee, and by the University of ...
Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S
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
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 18, No 1 (2006) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
The Resistable Rise of Surgical Sepsis in Malawi. C Lavy, C Schmidt, E Kalau, J Phuka. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about ...
NGO The Malawi Safe Motherhood Project. unspecified. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 18, No 3 (2006) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
No Abstract. Malawi Medical Journal Vol. 18 (3) 2006: pp. 134-146. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v18i3.10918 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...
This paper gives an overview of the kind of community development projects that the Malawi Social Action Fund (MASAF) has supported since its inception in July 1996. The MASAF has tended to subscribe to a demand-driven approach in its evaluation of projects, thereby introducing an element of competition in commu ...
Adhikari, Radha; Grigulis, Astrida
.... In this article, we present findings from two independent research studies from Malawi and Nepal, which aimed to examine how overseas nurses encountered and overcame the challenges linked to recent...
Olusanya, Bolutife; Onoja, Godfrey; Ibraheem, Waheed; Bekibele, Charles
Low vision is an important public health problem; however, very few low vision clinics are available to address the needs of low vision patients in most developing countries. The purpose of this study was to describe the characteristics of patients attending the low vision clinic of a Nigerian tertiary hospital. This was a prospective cross sectional study of all new patients seen at the low vision clinic over a 36 month period. Patients were administered with a structured questionnaire, and were examined and tested with low vision devices by the attending low vision specialist. Information on the demographic and clinical characteristics of the patients was recorded. A total of 193 new patients seen during the period were studied. The mean age was 41.4 years, and their ages ranged between 6 and 90 years with a male to female ratio of 1.9:1. Majority (58%) were aged below 50 years, 23.3% were children (≤ 15 years), while 21.8% were elderly patients (≥ 65 years). The commonest cause of low vision was retinitis pigmentosa (16.6%); 14.5% had age related macular degeneration (ARMD); 9.8% had albinism; while only 1% had diabetic retinopathy. ARMD (45.2%) was the commonest cause in the elderly patients, while albinism (24.4%) and optic atrophy (24.4%) were the commonest in children. The demographic and clinical characteristics of low vision patients seen in this clinic are similar to that of patients in other developing countries, but different from those in developed countries. Elderly patients and females may be under-utilising low vision services. There is a need for further research into the determinants of low vision service utilisation in developing countries. This would further aid the planning and delivery of services to low vision patients in these countries.
Malawi has been ranked by the World Bank as one of the poorest countries in Africa. Malawi's only resources are its people and fertile soil, which comprises about 55% of land area. Environmental degradation and population growth conditions in Malawi were used to illustrate the model of environmental degradation linked to population pressure on land resources and government development strategies that favored large-scale agricultural farms. The result has been deforestation, overgrazing, overuse of land for subsistence, and increased population density. The argument was that population growth in some developing countries has been so rapid that environmental collapse is the result. The theoretical framework linking population growth, environment, and resources emphasized processes: 1) the precursor stage of underlying causes; 2) the problem phase with potential ecological and economic decline; and 3) consequences (environmental decline, reduction in food production systems, and reduction in standard of living). The precursors were identified as an agrarian society, lack of a population policy, and emphasis on large families. The problems were rapid population growth and immigration from Mozambique, which led to increased demand for trees for fuel and consequent deforestation, increased demand for arable land and consequent landlessness, increased investment in livestock and consequent overgrazing, and continued population momentum which was a financial burden to government and resulted in increased labor competition. The ecological consequences were soil erosion, degradation of vegetation, and water supply contamination and decline. Eventually, famines will occur and lead to disease, migration, deserted villages, urbanization, unemployment, ethnic conflicts, and political unrest. Population was estimated at 8.75 million in 1990, with exponential growth expected. Completed family size was 6.6 children per woman. Even replacement fertility would mean growth for 50 more
The maternal mortality ratio in Malawi is currently estimated to be 620 per ... maternal mortality. The indicators proposed use'the rationale that critical pathways to reducing maternal mortality include improvements to the accessibility, utilisation and quality of care for the ... development, operations research and ﬁeld testing.
Madsen, Henry; Bloch, Paul; Makaula, Peter
Historically, open shorelines of Lake Malawi were free from schistosome, Schistosoma haematobium, transmission, but this changed in the mid-1980s, possibly as a result of over-fishing reducing density of molluscivore fishes. Very little information is available on schistosome infections among...
van den Broek Nynke
Full Text Available Abstract Background 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. Methods SWOT (strengths, weaknesses, opportunities and threats analysis of the process of maternal death review during a workshop in Malawi. Results 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. Conclusion 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.
Baur, Ivo; Tabin, Léa; Banda, McLoyd; Chiumia, Daniel; Lips, Markus
Milk production in Malawi is stagnating while steadily increasing in neighboring countries. We performed a literature review to identify factors negatively affecting milk production in Malawi and propose potential solutions to overcome the particular constraints. We structured the analysis along the value chain with three major components: upstream providers, on-farm production, and downstream providers. It is shown that the literature strongly focuses on on-farm constraints and most prominently on animal health, breed choice, and milk yield. The literature research did not reveal any reasons specific to Malawi that would hinder an increase in milk production as experienced in neighboring countries. We suggest a focus on crossbreeds accompanied by local breeding programs, which would reduce dependence on imported semen and strengthen the currently unreliable artificial insemination services. In addition, crossbreeds may be better suited than pure breeds for current feeding practices and climate conditions and thus come close to reaching their genetic potential. We conclude that cost advantages of crossbreeds clearly compensate for the lower revenues compared with exotic breeds such as Holstein-Friesian or Jersey.
Monique Borgerhoff Mulder
Full Text Available 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.
Daud J. Kachamba
Full Text Available In this study we present general (multiple tree species from several sites above- and belowground biomass models for trees in the miombo woodlands of Malawi. Such models are currently lacking in the country. The modelling was based on 74 trees comprising 33 different species with diameters at breast height (dbh and total tree height (ht ranging from 5.3 to 2 cm and from 3.0 to 25.0 m, respectively. Trees were collected from four silvicultural zones covering a wide range of conditions. We tested different models including dbh, ht and wood specific gravity ( ρ as independent variables. We evaluated model performance using pseudo-R2, root mean square error (RMSE, a covariance matrix for the parameter estimates, mean prediction error (MPE and relative mean prediction error (MPE%. Computation of MPE% was based on leave-one-out cross-validation. Values of pseudo-R2 and MPE% ranged 0.82–0.97 and 0.9%–2.8%, respectively. Model performance indicated that the models can be used over a wide range of geographical and ecological conditions in Malawi.
Makoka Mwai H
Full Text Available Abstract Background Life-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data. Methods Culture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi. Results Between July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were Staphylococcus aureus, Escherichia coli, Salmonella species and Streptococcus pneumoniae, whereas Streptococcus pneumoniae and Cryptococcus neoformans were most frequently detected from cerebrospinal fluid. Haemophilus influenzae was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility. Conclusions There is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.
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.
Moise, Imelda K; Kalipeni, Ezekiel; Jusrut, Poonam; Iwelunmor, Juliet I
One of the key objectives of the Millennium Development Goals (MDGs) was to improve the lives of infants and children, particularly the reduction of high infant and childhood mortality rates throughout the developing world. This paper examines the experiences of Malawi in tackling the problem of high infant and childhood mortality over recent decades, 1990-2010. We highlight the strategies that were used in Malawi which led to Malawi's stellar performance in achieving the targets set by the MDGs with reference to infant and childhood mortality. The data for the analysis were obtained from Demographic and Health Surveys and from the various censuses the country has conducted. Regression analysis using district as the unit of observation reveals several important factors that have led to the commendable declines in infant mortality. Significant factors included immunisation of infants as well as increasing levels of female education and the availability of skilled birth attendants. What Malawi's case demonstrates is that given a correct mix of strategies, even a poor country such as Malawi can meet some of the lofty targets set by the MDGs.
Background National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan. Methods Data from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions. Results The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006. Conclusion There is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens. PMID:21062503
A growing body of literature has examined the impact of different types of family structures on children’s schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children’s schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children’s schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children’s schooling. PMID:27822897
A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.
Full Text Available In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University of São Paulo (ECA-USP. Entitled Radio Beyond Borders the dossier gathers six articles and the intention of reuniting works on the perspectives of usage of such media as much as on the new possibilities of aesthetical experimenting being build up for it, especially considering the new digital technologies and technological convergences. It also intends to present works with original theoretical approach and original reflections able to reset the way we look at what is today already a centennial media. Having broadened the meaning of “beyond borders”, four foreign authors were invited to join the dossier. This is the first time they are being published in this country and so, in all cases, the articles where either written or translated into Portuguese.The dossier begins with “Radio is dead…Long live to the sound”, which is the transcription of a thought provoking lecture given by Armand Balsebre (Autonomous University of Barcelona – one of the most influential authors in the world on the Radio study field. It addresses the challenges such media is to face so that it can become “a new sound media, in the context of a new soundscape or sound-sphere, for the new listeners”. Andrew Dubber (Birmingham City University regarding the challenges posed by a Digital Era argues for a theoretical approach in radio studies which can consider a Media Ecology. The author understands the form and discourse of radio as a negotiation of affordances and
Chimwaza, Wanangwa; Chipeta, Effie; Ngwira, Andrew; Kamwendo, Francis; Taulo, Frank; Bradley, Susan; McAuliffe, Eilish
Malawi faces a severe shortage of health workers, a factor that has contributed greatly to high maternal mortality in the country. Most clinical care is performed by mid-level providers (MLPs). While utilization of these cadres in providing health care is a solution to the current shortages, demotivating factors within the Malawian health system are pushing them into private, non-governmental, and other non-health related positions. This study aims to highlight these demotivating factors by exploring the critical aspects that influence MLPs' intention to leave their jobs. This descriptive qualitative study formed part of the larger Health Systems Strengthening for Equity (HSSE) study. Data presented in this paper were collected in Malawi using the Critical Incident Analysis tool. Participants were asked to narrate an incident that had happened during the past three months which had made them seriously consider leaving their job. Data were subjected to thematic analysis using NVivo 8 software. Of the 84 respondents who participated in a Critical Incident Analysis interview, 58 respondents (69%) indicated they had experienced a demotivating incident in the previous three months that had made them seriously consider leaving their job. The most commonly cited critical factors were being treated unfairly or with disrespect, lack of recognition of their efforts, delays and inconsistencies in salary payments, lack of transparent processes and criteria for upgrading or promotion, and death of patients. Staff motivation and an enabling environment are crucial factors for retaining MLPs in the Malawian health system. This study revealed key 'tipping points' that drive staff to seriously consider leaving their jobs. Many of the factors underlying these critical incidents can be addressed by improved management practices and the introduction of fair and transparent policies. Managers need to be trained and equipped with effective managerial skills and staff should have access
Ekenze, S O; Ngaikedi, C; Obasi, A A
The purpose of the present study was to evaluate the problems, treatment outcome, and contributory factors to delayed presentation in Hirschsprung's disease (HD) after 1 year of age in a resource-limited setting. This retrospective study included 41 children aged >1 year with HD managed at the University of Nigeria Teaching Hospital, Enugu, in south eastern Nigeria, between January 2000 and June 2009. Complications of HD were evident at presentation in 38 (92.7%) of the 41 children. Late presentation was due to delayed referral in 27 cases (65.9%), parental ignorance in 11 (26.8%), and poverty in 3 (7.3%). The HD was rectosigmoid in 33 patients (80.5%) and was of ultra-short length variety in 8 patients (19.5%). Thirty-five patients (85.4%) required colostomy for decompression, and colostomy-related complications occurred in 24 of them (68.6%). The definitive surgical procedure was a Swenson pullthrough in 34 cases (82.9%) and posterior myectomy in 7 others (17.1%). Twenty patients (48.8%) experienced at least one postoperative complication. After follow-up of 7-64 months (mean: 31 months), 31 (75.6%) patients had a good outcome, 6 (14.6%) had persistent constipation, 3 had (7.3%) incontinence, and one child (2.4%) died from overwhelming infection. Hirschsprung's disease presenting after 1 year of age may be associated with high colostomy rates and increased morbidity. Continued dissemination of updated information on HD to medical practitioners and a public awareness campaign may improve time to diagnosis.
Stevenson, Anna Clare; Edwards, Christopher; Langton, Josephine; Zamawe, Collins; Kennedy, Neil
Although pneumonia is a common cause of death in children in Malawi, healthcare staff frequently encounter patients or carers who refuse oxygen therapy. This qualitative study documents factors that influence acceptance or refusal of oxygen therapy for children in Malawi. Nine group interviews involving 86 participants were held in community and hospital settings in rural and urban Malawi. Eleven in-depth interviews of healthcare staff providing oxygen were held in a central hospital. Thematic analysis of transcripts of the audio recordings was carried out to identify recurring themes. Similar ideas were identified in the group interviews and in-depth staff interviews. Past experiences of oxygen use (direct and indirect, positive and negative) had a strong influence on views of oxygen. A recurrent theme was fear of oxygen, often due to a perceived association between death and recent oxygen use. Fears were intensified by a lack of familiarity with equipment used to deliver oxygen, distrust of medical staff and concerns about cost of oxygen. This study identifies reasons for refusal of oxygen therapy for children in a low-income country. Findings from the study suggest that training of healthcare staff to address fears of parents, and information, education and communication (IEC) approaches that improve public understanding of oxygen and provide positive examples of its use are likely to be helpful in improving uptake of oxygen therapy in Malawi. 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.
Gajewski, Jakub; Dharamshi, Rachel; Strader, Michael; Kachimba, John; Borgstein, Eric; Mwapasa, Gerald; Cheelo, Mweene; McCauley, Tracey; Bijlmakers, Leon; Brugha, Ruairi
To examine age and gender distribution for the most common types of surgery in Malawi and Zambia. Data were collected from major operating theatres in eight district hospitals in Malawi and nine in Zambia. Raw data on surgical procedures were coded by specialist surgeons for frequency analyses. In Malawi female surgical patients had a mean age of 25 years, with 91% aged 16-40 years. Females accounted for 85%, and obstetric cases for 75%, of all surgical patients. In Zambia, female surgical patients had a mean age of 26, with 75% aged 16-40 years. They accounted for 55% of all cases, 34% being obstetric. Male surgical patients in Malawi were on average older (33 years) than in Zambia (23 years). General surgical cases in men and women, respectively, had a median age of 42 and 32 in Malawi and 26 and 30 in Zambia. The median age of trauma patients was 12 in males and 10 in females in both countries. Children aged 0-15 years accounted for 64-65% of all trauma cases in Malawi and 57-58% in Zambia, with peak incidences in 6- to 10-year-olds. Women of reproductive (16-45 years) mainly undergoing Caesarean sections and children aged 0-15 years who accounted for two-thirds of trauma cases are the main patient populations undergoing surgery at district hospitals in Zambia and Malawi. Verification and analysis of routine hospital data, across 10-30% of districts countrywide, demonstrated the need to prioritise quality assurance in surgery and anaesthesia, and preventive interventions in children. © 2017 John Wiley & Sons Ltd.
Lindgren, Teri; Rankin, Sally H; Rankin, William W
Heterosexually transmitted HIV/AIDS continues to devastate the health and economy of sub-Saharan African countries. In Malawi, 15.4% of 15-49 year olds are infected with HIV and 18-26% of pregnant women are living with HIV. Research has shown that sociocultural factors, especially gender roles and relationships, play a significant role in the transmission of HIV in Africa but little is known about Malawi women's perspective on HIV/AIDS. What do Malawi women say about the impact of HIV/AIDS on their lives, their role in prevention, and the barriers they face in trying to stem the spread of the disease? To answer these questions, three focus groups with Malawi women were conducted and analyzed for themes. The purpose of this paper is to describe one emergent theme captured in the statement, "We are just vessels for our husbands." This theme is explicated through discussions of women's and men's images, women's roles, gender/power relationships, disempowerment, role models and empowerment. Evident in this theme are interrelated messages for those involved in HIV/AIDS prevention. Health education alone is insufficient to stem the tide of HIV in Malawi. A multidisciplinary, systematic approach that includes women's education and economic empowerment as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi is suggested as necessary additions to HIV and AIDS intervention programs. Only through forging partnerships between health, education, women's development groups, and political and social leaders will we be able to reduce the impact of HIV/AIDS in Malawi.
Full Text Available Lymphogranuloma venereum (LGV is a sexually transmitted infectious disease caused by serovars L1, L2 and L3 of Chlamydia trachomatis. The initial presentation is usually a painless ulcerated papule on the genitalia or distal proctitis. The progression of the infection can lead to major complications: rectal strictures, intestinal obstruction or perforation. We present five cases of LGV proctitis as the initial presentation of the disease. All patients were male, mean age 44.6 years, with positive serology to human immunodeficiency virus (HIV and promiscuous men who have sex with men (MSM. The initial diagnosis was made by rectosigmoidoscopy indicated for pain and anal discharge. All cases were confirmed by polymerase chain reaction technique in rectal tissue. Endoscopic images obtained showed a great variety of rectal lesions, from mild erythema of the mucosa and ulcers to deep ulcers with elevated borders and purulent exudate. All cases were resolved after treatment with doxycycline for 3 weeks. It emphasizes the importance of suspecting this re-emerging disease in patients with risk factors (HIV and MSM, with the aim of early treatment and to avoid major complications.
López-Vicente, Jorge; Rodríguez-Alcalde, Daniel; Hernández-Villalba, Luis; Moreno-Sánchez, Diego; Lumbreras-Cabrera, Mercedes; Barros-Aguado, Carlos; Galán, Juan Carlos
Lymphogranuloma venereum (LGV) is a sexually transmitted infectious disease caused by serovars L1, L2 and L3 of Chlamydia trachomatis. The initial presentation is usually a painless ulcerated papule on the genitalia or distal proctitis. The progression of the infection can lead to major complications: rectal strictures, intestinal obstruction or perforation. We present five cases of LGV proctitis as the initial presentation of the disease. All patients were male, mean age 44.6 years, with positive serology to human immunodeficiency virus (HIV) and promiscuous men who have sex with men (MSM).The initial diagnosis was made by rectosigmoidoscopy indicated for pain and anal discharge. All cases were confirmed by polymerase chain reaction technique in rectal tissue. Endoscopic images obtained showed a great variety of rectal lesions, from mild erythema of the mucosa and ulcers to deep ulcers with elevated borders and purulent exudate. All cases were resolved after treatment with doxycycline for 3 weeks. It emphasizes the importance of suspecting this re-emerging disease in patients with risk factors (HIV and MSM), with the aim of early treatment and to avoid major complications.
Hidden risks for pneumonia in Malawi. 06 Fullerton', SB Gordon2. 1. Department of ... cal but unseen risk factors for pneumonia. This paper reviews how recent research in Malawi and ..... Gyorkey F, Lahart C, Rossen RD. The effect of HIV infection on phagocytosis and killing of Staphylococcus aureus by human. 51. 52. 54.
Award-winning abstracts from the first Paediatric and Child Health Association of Malawi Conference. Theme: Using a multidisciplinary team approach to improve child health outcomes throughout Malawi. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Kalanda, Boniface F.; Verhoeff, Francine H.; Brabin, Bernard J.
BACKGROUND: The anthropometry of adolescent pregnancy has been little described in developing countries. This paper outlines the anthropometry of adolescents living in poor rural communities in southern Malawi. METHODS: A cross-sectional descriptive analysis of 991 women who attended for their first
children under age 5 years each year1. More than 90% of childhood deaths attributed to rotavirus infection occur in developing countries, making prevention by vaccination a priority in such settings. This review chronicles the history of rotavirus research in Malawi, from its first identification in the stools of diarrhoeic children ...
There has been a common narrative that low-income countries do not have the necessary doctors to service their health sectors because of low production from medical schools as well as the brain drain. Malawi does not have a brain drain problem but it does have other challenges. Research shows that Malawian health.
Malawi is one of the poorest countries in Africa with a high population density and HIV prevalence. Most smallholder farmers grow maize as a staple, which is highly dependent on the uni-modal rainfall and off-farm inputs. The ‘New Variant Famine’ hypothesis argues that AIDS has aggravated food
Smith, William C.; Ikoma, Sakiko; Baker, David P.
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…
Full Text Available Challenges for the Dutch Reformed Church in Southern Africa with Malawi and Zambia as illustration areas What will be the challenges for the Dutch Reformed Church in South Africa if in the coming decades its isolation from Africa could be ended because of political developments in a post-apartheid era? The Dutch Reformed Church planted indigenous churches in many African Countries like Botswana, Malawi, Zimbabwe, Zambia, Mozambique and Namibia. The role of the church in Africa will be determined by its relations with these younger churches. The challenges in the fields of evangelism, church ministry, the youth and in the socioeconomic and political areas are illustrated specifically in the cases of Malawi and Zambia.
Carr, Stephen; Kool, Hanna; Giller, K.E.
Not everyone dealing with agricultural issues in Malawi appreciates the fact that smallholders in this country face challenges which are unique in Africa. No other country in Sub-Saharan Africa has population densities of up to 250 to the square km combined with a single rainy season of five months.
This report summarizes the training and educational courses for Asian countries carried out in Japan by the related institutions. The 2nd Workshop on Human Resources Development in the Nuclear Field was held on 27 and 28 of November 2000, based on FNCA (Forum for Nuclear Cooperation in Asia) organized by the Nuclear Energy Commission, and then the following day ''The Present Status of the International Training and Education in Japan for Asian Countries'' was reported for Asian participants on 29, November. This report is the Japanese edition of the handout distributed at the meeting. I believe it can be helpful for the related institutions in Japan to support the human resources development in the nuclear field efficiently and effectively in future. (author)
Emmanuel, Nikolas G.
Donors hope that their foreign aid can be influential, far beyond the development projects that they fund. Frequently, aid providers attach political conditions to their monies in the hope that these demands can serve as catalysts to improve the governance in the recipient. This is called a polit...... factors were critical in this process: 1) aid dependency, 2) donor coordination, and 3) a strong and persistent domestic opposition. With their combined weight, foreign donors and Malawian civil society were able to change the tide in this once highly authoritarian country....
Nielsen, Line; Damsgaard, Mogens Trab; Meilstrup, Charlotte; Due, Pernille; Madsen, Katrine Rich; Koushede, Vibeke; Holstein, Bjørn Evald
This comparative study examines absolute and relative socioeconomic differences in emotional symptoms among adolescents using standardised data from five Nordic countries and gives recommendations on how to present socioeconomic inequality. The Health Behaviour in School-aged Children (HBSC) international cross-sectional study from 2005/2006 provided data on 29,642 11-15-year-old adolescents from nationally random samples in Denmark, Finland, Iceland, Norway and Sweden. The outcome was daily emotional symptoms. Family Affluence Scale (FAS) was used as indicator of socioeconomic position. We applied four summary measures of inequality: Prevalence Difference, Odds Ratio, Slope Index of Inequality and Relative Index of Inequality, and presented the socioeconomic inequality by a graphical illustration of the prevalence of emotional symptoms, the size of the FAS groups and the summary indices of inequality in each country. The prevalence of emotional symptoms ranged from 8.1% in Denmark to 13.2% in Iceland. There were large country variations in the size of the low FAS-group ranging from 2% in Iceland to 12% in Finland. The largest absolute and relative socioeconomic inequalities were found in Iceland and the smallest in Finland for girls and in Denmark for boys. Emotional symptoms were more common among nordic adolescents from low affluence families this association appeared in the study of both absolute and relative inequality. A comprehensive presentation of socioeconomic inequality should include the prevalence of the health outcome, the size of the socioeconomic groups, and the regression line representing the summary indices of inequality. © 2014 the Nordic Societies of Public Health.
Thornton, Arland; Pierotti, Rachael S; Young-DeMarco, Linda; Watkins, Susan
This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between
Pierotti, Rachael S.; Young-DeMarco, Linda; Watkins, Susan
This paper examines the extent to which developmental idealism has been disseminated in Malawi. Developmental idealism is a set of beliefs and values about development and the relationships between development and family structures and behavior. Developmental idealism states that attributes of societies and families defined as modern are better than attributes defined as traditional, that modern societies help produce modern families, that modern families facilitate the achievement of modern societies, and that the future will bring family change in the direction of modernity. Previous research has demonstrated that knowledge of developmental idealism is widespread in many places around the world, but provides little systematic data about it in sub-Saharan Africa or how knowledge of it is associated with certain demographic characteristics in that region. In this paper, we address this issue by examining whether ordinary people in two settings in Malawi, a sub-Saharan African country, have received and understood messages that are intended to associate development with certain types of family forms and family behaviors. We then examine associations between demographic characteristics and developmental idealism to investigate possible mechanisms linking global discourse about development to the grassroots. We analyze data collected in face-to-face surveys from two samples of Malawian men in 2009 and 2010, one rural, the other in a low-to-medium income neighborhood of a city. Our analysis of these survey data shows considerable evidence that many developmental idealism beliefs have been spread in that country and that education has positive effects on beliefs in the association between development and family attributes. We also find higher levels of developmental idealism awareness in the urban sample than we do in the rural sample, but once dissimilarities in education and wealth between the two samples are controlled, awareness levels no longer differed between
Iqbal, Nayyar; Basheer, Aneesh; Mookkappan, Sudhagar; Ramdas, Anita; Varghese, Renu G'Boy; Padhi, Somanath; Shrimanth, Bhairappa; Chidambaram, Saranya; Anandhalakshmi, S; Kanungo, Reba
Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. We aim to describe the clinical, laboratory and pathological features of patients hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013. Seven of 88 (8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality while leucopenia was rare. Transaminase elevation was almost universal. S. Typhi and S. Paratyphi A were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi A and histiocytic hemophagocytosis was noted in two cases. FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia, and presence of thrombocytopenia, bicytopenia or pancytopenia. In addition, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.
Millennium Challenge Corporation — Social Impact was contracted by MCC to develop and conduct an evaluation of the Malawi Compact. Specifically, SI has been tasked to “assess the program design and...
Full Text Available BACKGROUND: In high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs. However, research on news coverage of health in LMICs is scarce. PRINCIPAL FINDINGS: The present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 - December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with 'disease, disaster and despair' news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs. SIGNIFICANCE: Media consumers' perceptions of disease burdens in LMICs and of these nations' capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and
Imison, Michelle; Chapman, Simon
In high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs). However, research on news coverage of health in LMICs is scarce. The present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 - December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s) it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with 'disease, disaster and despair' news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs. Media consumers' perceptions of disease burdens in LMICs and of these nations' capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and fundraising efforts.
Mitigating Negative Externalities Affecting Access and Equity of Education in Low-Resource Countries: A Study Exploring Social Marketing as a Potential Strategy for Planning School Food Programs in Malawi
School feeding programs enhance the efficiency of the education system by improving enrollment, reducing dropouts and increasing perseverance. They also have the potential to reach the poor, directly making them an effective social safety net. In many low-resource countries, school feeding programs are designed to protect children from the effects…
However, men felt more comfortable to disclose to their spouses than women, who were fearful of being blamed for bringing HIV into the family. Conclusion: Though the understanding of the illness and the ART therapy is good, the high cost of accessing ART presents a threat to adherence for most female and male patients.
Datta, Niloy R., E-mail: email@example.com [Centre for Radiation Oncology, Kantonsspital Aarau - Kantonsspital Baden, Kantonsspital Aarau, Aarau (Switzerland); Samiei, Massoud [Consultancy Practice, Vienna (Austria); Bodis, Stephan [Centre for Radiation Oncology, Kantonsspital Aarau - Kantonsspital Baden, Kantonsspital Aarau, Aarau, Switzerland, and Department of Radiation Oncology, University Hospital Zurich (Switzerland)
Purpose: Radiation therapy, a key component of cancer management, is required in more than half of new cancer patients, particularly in low- and middle-income countries (LMICs). The projected rise in cancer incidence over the next decades in LMICs will result in an increasing demand for radiation therapy services. Considering the present cancer incidence and that projected for 2020 (as listed in GLOBOCAN), we evaluated the current and anticipated needs for radiation therapy infrastructure and staffing by 2020 for each of the LMICs. Methods and Materials: Based on World Bank classification, 139 countries fall in the category of LMICs. Details of teletherapy, radiation oncologists, medical physicists, and radiation therapy technologists were available for 84 LMICs from the International Atomic Energy Agency–Directory of Radiotherapy Centres (IAEA-DIRAC) database. Present requirements and those for 2020 were estimated according to recommendations from the IAEA and European Society for Radiotherapy and Oncology (ESTRO-QUARTS). Results: Only 4 of the 139 LMICs have the requisite number of teletherapy units, and 55 (39.5%) have no radiation therapy facilities at present. Patient access to radiation therapy in the remaining 80 LMICs ranges from 2.3% to 98.8% (median: 36.7%). By 2020, these 84 LMICs would additionally need 9169 teletherapy units, 12,149 radiation oncologists, 9915 medical physicists, and 29,140 radiation therapy technologists. Moreover, de novo radiation therapy facilities would have to be considered for those with no services. Conclusions: Twelve pragmatic steps are proposed for consideration at national and international levels to narrow the gap in radiation therapy access. Multipronged and coordinated action from all national and international stakeholders is required to develop realistic strategies to curb this impending global crisis.
The Soil and Terrain database for Malawi (version 1.0), at scale 1:1 million, was compiled based on the soil map of Malawi at scale 1:250,000 (compiled by the Land Resources Evaluation Project) that was complemented with soil boundary information from the provisional soil map at scale 1:1 million.
Although Malawi started a Medical College in 1991 to train medical doctors, it continues to face a chronic shortage of medical staff. Malawi Medical Journal Vol. 20 (3) 2008: pp. 74-77. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury ...
taken by Malawi under the leadership of President Bingu wa Mutharika in 2011 and President Joyce Banda in .... fact that it is not an easy task to arrest a sitting Head of State due to the fear of conflicting with the government of .... If the answer is in favour of Malawi, then ICC and AU must modify their principles with respect to ...
Dickinson, Natalie; Gulliver, John; MacPherson, Gordon; Atkinson, John; Rankin, Jean; Cummings, Maria; Nisbet, Zoe; Hursthouse, Andrew; Taylor, Avril; Robertson, Chris; Burghardt, Wolfgang
Global food insecurity is associated with micronutrient deficiencies and it has been suggested that 4.5 billion people world-wide are affected by deficiencies in iron, vitamin A and iodine. Zinc has also been identified to be of increasing concern. The most vulnerable are young children and women of childbearing age. A pilot study has been carried out in Southern Malawi, to attempt to link the geochemical and agricultural basis of micronutrient supply through spatial variability to maternal health and associated cultural and social aspects of nutrition. The aim is to establish the opportunity for concerted action to deliver step change improvements in the nutrition of developing countries. Field work undertaken in August 2007 and July/August 2008 involved the collection of blood, soil and crop samples, and questionnaires from ~100 pregnant women. Complex permissions and authorisation protocols were identified and found to be as much part of the cultural and social context of the work as the complexity of the interdisciplinary project. These issues are catalogued and discussed. A preliminary spatial evaluation is presented linking soil quality and food production to nutritional health. It also considers behavioural and cultural attitudes of women and children in two regions of southern Malawi, (the Shire Valley and Shire Highlands plateau). Differences in agricultural practice and widely varying soil quality (e.g. pH organic matter, C/N and metal content) were observed for both regions and full chemical analysis of soil and food is underway. Early assessment of blood data suggests major differences in health and nutritional status between the two regions. Differences in food availability and type and observations of life style are being evaluated through questionnaire analysis. The particular emphasis of the study is on the interdisciplinary opportunities and the barriers to progress in development support in subsistence communities. Engaging at the community level
Theresa J Allain
Full Text Available The epidemic of non-communicable diseases (NCDs in low and middle income countries (LMICs is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a "double burden" of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi's largest hospital.Primary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender.10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs.Infectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.
Full Text Available Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma is a life-threatening and rare condition in western countries with an incidence of less than 3% because of early detection of cirrhosis and neoplasm. Here, we describe a case of a 66-year-old male patient with altered mental status with hemorrhagic shock. Computed tomography scan of abdomen revealed hemoperitoneum and mass in liver. Patient underwent resection of liver tumor and biopsy revealed multinodular hepatocellular carcinoma. A high degree of suspicion is required where severe anemia and hemoperitoneum can be a first presentation for hepatocellular carcinoma especially in patients with chronic hepatitis C infection. Early diagnosis is crucial since mortality rates remain high for untreated cases.
Elizabeth Kamwendo; Lameck Manda; Mphatso Makanda; Isaac Thom Shawa; Daniel Lawadi Banda; G. Tom Heikens
Purpose: Diarrhoea in children is a common problem in low resourced countries including Malawi. It is caused by many intestinal parasites including Cryptosporidium parvum and Isospora belli. Both infections are prevalent in severely immunocompromised individuals and may cause severe life-threatening diarrhoea. The main aim of the study was to assess the prevalence of Cryptosporidium parvum and Isospora belli infections among children presenting with diarrhoea admitted to QECH - paediatrics wa...
Dirk H Mueller
Full Text Available Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres. Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all levels of facilities (e.g. Cotrimoxazole was sufficiently available to treat the average number of patients in only 27% of health centres. Although a few health workers noted some improvement in infrastructure and working conditions, they still considered them to be widely inadequate. In Malawi, as in similar resource poor countries, greater attention needs to be given to the health system constraints to delivering health care. Removal of these constraints should receive priority over the considerable focus on the development and implementation of essential
Malawi has the highest preterm delivery rate in the world. Topic: MATERNAL AND CHILD HEALTH, HEALTH FACILITIES, DECISION MAKING, MALAWI, TRAINING, SOUTHEAST ASIA. Region: Malawi, Canada. Program: Maternal and Child Health. Total Funding: CA$ 981,153.00. Expanding Business Opportunities for ...
Improving high quality, equitable maternal health services in Malawi (IMCHA). Project. Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. Topic: MATERNAL AND CHILD HEALTH, MATERNAL MORTALITY, HEALTH AID, MALAWI, INFORMATION, AFRICA.
Malawi Medical Journal; 26(4) 133-137 December 2014. Health spending 133. MMJ 26(4) December 2014 www.mmj.medcol.mw. Health spending, illicit financial flows and tax incentives in Malawi. Abstract. This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps.
Seventy-one per cent of the graduates had passed through Chancellor College, Zomba, and 27% had attended the Kamuzu Academy, Kasunga, Malawi. So far, most of these graduates have remained in Malawi, working in various locations in government and mission hospitals and at the University of Malawi. Many have ...
in rural Malawi: Lungwena nutrition studies. Background of the studies. Malawi is one of the poorest ... to consider underweight and stunting as being resultant from the same causal factors. The epidemiology of ... a community based nutritional intervention for malnourished children in rural Malawi. The studies are explained ...
Ujjan, Badar; Waqas, Muhammad; Khan, Muhammad Babar; Bakhshi, Saqib Kamran; Bari, Muhammad Ehsan
Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score was 11.6±3.9, mean Marshall Score was 2.26±0.95 and the mean revised trauma score at presentation was 10.58±1.7. Younger age, lower GCS score after resuscitation, lower revised trauma score, absent cisterns on imaging, associated subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) and a lower Marshall score were associated with higher mortality.
Redican, Kerry J; Abbas, Kaja; Elvinger, Francois; Hosig, Kathy; Marmagas, Susan West; Chitsulo, Phindile; Kelly, Patricia; Burton, John; Tlou, Josiah; Carter-Tod, Sheila
A 2-year U.S. Department of State-funded project* was conducted with the purpose of engaging health professionals from Malawi and Zambia who are actively involved in health care and health education for marginalized populations to develop, implement, and evaluate health education and public health interventions/programs. Twenty-six health professionals from Malawi and Zambia, referred to as Global Health Fellows, participated in the 2-year program, of which the main training component was conducted in the United States. Fellows were exposed to health education and public health best practices and developed an action plan to address a health problem of concern in their respective communities/countries. After completion of the program, Fellows received $300 to implement their action plans. Teams of Americans involved in the training program participated in follow-up visits to Malawi and Zambia to observe real-time progress on Fellows' respective action plans. The project was successful in creating an educational experience focused on health education best practices as well as implementation of action plans to address selected health problems in Malawi and Zambia.
Glasson, George E.; Frykholm, Jeffrey A.; Mhango, Ndalapa A.; Phiri, Absalom D.
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.
Brabin, B. J.; Prinsen-Geerligs, P. D.; Verhoeff, F. H.; Fletcher, K. A.; Chimsuku, L. H. E.; Ngwira, B. M.; Leich, O. J.; Broadhead, R. L.
An integrative review of the results of two published and two unpublished studies of anaemia in children, adolescent females, pregnant women and adults living in southern Malawi is presented. Anaemia was universally present in all age-groups, with the higher prevalences in infants (100%) and
Joy E. Hecht
Full Text Available Both development practitioners and conservation organizations are focused on community ownership and management of natural resources as a way to create incentives for the conservation of biodiversity. This has led to the implementation of a number of large community-based conservation projects in sub-Saharan Africa, in countries including Namibia, Zimbabwe, Malawi, Zambia, and Rwanda. While the concept is logical, and valuation studies may suggest that conservation is more valuable than other uses of the resources in some areas, there has been little detailed analysis of the ﬁnancial costs and beneﬁts to the communities, to determine whether they would actually have an incentive to conserve if they had more extensive legal rights to the resources. This paper assesses the conditions under which this approach may be viable, based on a valuation study of the resources of Mount Mulanje in southern Malawi.Les spécialistes du développement et les organisations de conservation s’intéressent à la propriété et à la gestion communautaire des ressources naturelles comme moyen de créer des mesures d’incitation en faveur de la conservation de la biodiversité. Cette approche a conduit à la mise en œuvre d’un certain nombre de grands projets de conservation communautaires en Afrique subsaharienne, notamment en Namibie, au Zimbabwe, au Malawi, en Zambie et au Rwanda. Même si cette approche est logique et si les études d’évaluation semblent suggérer que, dans certaines régions, la conservation est plus utile que l’exploitation des ressources, il existe peu d’analyses détaillées sur les coûts et les avantages financiers que cela engendrerait pour les communautés, analyses qui permettraient de déterminer si le développement des droits légaux des communautés sur ces ressources les inciterait à les conserver. Ce rapport évalue les conditions de viabilité de cette approche sur la base d’une étude d’évaluation des
Taniguchi, Kyoko; Hirakawa, Yukiko
School management in many sub-Saharan African countries has been enhanced through community participation in an attempt to improve education quality. This study uses field research in a rural district of Malawi to assess how community and parent participation differs between schools, the intentions of communities and parents when carrying out…
In this paper, I argue two main points. First, in premarital, sexual partnerships in rural Malawi, the purpose of money exchange extends beyond the alleviation of female partners' economic constraints, and, second, by clarifying this broader purpose, it becomes possible to recognize where women exert control over their own sexual selves. These findings come from field observations and a rich set of in-depth interviews (N=54), bolstered on occasion by survey data, conducted with young women and men, aged 15-24 years, in the Balaka district in the southern region of the country. This research demonstrates that, contrary to typical expectations, money and gift transfers in sexual partnerships are part and parcel of the courting practices of young Malawian women and men. Transfers are as much about the expression of love and commitment as they are about meeting the financial needs of women or the acquisition of sex for men. Using narrative information to shed light on the semiotics of the sex-money link, these findings from Malawi offer a new perspective that broadens usual interpretations of transactional sex, the understanding of which is critical in fighting AIDS.
Holm, Rochelle; Wandschneider, Philip; Felsot, Allan; Msilimba, Golden
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
Nakagomi, Toyoko; Nakagomi, Osamu; Dove, Winifred; Doan, Yen Hai; Witte, Desiree; Ngwira, Bagrey; Todd, Stacy; Steele, A Duncan; Neuzil, Kathleen M; Cunliffe, Nigel A
The human, G1P 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, G1P, G9P, and G8P 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
Schouten Erik J; Jahn Andreas; Ben-Smith Anne; Makombe Simon D; Harries Anthony D; Aboagye-Nyame Francis; Chimbwandira Frank
Abstract The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This sy...
Molebatsi, Tshegofatso Queen
Introduction: Unmet need for family planning is high in most African countries including South Africa and Malawi as witnessed by high levels of teenage pregnancies, unwanted births and unsafe abortion. As such unmet need for family planning was added to the fifth Millennium Development Goal (MDG) as an indicator for tracking progress on improving maternal health. Objective: The primary objective of the study is to determine the correlates of unmet need for family planning among women of re...
Courtright, P; Hoeshcmann, A; Metcalfe, N.; Chirambo, M; Noertjojo, K; Barrows, J; Katz, J
Background/aims: In the coming two decades significant increases in the burden of blindness are anticipated unless concerted efforts are made to improve eye care in developing countries. Evidence of changing prevalence rates or numbers of blind people are few. The change in blindness prevalence and the number of blind people in an adult population of Malawi was measured over a 16 year period.
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
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...
Adhikari, Radha; Grigulis, Astrida
The UK National Health Service has a long history of recruiting overseas nurses to meet nursing shortages in the UK. However, recruitment patterns regularly fluctuate in response to political and economic changes. Typically, the UK government gives little consideration of how these unstable recruitment practices affect overseas nurses. In this article, we present findings from two independent research studies from Malawi and Nepal, which aimed to examine how overseas nurses encountered and overcame the challenges linked to recent recruitment and migration restrictions. We show how current UK immigration policy has had a negative impact on overseas nurses' lives. It has led them to explore alternative entry routes into the UK, affecting both the quality of their working lives and their future decisions about whether to stay or return to their home country. We conclude that the shifting forces of nursing workforce demand and supply, leading to abrupt policy changes, have significant implications on overseas nurses' lives, and can leave nurses 'trapped' in the UK. We make recommendations for UK policy-makers to work with key stakeholders in nurse-sending countries to minimize the negative consequences of unstable nurse recruitment, and we highlight the benefits of promoting circular migration.
The nuclear reactor industry has been in a state of decline for more than a decade in most of the world. The reasons are numerous and often unique to the energy situation of individual countries. Two commonly cited issues influence decisions relating to construction of reactors: costs and the need, or lack thereof, for additional generating capacity. Public concern has ''politicized'' the nuclear industry in many non-communist countries, causing a profound effect on the economics of the option. The nuclear installations and future plans are reviewed on a country-by-country basis for 36 countries in the light of the resources and objectives of each. Because oil and gas for power production throughout the world are being phased out as much as possible, coal-fired generation currently tends to be the chosen alternative to nuclear power production. Exceptions occur in many of the less developed countries that collectively have a very limited operating experience with nuclear reactors. The Chernobyl accident in the USSR alarmed the public; however, national strategies and plans to build reactors have not changed markedly in the interim. Assuming that the next decade of nuclear power generation is uneventful, additional electrical demand would cause the nuclear power industry to experience a rejuvenation in Europe as well as in the US. 80 refs., 3 figs., 22 tabs.
Chai-Adisaksopha, C; Rattarittamrong, E; Norasetthada, L; Tantiworawit, A; Nawarawong, W
Acquired haemophilia A is a rare bleeding disorder caused by autoantibodies against factor VIII (FVIII). There is a scarcity of acquired haemophilia A studies from Asian countries. The aim of this study was to evaluate clinical characteristics and outcomes of acquired haemophilia A among Asian populations. Data were collected from a retrospective case series and combined with a systematic review. The case series included all patients with acquired haemophilia A from 1999 to 2012 at Chiang Mai University Hospital. The systematic review searched MEDLINE and EMBASE databases for relevant keywords. A total of 111 patients were reviewed in this study (including 26 patients from the present series). There were 56 male (50.5%) and 55 female (49.5%) patients. We compared the demographic data with ECAH2 and UKHCDO studies. The weighted mean (SD) age at diagnosis was 58.10 (16.96) years compared with 75.70 (14.47) years in the European series (absolute difference 17.6 years, 95% confidence interval [CI] 14.20–20.99, P = 0.025). The mean (SD) FVIII activity was 2.97 (3.81) IU dL(−1) and the mean (SD) FVIII inhibitor titre was 26.35 (399.16) BU mL(−1). Fifty-six per cent of the patients underwent immunosuppression with steroids alone. The pool complete remission rate was comparable to the European studies, at 67.2% vs. 66.6% respectively (absolute difference 0.7, 95% CI 0.18 to 1.22, P = 0.99). This study reveals a novel finding of younger age at diagnosis of acquired haemophilia A among Asian patients.
Zafar, Shamsa; Jean-Baptiste, Rachel; Rahman, Atif; Neilson, James P.; van den Broek, Nynke R.
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 (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 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
Educational reforms, particularly in a contested subject such as Religious Education (RE), have unsettled boundaries principally because actors demand or expect different outcomes of these reforms. In the cases of Scotland and Malawi the present paper examines how different stakeholders have engaged with RE reforms. It thus ascertains whether, if…
Full Text Available 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 performance assessments, and extreme scrutiny from political parties and the popular press. The purposes of this paper are to (a familiarize the measurement community in the US about Malawi’s assessment programs, (b discuss some of the unique challenges inherent in such a program, (c compare testing conditions and test administration formats between Malawi and the US, and (d provide suggestions for improving large-scale testing in countries such as the US and Malawi. By learning how a small country instituted and supports its current testing programs, a broader perspective on resolving current measurement problems throughout the world will emerge.
Epidemiology of HIV/AIDS in adults in Malawi. E Geubbels, C Bowie. Abstract. No Abstract. Malawi Medical Journal Vol. 18 (3) 2006: pp. 111-133. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v18i3.10917 · AJOL African ...
Khaddoor, Rouba; Al-Amoush, Siham; Eilks, Ingo
This study investigates the nature of intended secondary chemistry curricula, as they are represented by chemistry textbooks, from seven Arabic countries: Algeria, Egypt, Jordan, Kuwait, Palestine, Saudi Arabia and Syria. The curricula are evaluated through analysis of the officially approved 10th grade chemistry textbooks used nationwide in all…
Full Text Available Two case studies are presented here of nitrogen (N dynamics in potato/maize systems. Contrasting systems were investigated from (1 the highland tropics of Dedza, Malawi in southern Africa and (2 the northern temperate Great Lakes region of Michigan. Formal surveys were conducted to document grower perceptions and N management strategies. Survey data were linked with N budgets conducted by reviewing on-farm data from representative farms in the targeted agroecosystems and simulation modeling to estimate N losses. Potential N-loss junctures were identified. Interventions that farmers might accept are discussed. The Malawi system uses targeted application of very small amounts of fertilizer (average 18 kg N ha-1 to growing plants. This low rate is on the steep part of plant response to N curve and should serve to enhance efficiency; plant growth, however, is generally stunted in Malawi due to degraded soils and weed competition. Very limited crop yields reduce N efficiency from a simulated 60 kg grain per kg N to an actual of ~20 kg grain per kg N (at 40 kg N ha-1 applied. Legume-intensified systems could improve growth potential and restore N use efficiency through amelioration of soil quality and transfer functions and from biological fixation N inputs. In the Michigan system, N efficiency is enhanced currently through multiple, split applications of N fertilizer tailored to plant growth rate and demand. Fertilizer N rates used by growers, however, averaged 32% higher than recommended rates and 40% higher than N removed in crop product. Application of 50 kg N ha-1 to cover crops in the fall may contribute to the apparent high potential for N leaching losses. Careful consideration of N credits from legumes and residual soil N would improve N efficiency. Overall, N budgets indicated 0 to 20 kg N ha-1 loss potential from the Malawi systems and tenfold higher loss potential from current practice in Michigan maize/potato rotations. Best management
... Environmental Management Act. Effort should focus on public awareness and human resource capacity development so that the EIA process is diligently executed and that enforcement and follow-ups are properly done by the Department of Environmental Affairs which is a lead agency on environmental issues in Malawi.
The Malawi Journal of Science and technology publishes original articles in science and technology within the following categories: Research Reports Articles of substancial length which include a critical discussion of the results of original experimental or theoretical work. Reviews In-depth treaties on specialised topics ...
theory backed practice would be achieved. KEY TERMS: Malawi, social ... Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages .... social work administration, social work with disabilities and special populations, family and child welfare, life course and ageing ...
and their diet should be supplemented during preg- nancy 16. In Blantyre, Malawi the study by van den Broek et al showed that one third of anaemic women (n=150) had serum vitamin B12 concentrations <148umol/L, which is the accepted lower limit outside pregnancy. When deficiency was defined as serum vitamin B12.
Chowa, Clodina; Garforth, Chris; Cardey, Sarah
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…
policy development for service expansion to advocate modifications in strategies and policies which will facilitate the expansion of child spacing services and promote re- productive healm. Management Structure .... In Malawi the median age at marriage is 17.4, 17 in rural areas. This early marriage leads to early and ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 2 (1992) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Ethics and epidemiological research. T Cullinan. Abstract. No Abstract. Full Text:.
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 2 (1992) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here ...
treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative. PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were sur- veyed to determine actual diagnostic practice. This cross- sectional study identified 150 ...
Abstract. Through preservation, access, use and re-use of documentary heritage can be promised. The paper explored the preservation of documentary heritage in Malawi as there was there is lack of appreciation on the importance of preservation of documentary heritage by policy makers making it a least government ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Respiratory Disease in Malawi 135. Pneumonia is the most common cause of morbidity and mortality in HIV-infected children." HIV infection of children alters the pattern of respiratory il,l.ness.('*l>8 HIV .... infection, Vitamin A deficiency and concomitant viral ..... d ifferences between developing and developed countriesi.
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Cholera Epidemic Control. R Zachariah. Full Text: EMAIL FREE ...
It includes contributions on empirical or theoretical investigations that cover the full range of science and technology, particularly those relevant to Malawi. Full length papers and short communications (500- 800 words) on original research, as well as succinct review articles, will be considered for publication.
chlamydial infections, or trichomoniasis.9 . . ' This association between HIV and other SIDs has been observed in studies in Malawi. Cross-sectional data from Queen. Elizabeth Central Hospital (QECH) in Blantyre shpws signifi- cantly higher prevalences of all common STDs in IlIV-infected antenatal women as compared to ...
2006). In Malawi while archivists appreciate the importance of documentary heritage, policy makers question their relevance. This lack of appreciation leads to inadequate support to the preservation of these precious materials that provide national identity. Documentary heritage have to be appreciated so that preservation ...
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 29, No 3 (2017) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...
Kimura, Masumi [Japan National oil Corp., Tokyo (Japan)
Brazil, Venezuela and Iran made the way to the pair outside release policy one after another between this several years. chauvinism in the flow of a period of big competition has ever come to a deadlock in this. Brazilian oil deposits are 7,300 million bbl in 1997, and it can be never said that it is big in rising oil-producing countries. As for the Venezuelan oil deposits, it is the oil-producing country of a world the 6th prize with 72,600 million bbl, the amount of production is a world the 6th prize with 3.2 million BPD in 1998. As for the Iranian oil deposits, with 89,700 million bbl in a world the 5th prize. The amount of petroleum production is a world the 4th prize with 3.6 million PD in 1998. (NEDO)
Mathanga Don P
Full Text Available Abstract Background In Africa, national governments and international organizations are focusing on rapidly "scaling up" malaria control interventions to at least 60 percent of vulnerable populations. The potential health and economic benefits of "scaling up" will depend on the equitable access to malaria control measures by the poor. This paper analyses the present inequalities in access to malaria interventions in Malawi. Methods Equity in access to malaria control measures was assessed using the Malawi Demographic Health Survey (DHS 2000 and the 2004 national survey on malaria control. Utilisation of malaria control methods was compared across the wealth quintiles, to determine whether the poor were being reached with malaria control measures. Results Overall ITN coverage increased from 5% in 2000 to 35% in 2004. However, there was a disproportionate concentration of ITNs amongst the least poor compared to the poorest group. Effective treatment of fever remains unacceptably low with only 17% of the under-five children being promptly treated with an effective antimalarial drug. And only 29 percent of pregnant women received the recommended dose of at least two doses during the pregnancy. No income related inequalities were associated with prompt treatment and IPT use. Conclusion The present distribution strategies for ITNs are not addressing the needs of the vulnerable groups, especially the poor. Increasing access to ITNs by the poor will require innovative distribution models which deliberately target the poorest of the poor.
Kuuire, Vincent Z; Kangmennaang, Joseph; Atuoye, Kilian N; Antabe, Roger; Boamah, Sheila A; Vercillo, Siera; Amoyaw, Jonathan A; Luginaah, Isaac
As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log-log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.
Neville, Ron; Neville, Jemma
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.
Nampota, Dorothy; Thompson, Jeff; Wikeley, Felicity
Faced with accelerating poverty, the Malawi government has re-awakened its commitment to the development of human capacity and the role of development in this context. This paper explores the relationship between development and science and technology. It goes on to review the country's science and technology needs and how these justify taking developmental action. It concludes that strategies designed to increase access to education should not be limited to the primary sector, but should also include secondary curricula and university science and technology programmes. Drawing on the arguments in the article and personal experience, the authors suggest promoting the development of human capacity in Malawi by creating special "science schools" in the secondary sector and increasing the number of scholarships for university science students.
Full Text Available This paper discusses tomato value chain performance in Malawi and Mozambique using data collected from a market study commissioned by the International Centre for Tropical Agriculture as part of a regional research on conservation agriculture in maize-based farming systems in Sub-Saharan Africa. The results show that Malawi has a slightly higher competitive advantage in the production of tomato compared to Mozambique. Malawi’s relative competitiveness in tomato is mainly due to slightly higher productivity and the cost advantage in labor (low wages and irrigation costs. The paper proposes policy implications aimed at raising the productivity and trade competitiveness of tomato, as this will ensure the overall productivity of the maize-based smallholder farming systems in the two countries.
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
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.
Sitrin, Deborah; Guenther, Tanya; Waiswa, Peter; Namutamba, Sarah; Namazzi, Gertrude; Sharma, Srijana; Ashish, KC; Rubayet, Sayed; Bhadra, Subrata; Ligowe, Reuben; Chimbalanga, Emmanuel; Sewell, Elizabeth; Kerber, Kate; Moran, Allisyn
Background Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW) during pregnancy (0, 1–2, 3+) – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of increasing facility
Lawrence Phiri Captain, Malawi Defense Force Marine Unit B.Sc., Electrical Engineering, University of Malawi, 2007 Submitted in partial fulfillment of...of over 6,000 fighters, attacking railway lines, electrical power lines, schools and hospital infrastructures.96 Malawi as a geographically land...African philosopher: At 4 o’clock in the morning, one day in September in 1973, the security forces raided Moto village in Mangochi District. They
Sambala, Evanson Z; Manderson, Lenore
ABSTRACT Background: In 2006, Malawi developed a national influenza plan to mitigate, prevent and manage the burden of infection should an outbreak occur. In 2009, it translated its contingency plan to respond to the unfolding influenza pandemic. However, little is known of how Malawi translated its national influenza plan into response actions, or the success of these responses. Objective: To investigate how Malawi translated its preparedness plan and so broaden our understanding of the outc...
Wahlström, Helene; Enemark, Heidi L; Davidson, Rebecca K; Oksanen, Antti
When Echinococcus (E.) multilocularis was first detected in mainland Scandinavia in Denmark in 2000, surveillance was initiated/intensified in Sweden, mainland Norway and Finland. After 10 years of surveillance these countries all fulfilled the requirements of freedom from E. multilocularis as defined by the EU, i.e. a prevalence in final hosts <1% with 95% confidence level. However, in 2011 E. multilocularis was detected in Sweden for the first time and surveillance was increased in all four countries. Finland and mainland Norway are currently considered free from E. multilocularis, whereas the prevalence in foxes in Sweden and Denmark is approximately 0.1% and 1.0%, respectively. E. multilocularis has been found in foxes from three different areas in Denmark: Copenhagen (2000), Højer (2012-14) and Grindsted (2014). Unlike Sweden, Norway and Finland, human alveolar echinococcosis (AE) is not notifiable in Denmark, and the number of human cases is therefore unknown. In Sweden, E. multilocularis has been found in foxes in four counties, Västra Götaland, Södermanland, Dalarna (2011) and Småland (2014). E. multilocularis has also been found in an intermediate host in Södermanland (2014). Two cases of AE have been reported in humans (2012), both infected abroad. No cases of E. multilocularis or AE have been reported in Finland and Norway. Recommendations and future considerations are discussed further. Copyright © 2015. Published by Elsevier B.V.
Full Text Available Abstract Background For HIV infected mothers in developing countries, choosing to enroll in a prevention of mother to child transmission (PMTCT of HIV program is supposed to represent the first step towards protecting their child from possible transmission of HIV from mother to child. Counseling and testing enable HIV infected mothers to learn about their status and to obtain the benefits of a PMTCT package. The study on which this article is based explored experiences of HIV positive women and their partners linked to Prevention of Mother to Child Transmission of HIV (PMTCT programs in Chiradzulu district, Southern Malawi. Methods A qualitative study using in-depth interviews (IDIs, focus group discussion (FGDs and case studies was carried at two PMTCT sites. IDIs and FGDs were recorded and transcribed. The case studies involved a deeper inquiry into the past, present and situational factors of selected participants. Results In a context of customary matrilineal kinship, matrilocal residence patterns and complete male absence from the PMTCT program, the demand by the PMTCT program for partner disclosure played up fears of rejection among men given accusations of infidelity by the wives' relatives. This situation led many men to abandon their families. Mothers enrolled in PMTCT programs hence faced not only the fear of transmitting the virus to their infants, but also the loss of income and support associated with a departed husband and the social disgrace of a ruined family. Community members referred to the PMTCT program as 'the divorce program' Conclusions PMTCT programs may vary in effectiveness in different contexts unless they fundamentally respond to socio-cultural factors as lived out in communities they intend to serve. The PMTCT program in rural southern Malawi is a case in point.
Njunga, John; Blystad, Astrid
For HIV infected mothers in developing countries, choosing to enroll in a prevention of mother to child transmission (PMTCT) of HIV program is supposed to represent the first step towards protecting their child from possible transmission of HIV from mother to child. Counseling and testing enable HIV infected mothers to learn about their status and to obtain the benefits of a PMTCT package. The study on which this article is based explored experiences of HIV positive women and their partners linked to Prevention of Mother to Child Transmission of HIV (PMTCT) programs in Chiradzulu district, Southern Malawi. A qualitative study using in-depth interviews (IDIs), focus group discussion (FGDs) and case studies was carried at two PMTCT sites. IDIs and FGDs were recorded and transcribed. The case studies involved a deeper inquiry into the past, present and situational factors of selected participants. In a context of customary matrilineal kinship, matrilocal residence patterns and complete male absence from the PMTCT program, the demand by the PMTCT program for partner disclosure played up fears of rejection among men given accusations of infidelity by the wives' relatives. This situation led many men to abandon their families. Mothers enrolled in PMTCT programs hence faced not only the fear of transmitting the virus to their infants, but also the loss of income and support associated with a departed husband and the social disgrace of a ruined family. Community members referred to the PMTCT program as 'the divorce program' PMTCT programs may vary in effectiveness in different contexts unless they fundamentally respond to socio-cultural factors as lived out in communities they intend to serve. The PMTCT program in rural southern Malawi is a case in point.
Chasukwa Mwalwenje, Yvonne; Chasukwa, Steria
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
Full Text Available BACKGROUND: Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community. METHODOLOGY: A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling "E" chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery. RESULTS: A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7% were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye among persons aged 50 and above was 3.3% (95% CI 2.5-4.1. Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8% and cornea scarring (12.3%. The cataract surgical coverage in blind persons was 44.6%. CONCLUSION: The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi.
Kalua, Khumbo; Lindfield, Robert; Mtupanyama, Maxwell; Mtumodzi, Davie; Msiska, Vincent
Data on prevalence and causes of avoidable blindness in Malawi are not readily available. The purpose of this study was to determine the prevalence and causes of blindness in persons aged 50 and above in southern Malawi to plan eye care services for the community. A population-based survey was conducted in 7 districts in southern Malawi. Villages were selected by probability proportionate to size within each district. Clusters were further subdivided into segments. A predetermined number of segments were selected randomly in each cluster. The survey team moved from house to house in each segment until they had examined 50 people over the age of 50. Examination consisted of visual acuity measurement with tumbling "E" chart and ocular examination by an ophthalmologist. Participants were categorized by visual acuity. Those who were visually impaired (VA<6/18 in the better eye with available correction) were assigned a main cause of visual loss. Further information was sought from anyone who had received cataract surgery. A total number of 3,583 persons aged 50 and above were sampled; among these 3,430 (95.7%) were examined. The prevalence of blindness (presenting visual acuity <3/60 in the better eye) among persons aged 50 and above was 3.3% (95% CI 2.5-4.1). Cataract was the most common cause of blindness contributing to 48.2% of all cases, followed by glaucoma (15.8%) and cornea scarring (12.3%). The cataract surgical coverage in blind persons was 44.6%. The prevalence of blindness and visual impairment in persons aged 50 and above was lower than the WHO estimate for Malawi. The majority of the causes were avoidable, with cataract accounting for approximately half of all cases of blindness. The data suggests that expansion of eye care programs to address avoidable causes of blindness is necessary in this area of southern Malawi.
Bazile, Junior; Rigodon, Jonas; Berman, Leslie; Boulanger, Vanessa M; Maistrellis, Emily; Kausiwa, Pilira; Yamin, Alicia
Maternal mortality, although largely preventable, remains unacceptably high in developing countries such as Malawi and creates a number of intergenerational impacts. Few studies have investigated the far-reaching impacts of maternal death beyond infant survival. This study demonstrates the short- and long-term impacts of maternal death on children, families, and the community in order to raise awareness of the true costs of maternal mortality and poor maternal health care in Neno, a rural and remote district in Malawi. Qualitative in-depth interviews were conducted to assess the impact of maternal mortality on child, family, and community well-being. We conducted 20 key informant interviews, 20 stakeholder interviews, and six sex-stratified focus group discussions in the seven health centers that cover the district. Transcripts were translated, coded, and analyzed in NVivo 10. Participants noted a number of far-reaching impacts on orphaned children, their new caretakers, and extended families following a maternal death. Female relatives typically took on caregiving responsibilities for orphaned children, regardless of the accompanying financial hardship and frequent lack of familial or governmental support. Maternal death exacerbated children's vulnerabilities to long-term health and social impacts related to nutrition, education, employment, early partnership, pregnancy, and caretaking. Impacts were particularly salient for female children who were often forced to take on the majority of the household responsibilities. Participants cited a number of barriers to accessing quality child health care or support services, and many were unaware of programming available to assist them in raising orphaned children or how to access these services. In order to both reduce preventable maternal mortality and diminish the impacts on children, extended families, and communities, our findings highlight the importance of financing and implementing universal access to emergency
Sandra D Reid; Jannel Gentius
.... Data on drinking patterns, injury type, drinking context prior to injury, and demographics were collected from patients presenting with injuries to the Emergency Departments (ED) of four hospitals...
Full Text Available Many Malawian politicians have exploited religious and cultural discourses, encouraging the discourse of the “God-fearing Malawi nation” while also acknowledging the country as a secular state. This discourse – which most recently underwent further development in the early 1980s when Christians and Muslims, funded by donor money, accelerated their evangelical drives in the context of a one-party Malawi – resonates with a patriarchal, conservative political dispensation. This paper traces the evolution of the “God-fearing nation” discourse in Malawian politics. It posits that the government used the “gay rights issue” as a strategy to disorient human rights activists and donors. Gay rights were de-linked from other civil rights, forcing a binary approach toward gay rights, which were seen by government supporters as “anti-Christian”, “anti-Malawian” concepts. The debate with donors enabled the government to claim “sovereign autonomy” and galvanise the population into an anti-aid mentality (better no aid than aid that supports homosexuality.Für ihren Diskurs der “God-fearing Malawi Nation” bedienten sich viele Politiker Malawis an religiösen und kulturellen Debatten, während sie Malawi gleichzeitig als säkularen Staat anerkannten. Dieser Diskurs wurde in den frühen 1980er Jahren fortentwickelt, als Christen und Muslime im Rahmen des malawischen Einparteiensystems – und unterstützt von externen Geldgebern – ihren Glaubenseifer steigerten. In ihm schwingt die Vorstellung partriarchalischer, konservativer politischer Verhältnisse mit. Der vorliegende Beitrag verfolgt die Entwicklung des Diskurses der “God-fearing Nation” in der malawischen Politik. Die Autoren zeigen auf, wie die Regierung die Frage der Rechte für Homosexuelle zur Desorientierung von Menschenrechtsaktivisten und Gebern einsetzte: Die Rechte Homosexueller wurden von den anderen Bürgerrechten getrennt betrachtet und so konnte zu diesen
Fogarty, Linda; Kim, Young Mi; Juon, Hee-Soon; Tappis, Hannah; Noh, Jin Won; Zainullah, Partamin; Rozario, Aleisha
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 Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P 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.
Kongnyuy, Eugene Justine; Mlava, Grace; van den Broek, Nynke
To assess and improve the management of obstructed labour in maternity units in Malawi. A criterion based audit of the management of obstructed labour was conducted in 8 hospitals in three districts in Malawi. Management practices were: (a) assessed by a retrospective review of 44 cases notes, and (b) compared with local standards established, by a multidisciplinary team, based on the Malawi Ministry of Health guidelines and World Health Organisation manuals. Gaps in current practice were identified, reasons discussed, and recommendations made and implemented. A re-audit (41 case notes) was conducted 3 months later. There were significant improvements in the attainment of four standards: draining of urinary bladder (70.5 vs. 90.2%; P = 0.022), administration of broad spectrum antibiotics (72.7 vs. 90.2%; P = 0.039), commencement of Caesarean section within 1 hour or delivery of the foetus within 2 h of diagnosis (38.6 vs. 61.0%; P = 0.023), and maintaining an observation chart (45.5 vs. 61.0%; P audit can improve the management of obstructed labour in countries with limited resources.
Msyamboza, Kelias Phiri; Kagoli, Mathew; M'bang'ombe, Maurice; Chipeta, Sikhona; Masuku, Humphrey Dzanjo
Cholera still remains a significant cause of morbidity and mortality in developing countries, although comprehensive surveillance data to inform policy and strategies are scarce. A desk review of the national cholera database and zonal and districts reports was conducted. Interviews were conducted with district health management teams, health workers, and participants in communities in six districts affected by cholera in 2011/2012 to obtain data on water, sanitation, and sociocultural issues. From 1998 to 2012, cholera outbreaks occurred every year in Malawi, with the highest number of cases and deaths reported in 2001/2002 (33,546 cases, 968 deaths; case fatality rate [CFR] 2.3%). In 2011/2012, cholera outbreak was widespread in the southern region, affecting 10 out of 13 districts, where 1,806 cases and 38 deaths (CFR 2.1%) were reported. Unsafe water sources, lack of maintenance of broken boreholes, frequent breakdown of piped water supply, low coverage of pit latrines (range 40%-60%), lack of hand washing facilities (disease spread, and sociocultural issues were some of the causes of the persistent cholera outbreaks in Malawi. Despite improvements in safe drinking water and sanitation, cholera is still a major public health problem. Introduction of a community-led total sanitation approach, use of social and cultural information in community mobilization strategies, and introduction of an oral cholera vaccine could help to eliminate cholera in Malawi.
Evans, Rhys D R; Cooke, William; Hemmila, Ulla; Calice-Silva, Viviane; Raimann, Jochen; Craik, Alison; Mandula, Chimwemwe; Mvula, Priscilla; Msusa, Ausbert; Dreyer, Gavin; Levin, Nathan W; Pecoits-Filho, Roberto
Obstetric-related acute kidney injury (AKI) is associated with adverse outcomes for mother and fetus, particularly in low-income countries. However, laboratory-independent tools to facilitate diagnosis are lacking. We assessed the diagnostic performance of a salivary urea nitrogen (SUN) dipstick to detect obstetric-related acute kidney disease in Malawi. Women at high risk for AKI admitted to an obstetric unit in Blantyre, Malawi, were recruited between 21 September and 11 December 2015. Patients underwent serum creatinine (SCr) testing alongside measurement of SUN using a dipstick on admission, and every 48 hours thereafter if evidence of kidney disease was found. A total of 301 patients were included (mean age 25.9 years, 11% HIV positive). Of the patients, 23 (7.6%) had AKI, stage 1 in 47.8%, most commonly due to preeclampsia/eclampsia. Mean presenting SCr values were 108.8 ± 21.8 μmol/l (1.23 ± 0.25 mg/dl), 118 ± 34.45 μmol/l (1.33 ± 0.39 mg/dl), and 136.1 ± 30.4 μmol/l (1.54 ± 0.34 mg/dl) in AKI stages 1 to 3 respectively. SUN > 14 mg/dl had a sensitivity of 12.82% and a specificity of 97.33% to detect acute kidney disease; the area under the receiver operating characteristic curve was 0.551. In patients with normal SUN on admission, perinatal mortality was 11.8%, and was 25.0% if SUN was > 14 mg/dl (P = 0.18). The SUN dipstick was specific but insensitive when used to diagnose obstetric-related AKI. Limited biochemical derangement and low salivary urea concentrations due to physiological changes in pregnancy, as opposed to a technical limitation of the dipstick itself, are the likely reason for the lack of sensitivity in this study.
This document discusses some development challenges and research needs related to environmental impact assessment (EIA) in development cooperation. After a general introduction to basic principles of EIA, the document deals with some general conditions for EIA in developing countries and in donor agencies. Through a presentation of experiences with EIA from selected donor agencies (with emphasis on NORAD) the report ends up with focusing on some research issues that may come up with recommendations for improving EIA practices in developing countries and donor agencies. 37 refs., 6 figs., 3 refs.
Phiri, Sam; Zadrozny, Sabrina; Weiss, Helen A; Martinson, Francis; Nyirenda, Naomi; Chen, Cheng-Yen; Miller, William C; Cohen, Myron S; Mayaud, Philippe; Hoffman, Irving F
The World Health Organization recommends the use of syndromic management for patients presenting with genital ulcer disease (GUD) in developing countries. However, effective treatment guidelines depend on a current country-specific GUD etiological profile, which may change over time. From 2004 to 2006, we conducted a cross-sectional analysis of baseline data from patients presenting with GUD at a reference STI clinic in Lilongwe, Malawi. Participants were enrolled in a randomized clinical trial of acyclovir added to syndromic management and followed up for up to 28 days. Serologies for HIV (using parallel rapid tests), herpes simplex virus type 2 (HSV-2; using Focus HerpeSelect IgG2 ELISA [Focus Technologies, Cypress Hill, CA]), and syphilis (rapid plasma reagin confirmed by Treponema pallidum hemagglutination) were determined, with plasma HIV-1 RNA and CD4 count in HIV-positive patients. Genital ulcer disease etiology was determined by real-time multiplex polymerase chain reaction from lesional swabs. A total of 422 patients with GUD (313 men; 74%) were enrolled. Overall seroprevalence of HIV-1, HSV-2, and syphilis were 61%, 72%, and 5%, respectively. Ulcer etiology was available for 398 patients and showed the following: HSV-2, 67%; Haemophilus ducreyi, 15%; T. pallidum, 6%; lymphogranuloma venereum, 6%; mixed infections, 14%, and no etiology, 20%. Most HSV-2 ulcers were recurrent (75%). Among all patients with HSV-2, HIV prevalence was high (67%) and HIV seroprevalence was higher among patients with recurrent HSV-2 compared with patients with first-episode HSV-2 (78% vs. 39%, P ulcers are highly prevalent in this symptomatic population and strongly associated with HIV. Unlike most locations in sub-Saharan Africa, H. ducreyi remains prevalent in this population and requires periodic monitoring and an appropriate treatment regimen.
Full Text Available 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 ( 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.
Simon D Makombe
Full Text Available BACKGROUND: HIV/AIDS is having a devastating effect on the education sector in sub-Saharan Africa. A national survey was conducted in all public sector and private sector facilities in Malawi providing antiretroviral therapy (ART to determine the uptake of ART by teachers and their outcomes while on treatment. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort study was carried out based on patient follow-up records from ART Registers and treatment master cards in all 138 ART clinics in Malawi; observations were censored on September 30(th 2006. By this date, Malawi's 102 public sector and 36 private sector ART clinics had registered a total of 72,328 patients for treatment. Of these, 2,643 (3.7% were teachers. Adjusting for double-registration caused by clinic transfers, it is estimated that 2,380 individual teachers had ever accessed ART. There were 15% of teachers starting ART in WHO clinical stage 1 or 2 with a CD4-lymphocyte count of
Sambala, Evanson Z; Manderson, Lenore
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
... of the economy of Malawi, accounting for over 70% of export earnings. Start Date: February 7, 2008. End Date: May 31, 2010. Topic: INDUSTRIAL CROPS, SUBSTITUTE PRODUCTS, GROUNDNUTS, TOBACCO. Region: Malawi, North of Sahara, South of Sahara, Bangladesh, Kenya. Program: Maternal and Child Health.
This review paper covers the issues of pit latrine emptying national policies and regulations with a focus on Malawi and Zambia. ... national policies and regulations taking faecal sludge management into account are weak and have wide gaps in the two study ...... Conference, Hanoi, Vietnam. Malawi Government (2004).
High adolescent fertility is recognized as a global challenge given its adverse consequences. As such understanding the factors that influence adolescent fertility is critical to addressing this challenge. This study aims at examining the causes of adolescent fertility in Malawi using the 2010 Malawi Demographic and Health ...
Editorials Einstein and the Health Service, e=mc2. E Molyneux. Tuberculosis in Malawi. F M Salaniponi, A D Harries. An interview with Jonathan Mwangata. Grace Malenga. Articles HIV seroprevalence in patients with tuberculosis in Malawi, EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT ...
In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality.
Combinaison de la chaîne de valeur du poisson après récolte et des interventions favorisant le changement social en Zambie et au Malawi (CultivAf). Project. Bien que les ressources ... Sujet: Food security, NUTRITION POLICY, CROP DIVERSIFICATION, MATERNAL AND CHILD HEALTH. Région: Africa, Malawi, South of ...
Project. Tobacco is the mainstay of the economy of Malawi, accounting for over 70% of export earnings. Start Date: February 7, 2008. End Date: May 31, 2010. Topic: INDUSTRIAL CROPS, SUBSTITUTE PRODUCTS, GROUNDNUTS, TOBACCO. Region: Africa, Malawi, South of Sahara. Program: Maternal and Child Health.
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 15, No 1 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Ankylosing spondylitis in a Malawian. NC Mkandawire. Abstract. [Malawi Med J ...
in Malawi who are less or not reached by vaccination services by using data from the ... urban) and mother's education are major determinants of ..... (1999). Immunisation in Malawi: quality of care, social demand and sustainability of vaccination services. Amsterdam: Het Spinhuis. Chilowa, W. and A. Munthali. 1999.
Lake Malawi Tilapia (chambo) fish species is widely consumed and forms the most important commercial fishery in Lake Malawi. However, as a highly perishable commodity, knowledge regarding how long fresh fish would remain in acceptable and safe condition in storage is indispensable for consumers and processors.
However, about 300 million couples in the developing world still do not have access to family planning and this figure is rising by the year. MSI is working to provide family health services to help satisfy this un-met need. Marie Stopes International (MSI) in Malawi. Marie Stopes International first become involved in Malawi.
This paper studies the trends in life expectancy in Malawi since independence and offers possible explanations regarding inter-temporal variations. Descriptive analysis reveals that the life expectancy in Malawi has trailed below the Sub Saharan African average. From the 1960s through to the early 1980s life expectancy ...
Appiah-Yeboah, Shirley Afua
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…
Publications from Malawi, January - June 2001. MJ Sherratt, HK Graham. Structure and Function The Medical Council of Malawi. MJ Manyozo-Phiri, E Gumbo, R Nalikungwi, AS Muula. Student Voice An Elective Experience With the University of Oklahoma. AT Msusa. Letter to the Editor The cost of congenital heart disease.
Many life-saving interventions have been successful in Malawi but they have not been scaled up into routine clinical practice. This project will determine whether a package of neonatal interventions, known as the Malawi Neonatal Package of Care, can be implemented at the health facility level to reduce neonatal mortality.
Costing of Community Health Service Packages - The Malawi Social Action Fund (MASAF) Experience. B Kalanda, C Mandala, M Maoni. Abstract. No Abstract Malawi Medical Journal Vol. 20 (1) 2008 pp. 7-14. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Focus and Scope. The Malawi Journal of Science and Technology (MJST), the research journal of the Faculty of Science, Chancellor College in Malawi is published once or twice in a year depending upon availability of manuscripts and financial support. It includes contributions on empirical or theoretical investigations that ...
The Library Automation project in the University of Malawi is described and analysed in terms of the extent to which it used successful planning techniques. After outlining the background of University of Malawi libraries and general barriers to successful library automation in Africa, the paper examines the extent to which ...
Journalism Practice in Malawi is a textbook written mainly to provide reference material for students of journalism, public relations, media and communications studies in Malawi. It is a seven-chapter book. The chapters are arranged in such a way that one must read them in that order to derive maximum benefit or ...
need to finalize the development of Agroforestry Strategy of Malawi by National. Agroforestry Steering Committee (NASC) of Malawi whose draft was produced in. January 2008. The implementation of National Agroforestry Strategy will involve various stakeholders depending on their strengths. The National Agroforestry.
AMPHIBIA). R. A. STEVENS. Chisambo Tea Estate, P.O. Box 60, Malosa-Mlanje, Malawi. ABSTRACT. Hyperolius spinigularis sp. nov. from Mlanje district of Malawi at ca. 6SS metres, characterised by presence of prominent black asperities on male venter and particularly on gular disc. Descriptions and variations of external ...
there is a lack of a national system of death certification. Two agencies, the Malawi Cancer Registry (MCR) .... about patients, cancer type and stage is developing. However much about the patient pathway ..... References. 1. Msyamboza, K., et al., Burden of cancer in Malawi; common types, incidence and trends: National ...
This article focuses on the decay of almost all of Malawi's indigenous languages with the exception of ciCewa. The languages facing loss and decay have been suppressed, neglected and not developed, particularly since Malawi attained her independence in 1964. This is a crucial matter in issues of national unity, group ...
http://www.prb.org/pdf12/malawi-datasheet-2012.pdf. (Accessed. 14/07/13). 3. Banza L. (firstname.lastname@example.org) Children's disability surgery in. Lilongwe. Email to Harrison W. (email@example.com) 25 May 2013. 4. Mkandewire N, Ngulube C, Lavy C. Orthopaedic Clinical Officer program in Malawi: A Model for providing ...
Recently libraries in Malawi, notably at the University of Malawi, have begun to create the first digital library collections of local documents such as theses, reports, scientific papers, speeches by politicians, and materials on HIV AIDS, reproductive health, and gender issues. Most of these documents were originally in printed ...
Dines, Alison M; Wood, David M; Galicia, Miguel; Yates, Christopher M; Heyerdahl, Fridtjof; Hovda, Knut Erik; Giraudon, Isabelle; Sedefov, Roumen; Dargan, Paul I
Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patients (25, 71.4 %) received no treatment and 30 (85.7 %) were discharged/self-discharged from the ED. There was one fatality amongst these lone-cannabis cases: an 18-year-old male collapsed with an asystolic cardiac arrest whilst smoking cannabis and suffered hypoxic brain injury related to prolonged cardiac arrest. THC was detected in a urine sample taken at ED arrival; no other drugs were detected. Lone acute cannabis toxicity was typically associated with neuro-behavioural symptoms and vomiting. Although uncommon, severe toxicity including cardiovascular toxicity and death may be under-recognised, and it is important that Emergency Physicians are aware of this.
Msyamboza, Kelias Phiri; Mwagomba, Beatrice Matanje; Valle, Moussa; Chiumia, Hastings; Phiri, Twambilire
Cervical cancer is a major public health problem in Malawi. The age-standardized incidence and mortality rates are estimated to be 75.9 and 49.8 per 100,000 population, respectively. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to reduce the morbidity and mortality associated with cervical cancer. In 2013, the country introduced a school-class-based HPV vaccination pilot project in two districts. The aim of this study was to evaluate HPV vaccine coverage, lessons learnt and challenges identified during the first three years of implementation. This was an evaluation of the HPV vaccination project targeting adolescent girls aged 9-13 years conducted in Malawi from 2013 to 2016. We analysed programme data, supportive supervision reports and minutes of National HPV Task Force meetings to determine HPV vaccine coverage, reasons for partial or no vaccination and challenges. Administrative coverage was validated using a community-based coverage survey. A total of 26,766 in-school adolescent girls were fully vaccinated in the two pilot districts during the first three years of the programme. Of these; 2051 (7.7%) were under the age of 9 years, 884 (3.3%) were over the age of 13 years, and 23,831 (89.0%) were aged 9-13 years (the recommended age group). Of the 765 out-of-school adolescent girls aged 9-13 who were identified during the period, only 403 (52.7%) were fully vaccinated. In Zomba district, the coverage rates of fully vaccinated were 84.7%, 87.6% and 83.3% in year 1, year 2 and year 3 of the project, respectively. The overall coverage for the first three years was 82.7%, and the dropout rate was 7.7%. In Rumphi district, the rates of fully vaccinated coverage were 90.2% and 96.2% in year 1 and year 2, respectively, while the overall coverage was 91.3%, and the dropout rate was 4.9%. Administrative (facility-based) coverage for the first year was validated using a community-based cluster coverage survey. The majority of the
Ewout S Schut
Full Text Available We have previously developed and validated a prognostic model to predict the risk for unfavorable outcome in Dutch adults with bacterial meningitis. The aim of the current study was to validate this model in adults with bacterial meningitis from two developing countries, Vietnam and Malawi. Demographic and clinical characteristics of Vietnamese (n = 426, Malawian patients (n = 465 differed substantially from those of Dutch patients (n = 696. The Dutch model underestimated the risk of poor outcome in both Malawi and Vietnam. The discrimination of the original model (c-statistic [c] 0.84; 95% confidence interval 0.81 to 0.86 fell considerably when re-estimated in the Vietnam cohort (c = 0.70 or in the Malawian cohort (c = 0.68. Our validation study shows that new prognostic models have to be developed for these countries in a sufficiently large series of unselected patients.
Williams, B Adam; 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
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. © The Author 2016. Published by
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 3 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Bettega Nadia; Leng Mhoira; Brown Judith; Grant Liz; Murray Scott A
Abstract Background Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. Methods Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health an...
Full Text Available Identification, propagation, and introduction of a nutritionally rich, indigenous plant species in the existing cropping system are presented in this paper as a method of rural nutrition intervention. A case study of Moringa (Moringa oleifera Lam., Moringaceae, which is a common tree in Malawi and one of the richest sources of vitamin A and vitamin C compared to the commonly consumed vegetables is presented to address the problem of vitamin A deficiency. After a brief review of the prevalence of vitamin A deficiency and the efforts to reduce its incidence in Malawi, Moringa is suggested as a potential solution to the problem. A framework for designing nutrition intervention with Moringa is described for actual implementation. It is argued that attempts to identify, document, and encourage the utilization of nutrient-rich indigenous plants could be cost-effective, and a sustainable method of improving the nutritional status of local populations.
Gehani, A A; El-Menyar, Ayman; Elgendy, Islam; Abuzaid, Ahmed; Ahmed, Emad; Haque, Saiful
We evaluated the prevalence and clinical profile of patients with left main coronary artery disease (LMCA) in Qatar between 2006 and 2010. Patients were divided into 2 groups: patients with LMCA and patients without LMCA but had severe 3-vessel disease (VeD) eligible for surgical revascularization. Among 7000 patients who underwent coronary angiography, 210 patients had significant LMCA and 200 patients with severe 3VeD were matched for age and sex. Diabetes mellitus and hypertension were comparable in the 2 groups. Presentations with myocardial infarction or heart failure were comparable in both groups. Isolated LMCA was 4-fold higher in women (P = .02). Dyslipidemia and smoking were more prevalent in patients with distal and proximal lesions, respectively. Renal failure was independent predictor of LMCA (adjusted odds ratio: 2.6; 95% confidence interval: 1.43-4.69). One-year mortality was higher in LMCA (P = .01). The LMCA carries high mortality. Certain cardiovascular risk factors were important predictors of stenosis site.
Pierre Le Pabic
Full Text Available Abstract Background Cichlid fishes from the Rift Lakes of East Africa have undergone the most spectacular adaptive radiations in vertebrate history. Eco-morphological adaptations in lakes Victoria, Malawi and Tanganyika have resulted in a vast array of skull shapes and sizes, yet primary axes of morphological variation are conserved in all three radiations, prominently including the size of the preorbital region of the skull. This conserved pattern suggests that development may constrain the trajectories of cichlid head morphological evolution. Results Here, we (1 present a comparative analysis of adult head morphology in two sand-dweller cichlids from Lake Malawi with preorbital size differences representative of the main axis of variation among the three lakes and (2 analyze the ontogeny of shape and size differences by focusing on known developmental modules throughout the head. We find that (1 developmental differences between the two species correlate with known developmental modules; (2 differences in embryonic cartilage development result in phenotypically integrated changes among all bones derived from a single cartilage, while differences in dermal bone development tend to influence isolated regions within a bone; and lastly (3 species-specific morphologies appear in the embryo as subtle differences, which become progressively amplified throughout ontogeny. We propose that this amplification takes place at skeletal growth zones, the locations and shapes of which are patterned during embryogenesis. Conclusions This study is the most anatomically comprehensive analysis of the developmental differences underlying cichlid skull evolution in the Rift Lakes of East Africa. The scale of our analysis reveals previously unnoticed correlations between developmental modules and patterns of phenotypic integration. We propose that the primary axes of morphological variation among East African cichlid adaptive radiations are constrained by the
Moyer-Lee, Jason; Prowse, Martin
This article applies a global value chain framework to tobacco in Malawi. It illuminates how cigarette manufacturers govern the chain and control first-tier suppliers: the leaf merchants. Due to credence and litigation concerns, manufacturers have become obsessed with leaf integrity. Contract...... farming offers merchants the ability to meet manufacturers’ compliance and traceability requirements. It also offers an opportunity for process and product upgrading by smallholders, but threatens to exclude poorer growers. The article concludes by outlining current contractual practices and the possible...
Chavula, Geoffrey Mudolole
Degradation of land resources in the drainage basin of Lake Malawi and other lakes of the African Rift Valley has been widespread over the past several decades. Causes for this degradation include inappropriate agricultural practices, indiscriminate disposal of wastes, and increasing population pressure. These factors pose serious threats to water quality in these important lakes. It is difficult and costly to monitor relevant water quality conditions, such as concentrations of chlorophyll-alpha in these large lakes using ground-based methods, and consequently, information on temporal and spatial variations in water quality conditions of these water bodies is quite limited. Methods that use satellite-based remote sensing data to infer lake clarity and chlorophyll levels have been developed in recent years and have potential for alleviating the problem of inadequate water monitoring data in large lakes in poor and developing countries. In addition to providing data on water quality and trophic state conditions of lakes, satellite imagery has potential for determining water circulation patterns in lakes through maps of lake surface temperature (LST). In turn, LST can be used to locate upwelling zones that may enhance commercial fishing in large deep lakes. Satellite imagery also may be used to characterize and map land use and land cover (LULC). Such information can serve as a basis for studies of the relationships between changes in LULC and lake conditions, such as lake level and water quality. This paper describes results of research to develop remote sensing tools to improve the understanding and management of Lake Malawi. It includes three major components, namely: estimating chlorophyll-alpha concentrations in Lake Malawi from MODIS/Terra satellite imagery; assessing the accuracy of existing split-window algorithms to estimate lake surface temperature from AVHRR and MODIS/Terra satellite data; and determining trends in forest cover and other categories of land
Terhi J Lohela
Full Text Available 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.
Blaauw, Duane; Ditlopo, Prudence; Maseko, Fresier; Chirwa, Maureen; Mwisongo, Aziza; Bidwell, Posy; Thomas, Steve; Normand, Charles
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, pjob 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
Emelda A Okiro
Full Text Available 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.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.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.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
Chaulagai, Chet N; Moyo, Christon M; Koot, Jaap; Moyo, Humphrey B M; Sambakunsi, Thokozani C; Khunga, Ferdinand M; Naphini, Patrick D
As in many developing countries, lack of reliable data and grossly inadequate appreciation and use of available information in planning and management of health services were two main weaknesses of the health information systems in Malawi. Malawi began strengthening its health management information system with an analysis of the strengths and weaknesses of existing information systems, sharing findings with all stakeholders. All were agreed on the need for reformation of various, vertical programme-specific information systems into a comprehensive, integrated, decentralized and action-oriented simple system. As a first step towards conceptualization and design of the system, a minimum set of indicators was identified and a strategy was formulated for establishing a system in the country. The design focused only on the use of information in planning, management and the improvement of quality and coverage of services. All health and support personnel were trained, employing a training of trainers cascade approach. Information management and use was incorporated into the pre-service training curriculum and the job description of all health workers and support personnel. Quarterly feedback, supportive supervision visits and annual reviews were institutionalized. Civil society organizations were involved in monitoring coverage of health services at local levels. A mid-term review of the achievements of the health information system judged it to be one of the best in Africa. For the first time in Malawi, the health sector has information by facility by month. Yet very little improvement has been noted in use of information in rationalizing decisions. The conclusion is that, no matter how good the design of an information system, it will not be effective unless there is internal desire, dedication and commitment of leadership to have an effective and efficient health service management system.
Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylène; Muula, Adamson S; Dzowela, Titha; Hanson, Kara
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.
Okiro, Emelda A.; Kazembe, Lawrence N.; Kabaria, Caroline W.; Ligomeka, Jeffrey; Noor, Abdisalan M.; Ali, Doreen; Snow, Robert W.
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 Pmalaria 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 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
John W. King and Kathryn Moran
Full Text Available Introduction Lake Malawi, located in the southern part of the East African Rift Valley, is one of the world’s largest, deepest (700 m and oldest (>7 Ma lakes and is renowned for its biodiversity, especially its unique ecosystem including hundreds of species of fi sh and invertebrates found nowhere else on Earth. Geologists and paleolimnologists have sought for several decades to establish a high-resolution East African geologic and climatic history through scientific drilling of the East African Rift Valley lakes. The Lake Malawi Scientific Drilling Project reached this goal by acquiring more than 623 m of core at two sites—one highresolution site and one deep site extending back to 1.5 Ma. A total of seven holes, including one hole in 600 m water depth that reached a subbottom depth of 380 m, were cored with an average recovery of 92%. The high-resolution site was triplecoredand extends back ~80 ky. The deep site was double cored in the upper part that covers the past ~200 ky and then single-cored to its target depth of 380 m (Figs. 1 and 2.
Thomas, Kevin J A; Inkpen, Christopher
Using data from Malawi, this study situates the discourse on migration, entrepreneurship, and development within the context of Africa's social realities. It examines self-employment differences among three groups of migrants and corresponding group differences in agricultural and non-agricultural self-employment. International migrants are found to be more engaged in self-employment than internal-migrants. However, our results suggest that previous findings on the development-related contributions of returning migrants from the West need to be appropriately contextualized. When returnees from the West invest in self-employment, they typically shy away from Africa's largest economic sector - agriculture. In contrast, levels of self-employment, especially in agricultural self-employment, are highest among returning migrants and immigrants from other African countries, especially from those nearby. We also underscore the gendered dimensions of migrants' contribution to African development by demonstrating that female migrants are more likely to be self-employed in agriculture than male migrants. Furthermore, as human-capital increases, migrants are more likely to concentrate their self-employment activities in non-agricultural activities and not in the agricultural sector. The study concludes by using these findings to discuss key implications for policy and future research.
Shacham, Enbal; Thornton, Rebecca; Godlonton, Susan; Murphy, Ryan; Gilliland, Jake
Prevalence of HIV in sub-Saharan African countries persists at alarming rates. There are currently four promoted methods to prevent HIV infection: adherence to antiretroviral therapy, male circumcision, pre-exposure prophylaxis and use of condoms. This study aimed to assess the availability and accessibility of one of the prevention efforts, condoms, in Kawale, Lilongwe, Malawi. A total of 220 potential condom-selling establishments were surveyed in 2012. Data were collected with store owners or staff and locations were geocoded to assess store density. Descriptive analyses were conducted. Of those audited, 96 stores sold condoms, 13 of which distributed free condoms. The stores were most often small shops and located in markets or trading centres. Condoms were most often found at the back of the store in an open space. There were approximately 1.2 stores per ¼ mile; 44% of the businesses in the study region carried condoms. This one method of prevention exhibited multiple barriers in this region: few stores sold condoms, high costs, condom locations within stores and limited availability. The limited accessibility is likely to influence social norms surrounding condom use. Future research should incorporate assessing norms and addressing barriers to uptake of HIV prevention efforts. © The Author(s) 2015.
Limaye, Rupali J; Rimal, Rajiv N; Mkandawire, Glory; Roberts, Peter; Dothi, William; Brown, Jane
The generalised AIDS epidemic in Malawi presents many challenges. As communication and advice from parents, peers, and partners are important factors in influencing sexual behaviour, understanding communication may provide insights into behaviour change programming. This mixed-method study used a household survey (n=1812) and 15 focus group discussions from the southern districts of Malawi to explore communication about sex and sexuality. Quantitative study findings point to the idea that self-efficacy, perceived benefits, and injunctive norms about talking about condom use are important factors influencing intentions to discuss condom use with partners. Qualitative study findings found that communication regarding sex between parents and children, partners, and peers was not common, and when there was communication, messages about sex focused on negative consequences of sexual activity. In Malawi, there is a need to increase efficacy in talking about sex and protective sexual behaviours, including condom use. Interventions should include components to increase communication skills, shift norms about sexual communication, and provide alternative mechanisms for individuals to gather pertinent information regarding their sexual behaviour.
Sujet: TOBACCO, SMOKING, Disease control, PREVENTIVE MEDICINE, HEALTH POLICY, PROGRAMME EVALUATION. Région: Burkina Faso, Ghana, ... Sujet: CLIMATE CHANGE, ADAPTATION TO CHANGE, AGRICULTURAL POLICY, FOOD SECURITY, DISASTER PREVENTION. Région: Malawi, Tanzania, North of ...
Topic: CLIMATE CHANGE, ADAPTATION TO CHANGE, NATURAL DISASTERS, DISASTER PREPAREDNESS, DISASTER PREVENTION, DISASTER MANAGEMENT, RESEARCH RESULTS, POLICY MAKING. Region: Kenya, Malawi, Uganda, North of Sahara, South of Sahara. Program: Climate Change. Total Funding: ...
Deraniyagala, Sonali; Kaluwa, Ben
This paper looks at policies for achieving full and productive employment in Malawi. The polices are consistent with ILO's Global Employment Agenda. Monetary and fiscal policies consistent with employment creation is proposed.
Start Date: February 24, 2012. End Date: August 24, 2015. Topic: HIGHER EDUCATION, KNOWLEDGE, AFRICA SOUTH OF SAHARA, INFORMAL SECTOR, INNOVATIONS, DEVELOPMENT POLICY. Region: Botswana, Malawi, Nigeria, Tanzania, Uganda, South Africa, South of Sahara. Program: Networked Economies.
Rogerson, Christian M; Magombo, Alice
.... This article investigates the historical evolution of tourism development in Malawi from its colonial origins to the current phase in which national government is seeking to scale up the tourism sector...
Topic: TOBACCO, TOBACCO INDUSTRY, CROP DIVERSIFICATION. Region: Argentina, Bangladesh, Brazil, India, Kenya, Lebanon, Malawi, Viet Nam. Program: Food, Environment, and Health. Total Funding: CA$ 347,250.00. Livelihood Diversification for Smallholder Tobacco Farmers in South Nyanza, Kenya - Phase I.
the prevalence of childhood deafness in societies similar to Malawi's and extrapolates ... dice chances of admission (personal communication). For those becoming deaf ... people other than his I her immediate family)?. 23. 10, Compared with ...
Kayser, Georgia L; Amjad, Urooj; Dalcanale, Fernanda; Bartram, Jamie; Bentley, Margaret E
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.
, Malawi. B.U.G. Mughogho, I.B.M. Kosamu. Abstract. The provision of potable water in the cities of developing countries has been of concern for a long time. Most of the urban population, especially in unplanned settlements, relies on ...
Full Text Available 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
In countries throughout sub-Saharan Africa, antiretroviral therapy is seen as the solution to not only treat existing patients, but also to prevent the future spread of HIV. New policies for the prevention of mother-to-child transmission place women on lifelong treatment as soon as they are tested HIV positive. This article looks at how women understand this prescription for lifelong treatment. Drawing on interviews with HIV-positive women in Lilongwe, Malawi (N = 65) during July-September 2014, I examine the process of making treatment decisions, and why - despite increased access - women refuse or stop treatment. Using treatment for preventative purposes transforms the experience of HIV from an acute to a chronic condition where both the symptoms of disease and the efficacy of treatment are unclear. Women look for evidence of the cost and benefit of treatment through their personal experiences with illness and drug-taking. For some women, the benefits were clearer: they interpreted past illnesses as signs of HIV infection, and felt healthier and more economically productive afterwards. For others, taking treatment sometimes led to marital problems, and side effects made them feel worse and disrupted their ability to work. While women understand the health benefits of antiretroviral therapy, taking treatment does not always make sense in their present circumstances when there are costly physical and economic repercussions. This study builds on existing sociological research on medical decision-making by situating decisions in a broader political economy of changing HIV policies, economic conditions, and everyday uncertainty. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available IntroductionTo achieve sustained reductions in child mortality in low- and middle-income countries, increased local capacity is necessary. One approach to capacity building is support offered via partnerships with institutions in high-income countries. However, lack of cooperation between institutions can create barriers to successful implementation of programs and may inadvertently weaken the health system they are striving to improve. A coordinated approach is necessary.BackgroundThree U.S.-based institutions have separately supported various aspects of pediatric care at Kamuzu Central Hospital (KCH, the main government referral hospital in the central region of Malawi, for several years. Within each institution’s experience, common themes were recognized, which required attention in order to sustain improvements in care. Each recognized that support of clinical care is a necessary cornerstone before initiating educational or training efforts. In particular, the support of emergency and acute care is paramount in order to decrease in-hospital mortality. Through the combined efforts of Malawian partners and the US-based institutions, the pediatric mortality rate has decreased from >10 to <4% since 2011, yet critical gaps remain. To achieve further improvements, representatives with expertise in pediatric emergency medicine (PEM from each US-based institution hypothesized that coordinated efforts would be most effective, decrease duplication, improve communication, and ensure that investments in education and training are aligned with local priorities.Call to actionTogether with local stakeholders, the three US-based partners created a multi-institutional partnership, Pediatric Alliance for Child Health Improvement in Malawi at Kamuzu Central Hospital and Environs (PACHIMAKE. Representatives from each institution gathered in Malawi late 2016 and sought input and support from local partners at all levels to prioritize interventions, which could
Madagascar. Malawi. Mali. ℓ. Mauritania. Mauritius. Morocco. Mozambique. Nepal†. Niger†. Nigeria. Peru†. Rwanda†. Saint Lucia. Sao Tome and Principe. Senegal. Seychelles. Sierra Leone. Somalia. ℓ. South Africa. South Sudan†. Sri Lanka. St. Kitts and Nevis. Sudan. Swaziland. Tanzania. Togo. Trinidad and Tobago.
Neel M Butala
Full Text Available BACKGROUND: Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI. However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS: Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2 tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01 or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively, although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87, this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55. CONCLUSIONS: We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but
Silva, Romesh; Amouzou, Agbessi; Munos, Melinda; Marsh, Andrew; Hazel, Elizabeth; Victora, Cesar; Black, Robert; Bryce, Jennifer
Most low-income countries lack complete and accurate vital registration systems. As a result, measures of under-five mortality rates rely mostly on household surveys. In collaboration with partners in Ethiopia, Ghana, Malawi, and Mali, we assessed the completeness and accuracy of reporting of births and deaths by community-based health workers, and the accuracy of annualized under-five mortality rate estimates derived from these data. Here we report on results from Ethiopia, Malawi and Mali. In all three countries, community health workers (CHWs) were trained, equipped and supported to report pregnancies, births and deaths within defined geographic areas over a period of at least fifteen months. In-country institutions collected these data every month. At each study site, we administered a full birth history (FBH) or full pregnancy history (FPH), to women of reproductive age via a census of households in Mali and via household surveys in Ethiopia and Malawi. Using these FBHs/FPHs as a validation data source, we assessed the completeness of the counts of births and deaths and the accuracy of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FBH/FPH for rolling twelve-month periods. For each method we calculated total cost, average annual cost per 1,000 population, and average cost per vital event reported. On average, CHWs submitted monthly vital event reports for over 95 percent of catchment areas in Ethiopia and Malawi, and for 100 percent of catchment areas in Mali. The completeness of vital events reporting by CHWs varied: we estimated that 30%-90% of annualized expected births (i.e. the number of births estimated using a FPH) were documented by CHWs and 22%-91% of annualized expected under-five deaths were documented by CHWs. Resulting annualized under-five mortality rates based on the CHW vital events reporting were, on average, under-estimated by 28% in Ethiopia, 32% in Malawi, and 9% in Mali relative
Full Text Available Most low-income countries lack complete and accurate vital registration systems. As a result, measures of under-five mortality rates rely mostly on household surveys. In collaboration with partners in Ethiopia, Ghana, Malawi, and Mali, we assessed the completeness and accuracy of reporting of births and deaths by community-based health workers, and the accuracy of annualized under-five mortality rate estimates derived from these data. Here we report on results from Ethiopia, Malawi and Mali.In all three countries, community health workers (CHWs were trained, equipped and supported to report pregnancies, births and deaths within defined geographic areas over a period of at least fifteen months. In-country institutions collected these data every month. At each study site, we administered a full birth history (FBH or full pregnancy history (FPH, to women of reproductive age via a census of households in Mali and via household surveys in Ethiopia and Malawi. Using these FBHs/FPHs as a validation data source, we assessed the completeness of the counts of births and deaths and the accuracy of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FBH/FPH for rolling twelve-month periods. For each method we calculated total cost, average annual cost per 1,000 population, and average cost per vital event reported.On average, CHWs submitted monthly vital event reports for over 95 percent of catchment areas in Ethiopia and Malawi, and for 100 percent of catchment areas in Mali. The completeness of vital events reporting by CHWs varied: we estimated that 30%-90% of annualized expected births (i.e. the number of births estimated using a FPH were documented by CHWs and 22%-91% of annualized expected under-five deaths were documented by CHWs. Resulting annualized under-five mortality rates based on the CHW vital events reporting were, on average, under-estimated by 28% in Ethiopia, 32% in Malawi, and 9% in
Méjean, Caroline; Traissac, Pierre; Eymard-Duvernay, Sabrina; Delpeuch, Francis; Maire, Bernard
To study how dietary patterns and physical activity vary with acculturation and with past and current exposure to socio-cultural norms of the home country among Tunisian migrants. A retrospective cohort study was conducted using quota sampling (n 150) based on age and residence. Dietary intake was assessed using a validated FFQ. Physical activity level and dietary aspects were compared according to length of residence (acculturation), age at migration (past exposure) and social ties with the home country (current exposure). Tunisian migrant men residing in the South of France. Migrants who had lived in France for more than 9 years had a higher percentage contribution of meat to energy intake (P = 0.04), a higher Na intake (P = 0.04), a lower percentage contribution of sugar and sweets (P = 0.04) and a lower percentage of carbohydrates (P = 0.03) than short-term migrants. Men who migrated before 21 years of age had a higher Na intake than 'late' migrants (P = 0.02). Men who had distant social ties with Tunisia had a lower physical activity level (P = 0.01) whereas men who had close ties had a higher percentage of fat (P = 0.01) and a higher ratio of MUFA to SFA (P = 0.02). Acculturation led to a convergence of some characteristics to those of the host population, while some results (meat and salt consumption) were at variance with other acculturation studies. Past and current exposure to the home country helped maintain some positive aspects of the diet. Nevertheless, present dietary changes in Tunisia could soon lessen these features.
Slekiene, Jurgita; Mosler, Hans-Joachim
Open defecation is a public health problem worldwide. NGOs in developing countries use various approaches to increase latrine coverage, but for little-understood reasons, some of the population does not adopt latrine construction. The objective of our research was to uncover which of the factors predicting latrine construction are relevant to the last nonowners of latrines, termed laggards in the diffusion of innovations theory. In a cross-sectional study, quantitative face-to-face interviews were conducted in households in rural Malawi (N = 824) to assess the behavioral determinants of latrine construction, mental health, and leadership. Around 14% of the households interviewed did not own a latrine. Study results suggest that nonowners have limited economic resources and perceive that latrine construction is expensive, that it is difficult to find money for latrine construction, and that it needs a lot of time and effort. The last nonowners of latrines live in smaller groups than latrine owners, communicate less with others about latrine construction, and are less influenced by the opinion of their leaders. They consist, in particular, of socially vulnerable households, are younger, are less educated, often have more impaired mental health, feel more vulnerable to contracting diseases, are less aware of the latrine construction of others in the village, feel less personally obliged to construct their own latrines, and are less confident in their ability to rebuild latrines damaged by flooding. The study confirmed that the assumptions of the diffusion of innovation theory are useful in combination with the risks, attitudes, norms, abilities, and self-regulation behavior change approach for developing evidence-based behavior change strategies in developing countries.
. Pays. Malawi, Nord du Sahara, Sud du Sahara. Chargé(e) de projet. Linda Kabwato. Institution. Registered Trustees of the Governance and Development Institute. Pays d' institution. malawi. Extrants. Rapports. Political parties brief. Rapports.
injecting drug abusers. KEY WORDS: Malawi, drug abuse, cannabis, HIV epidemiology, non injecting drug use, sexually transmitted infection. INTRODUCTION .... was given the authority to treat the patients with STIs using Malawi government ...
Roberts, J; Sealy, D; Marshak, H Hopp; Manda-Taylor, L; Gleason, P; Mataya, R
Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.
Kollias, C; Banza, L; Mkandawire, N
There is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitment into Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students' choice of careers in surgical disciplines. An on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format by several Malawian Medical Students, and then formal survey testing. Surgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appear to be a factor in specialty choice (p = 0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices. This is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty.
Stanton, Michelle C; Mkwanda, Square; Mzilahowa, Themba; Bockarie, Moses J; Kelly-Hope, Louise A
To quantify the geographical extent of filariasis and malaria control interventions impacting lymphatic filariasis (LF) in Malawi and to produce a multiple intervention score map (MISM) for prioritising surveillance and intervention strategies. Interventions included mass drug administration (MDA) for LF and onchocerciasis, and bed nets and indoor residual spraying (IRS) for malaria. District and subdistrict-level data were obtained from the Ministry of Health in Malawi, the Demographic and Health Survey (DHS) and President's Malaria Initiative reports. Single intervention scores were calculated for each variable based on population coverage thresholds, and these were combined in a weighted sum to form a multiple intervention score, which was then used to produce maps, that is MISMs. Districts were further classified into four groups based on the combination of their baseline LF prevalence and multiple intervention score. The district- and subdistrict-level MISMs highlighted specific areas that have received high and low coverage of LF-impacting interventions. High coverage areas included the LF-onchocerciasis endemic areas in the southern region of the country and areas along the shores of Lake Malawi, where malaria vector control had been prioritised. Three districts with high baseline LF prevalence measures but low coverage of multiple interventions were identified and considered to be most at risk of ongoing transmission or re-emergence. These maps and district classifications will be used by LF programme managers to identify and target high-risk areas that may not have received adequate LF-impacting interventions to interrupt the transmission of the disease.
Taylor, Faith; Malamud, Bruce; Millington, James
This work presents a method to coarsely zone urban areas into different infrastructure typologies, from which physical vulnerability to a range of natural hazards and multi-hazard interactions can be estimated, particularly for developing country contexts where access to data can be a challenge. This work builds upon techniques developed for urban micrometeorology for classifying 12 urban typologies (Stewart and Oke, 2011) using Landsat 8 30 m × 30 m remote sensing imagery (Betchel et al., 2015). For each of these 12 urban typologies, we develop general rules about the presence, type and level of service of 10 broad categories of infrastructure (including buildings, roads, electricity and water), which we refer to as 'urban textures'. We have developed and applied this technique to five urban areas varying in size and structure across Africa: Nairobi (Kenya); Karonga (Malawi); Mzuzu (Malawi); Ibadan (Nigeria) and Cape Town (South Africa). For each urban area, a training dataset of 10 samples of each of the 12 urban texture classes is digitised using Google Earth imagery. A random forest classification is performed using SAGA GIS, resulting in a map of different urban typologies for each city. Based on >1200 georeferenced field photographs and expert interviews for Karonga (Malawi) and Nairobi (Kenya), generally applicable rules about the presence, type and level of service of 12 infrastructure types (the 'urban texture') are developed for each urban typology. For each urban texture, we are broadly reviewing how each infrastructure might be physically impacted by 21 different natural hazards and hazard interactions. This can aid local stakeholders such as emergency responders and urban planners to systematically identify how the infrastructure in different parts of an urban area might be affected differently during a natural disaster event.
Kutcher, Stanley; Udedi, Michael; Gilberds, Heather; Brown, Adena; Chapota, Rex; Perkins, Kevin
Depression is one of the leading contributors to the global burden of disease and often has an onset during adolescence. While effective treatments are available, many low-income countries, such as Malawi, lack appropriately trained health providers in community health settings, and this limits access to effective mental healthcare for young people with depression. To address this need, a Canadian-developed youth depression Pathway to Care Model, linking school-based mental health literacy interventions to training of community healthcare providers, was adapted for use in Malawi and successfully applied. A sample of healthcare providers (N = 25) from community health clinics (N = 9) were trained in the use of comprehensive, systematic clinical interventions, addressing the identification, diagnosis, and treatment of depression in youth who had been referred from schools where mental health literacy interventions had been implemented. Referral outcomes were obtained using a standardised clinical record form. Over 120 clinical outcome forms were available for analysis. Seventy percent of youth referred by their teachers were diagnosed with depression. Most youth diagnosed with depression identified physical symptoms as their primary difficulty. Available standardised outcome measures applied by clinicians indicated that, overall, youth showed positive outcomes as a result of treatment. Community healthcare providers in Malawi were trained in the identification, diagnosis, and treatment of youth depression. When this training was applied in usual clinical care to youth referred from schools, it led to generally favourable clinical outcomes. To our knowledge, this is the first demonstration of a clinically feasible intervention that results in positive outcomes for young people with depression in Malawi, and it may provide a useful model to replicate elsewhere in sub-Saharan Africa.
Munthali, Alister C; Swartz, Leslie; Mannan, Hasheem; MacLachlan, Malcolm; Chilimampunga, Charles; Makupe, Cecilia
This paper explores the barriers which people with disabilities experience in accessing health care services in Malawi. Fifty-two in-depth interviews were conducted with people with various types of disabilities. These interviews were conducted in four districts in Malawi: Blantyre and Phalombe in the Southern Region; Ntchisi in the Central Region, and Rumphi in the North. A team of trained research assistants conducted the interviews. The major challenges that people with disabilities experience include the cost of accessing health care, long distances to health facilities, lack of transport, hilly terrains and flooding of rivers during the rainy season, communication challenges with the health providers and poor attitude of health workers. Some of these challenges are not unique to people with disabilities, but constitute more of a problem among people with disabilities. There is a need to address these challenges through the expansion of the provision of assistive devices, implementing comprehensive outreach services targeting people with disabilities and strengthening the links between key component of access to quality health care. Attitudinal barriers and lack of resources remain major challenges. Implications for rehabilitation Though people with disabilities face challenges accessing health care world-wide, the challenges are greater in low-income countries. The current study in Malawi confirms this. Major challenges include costs of care, transport costs, and inaccessible facilities. Lack of health worker awareness and attitudinal barriers are major issues of concern. It is imperative, given this situation, that effort is spent in Malawi and similar contexts on dealing with issues of stigma and discrimination especially in the health care sector. It is also important to explore cost-effective ways of assisting people with disabilities accessing appropriate transport, which should be seen as part of the healthcare system. Though the cost of providing
Leslie, Hannah H; Fink, Günther; Nsona, Humphreys; Kruk, Margaret E
Ending preventable newborn deaths is a global health priority, but efforts to improve coverage of maternal and newborn care have not yielded expected gains in infant survival in many settings. One possible explanation is poor quality of clinical care. We assess facility quality and estimate the association of facility quality with neonatal mortality in Malawi. Data on facility infrastructure as well as processes of routine and basic emergency obstetric care for all facilities in the country were obtained from 2013 Malawi Service Provision Assessment. Birth location and mortality for children born in the preceding two years were obtained from the 2013-2014 Millennium Development Goals Endline Survey. Facilities were classified as higher quality if they ranked in the top 25% of delivery facilities based on an index of 25 predefined quality indicators. To address risk selection (sicker mothers choosing or being referred to higher-quality facilities), we employed instrumental variable (IV) analysis to estimate the association of facility quality of care with neonatal mortality. We used the difference between distance to the nearest facility and distance to a higher-quality delivery facility as the instrument. Four hundred sixty-seven of the 540 delivery facilities in Malawi, including 134 rated as higher quality, were linked to births in the population survey. The difference between higher- and lower-quality facilities was most pronounced in indicators of basic emergency obstetric care procedures. Higher-quality facilities were located a median distance of 3.3 km further from women than the nearest delivery facility and were more likely to be in urban areas. Among the 6,686 neonates analyzed, the overall neonatal mortality rate was 17 per 1,000 live births. Delivery in a higher-quality facility (top 25%) was associated with a 2.3 percentage point lower newborn mortality (95% confidence interval [CI] -0.046, 0.000, p-value 0.047). These results imply a newborn mortality
Evanson Z. Sambala
Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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
Morgan, Elizabeth A; Sweeney, M Patrick; Tomoka, Tamiwe; Kopp, Nadja; Gusenleitner, Daniel; Redd, Robert A; Carey, Christopher D; Masamba, Leo; Kamiza, Steve; Pinkus, Geraldine S; Neuberg, Donna S; Rodig, Scott J; Milner, Danny A; Weinstock, David M
Diagnostics and supportive care for patients with non-Hodgkin lymphoma (NHL) in lower- and middle-income countries (LMICs) are lacking. We hypothesized that high-throughput transcription-based diagnostics could classify NHL specimens from Malawi amenable to targeted therapeutics. We established tissue microarrays and classified 328 cases diagnosed by hematoxylin and eosin as NHL at University of Malawi College of Medicine using immunohistochemistry (IHC) for conventional markers and therapeutic targets. A subset was analyzed using NanoString-based expression profiling with parsimonious transcriptional classifiers. Overall, 72% of lymphomas were high-grade B-cell tumors, subsets of which were enriched for expression of MYC, BCL2, and/or PD-L1. A 21-gene transcriptional classifier, previously validated in Western cohorts, divided 96% of diffuse large B-cell lymphomas (DLBCLs) with 100% of B-cell lymphomas, unclassifiable, into 1 cluster and 88% of Burkitt lymphomas into a separate cluster. Cell-of-origin categorization of 36 DLBCLs by NanoString lymphoma subtyping test (LST) revealed 69% concordance with IHC. All discordant cases were classified as germinal center B cell-like (GCB) by LST but non-GCB by IHC. In summary, utilization of advanced diagnostics facilitates objective assessment and segregation of biologically defined subsets of NHL from an LMIC without expert review, thereby establishing a basis for the implementation of effective and less toxic targeted agents.
Bryson Gwiyani Nkhoma
Full Text Available The paper examines the progress made regarding the development of small irrigation dams in Malawi with the view of establishing their significance in improving rural livelihoods in the country. The paper adopts a political economy theory and a qualitative research approach. Evidence from Mzuzu Agricultural Development Division (ADD, where small reservoirs acquire specific relevance, shows that despite the efforts made, the development of small dams is making little progress. The paper highlights that problems of top-down planning, high investment costs, negligence of national and local interests, over-dependency on donors, and conflicts over the use of dams – which made large-scale dams unpopular in the 1990s – continue to affect the development of small irrigation dams in Malawi. The paper argues that small irrigation dams should not be simplistically seen as a panacea to the problems of large-scale irrigation dams. Like any other projects, small dams are historically and socially constructed through interests of different actors in the local settings, and can only succeed if actors, especially those from formal institutions, develop adaptive learning towards apparent conflicting relations that develop among them in the process of implementation. In the case of Mzuzu ADD, it was the failure of the government to develop this adaptive learning to the contestations and conflicts among these actors that undermined successful implementation of small irrigation dams. The paper recommends the need to consider local circumstances, politics, interests, rights and institutions when investing in small irrigation dams.
Stewart, Robert C; Umar, Eric; Gleadow-Ware, Selena; Creed, Francis; Bristow, Katie
Quantitative studies have demonstrated that depression and anxiety in the perinatal period are common amongst women in low- and middle-income countries and are associated with a range of psychosocial and health-related stressors. In this exploratory qualitative study conducted in southern Malawi, we investigated the thoughts and emotions experienced by women in pregnancy and the postnatal period, their expectations of support from husband and others, problems and difficulties faced and the impact of these on psychological wellbeing. We conducted 11 focus group discussions with a total of 98 parous women. A thematic analysis approach was used. Three major themes were identified: pregnancy as a time of uncertainty, the husband (and others) as support and stressor, and the impact of stressors on mental health. Pregnancy was seen as bringing uncertainty about the survival and wellbeing of both mother and unborn child. Poverty, lack of support, HIV, witchcraft and child illness were identified as causes of worry in the perinatal period. Husbands were expected to provide emotional, financial and practical support, with wider family and friends having a lesser role. Infidelity, abuse and abandonment were seen as key stressors in the perinatal period. Exposure to stressors was understood to lead to altered mental states, the symptoms of which are consistent with the concept of common perinatal mental disorder. This study confirms and expands on evidence from quantitative studies and provides formative data for the development of a psychosocial intervention for common perinatal mental disorder in Malawi.
Dowling, Stephanie; Rouse, Martin; Farrell, John; Brennan, Darach
International health electives provide doctors and medical students with unique educational experiences. The HSE South East GP training programme in Waterford, Ireland has run a four-month elective to Malawi since 2006, and also ran a four-month placement in Australia between 2004 and 2011. The aim of this study was to see whether these overseas electives provide Irish GP trainees with any positive or negative experiences, and to make recommendations regarding future similar rotations abroad. This study used the Delphi survey technique, a qualitative research method. The first round questionnaire asked about challenges faced while overseas, what the trainees learned, and how the placement influenced their clinical practice on their return to Ireland. Doctors were also asked about the benefits and/or limitations of an overseas placement during GP training. These Irish GP trainees reported very positive outcomes from time spent in Malawi and Australia. They reported improved knowledge and skills, and increased awareness of health issues and cultural differences in another country. Moreover, they had an opportunity to reflect and grow personally as doctors. This is the first study looking at an international health elective as part of a vocational training programme in Ireland.
Gilroy, Kate E; Callaghan-Koru, Jennifer A; Cardemil, Cristina V; Nsona, Humphreys; Amouzou, Agbessi; Mtimuni, Angella; Daelmans, Bernadette; Mgalula, Leslie; Bryce, Jennifer
To assess the quality of care provided by Health Surveillance Assistants (HSAs)-a cadre of community-based health workers-as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted 'gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs. Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessment.
Tebug, Stanly Fon; Kasulo, Victor; Chikagwa-Malunga, Susan; Wiedemann, Steffi; Roberts, David J; Chagunda, Mizeck G G
Milk production in Malawi is still unsatisfactory despite efforts by different stakeholders to boost the dairy sector. To investigate the roots of the problem, a survey on the current production practices and constraints on smallholder dairy farming was conducted in the Northern Region of the country. A total of 210 farmers were interviewed. The results revealed that farmers had small herd sizes in the region with an average of 2.2 ± 0.6 cattle per farmer. Average herd size was larger in male-managed farms than in female-managed farms (2.6 ± 2.8 vs. 1.8 ± 1.3), farmers with more than 5 years of dairy farming experience had larger herds than those with less experience (2.6 ± 2.8 vs. 1.9 ± 1. 2) and farmers who grazed their animals tended to have larger herds than those that stall-fed their animals (4.4 ± 5.1 vs. 1.9 ± 1.3). Average milk production was 8.2 ± 6.5 l per cow per day. Higher average daily milk production was observed in farmers with above primary school education (10.3 ± 8.3 vs. 7.7 ± 5.6), those with dairy farming as main activity (9.3 ± 6.6 vs. 6. 5 ± 6.1) and farmers with more than 2 years of experience in dairy farming (9.3 ± 6.3 vs. 6.1 ± 6.4). Unreliable supply of improved animal genetics, poor animal health, feed shortage and poor prices for milk were considered to be the most important constraints to smallholder dairy farming in descending order.
Feasey, Nicholas A.; Masesa, Clemens; Jassi, Chikondi; Faragher, E. Brian; Mallewa, Jane; Mallewa, Macpherson; MacLennan, Calman A.; Msefula, Chisomo; Heyderman, Robert S.; Gordon, Melita A.
Background. The Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) has routinely collected specimens for blood culture from febrile patients, and cerebrospinal fluid from patients with suspected meningitis, presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, since 1998. Methods. We present bloodstream infection (BSI) and meningitis surveillance data from 1998 to 2014. Automated blood culture, manual speciation, serotyping, and antimicrobial susceptibility testing were performed at MLW. Population data for minimum-incidence estimates in urban Blantyre were drawn from published estimates. Results. Between 1998 and 2014, 167 028 blood cultures were taken from adult and pediatric medical patients presenting to QECH; Salmonella Typhi was isolated on 2054 occasions (1.2%) and nontyphoidal Salmonella (NTS) serovars were isolated 10 139 times (6.1%), of which 8017 (79.1%) were Salmonella Typhimurium and 1608 (15.8%) were Salmonella Enteritidis. There were 392 cases of NTS meningitis and 9 cases of Salmonella Typhi meningitis. There have been 3 epidemics of Salmonella BSI in Blantyre; Salmonella Enteritidis from 1999 to 2002, Salmonella Typhimurium from 2002 to 2008, and Salmonella Typhi, which began in 2011 and was ongoing in 2014. Multidrug resistance has emerged in all 3 serovars and is seen in the overwhelming majority of isolates, while resistance to third-generation cephalosporins and fluoroquinolones is currently uncommon but has been identified. Conclusions. Invasive Salmonella disease in Malawi is dynamic and not clearly attributable to a single risk factor, although all 3 epidemics were associated with multidrug resistance. To inform nonvaccine and vaccine interventions, reservoirs of disease and modes of transmission require further investigation. PMID:26449953
Feasey, Nicholas A; Masesa, Clemens; Jassi, Chikondi; Faragher, E Brian; Mallewa, Jane; Mallewa, Macpherson; MacLennan, Calman A; Msefula, Chisomo; Heyderman, Robert S; Gordon, Melita A
The Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) has routinely collected specimens for blood culture from febrile patients, and cerebrospinal fluid from patients with suspected meningitis, presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, since 1998. We present bloodstream infection (BSI) and meningitis surveillance data from 1998 to 2014. Automated blood culture, manual speciation, serotyping, and antimicrobial susceptibility testing were performed at MLW. Population data for minimum-incidence estimates in urban Blantyre were drawn from published estimates. Between 1998 and 2014, 167,028 blood cultures were taken from adult and pediatric medical patients presenting to QECH; Salmonella Typhi was isolated on 2054 occasions (1.2%) and nontyphoidal Salmonella (NTS) serovars were isolated 10,139 times (6.1%), of which 8017 (79.1%) were Salmonella Typhimurium and 1608 (15.8%) were Salmonella Enteritidis. There were 392 cases of NTS meningitis and 9 cases of Salmonella Typhi meningitis. There have been 3 epidemics of Salmonella BSI in Blantyre; Salmonella Enteritidis from 1999 to 2002, Salmonella Typhimurium from 2002 to 2008, and Salmonella Typhi, which began in 2011 and was ongoing in 2014. Multidrug resistance has emerged in all 3 serovars and is seen in the overwhelming majority of isolates, while resistance to third-generation cephalosporins and fluoroquinolones is currently uncommon but has been identified. Invasive Salmonella disease in Malawi is dynamic and not clearly attributable to a single risk factor, although all 3 epidemics were associated with multidrug resistance. To inform nonvaccine and vaccine interventions, reservoirs of disease and modes of transmission require further investigation. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
Tesfaye, Kindie; Jaleta, Moti; Jena, Pradyot; Mutenje, Munyaradzi
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.
Schulze Schwering, Markus; Schwering, Markus S; Chagaluka, George; Molyneux, Elizabeth
A 3-year-old girl presented to the Eye Hospital, Blantyre, Malawi, with multiple ulcerating lesions on her face and in her eyes. Her skin was freckled, with hypopigmented and hyperpigmented areas (poikilodermia) typical of xeroderma pigmentosa. The tumors on the conjunctiva of the right eye and the lower eyelid of the left eye appeared to be squamous cell carcinomas. Chemotherapy with intravenous 5-flourouracil (1000 mg/m) for 5 days and cisplatin (50 mg/m) for 2 days for 3 cycles every 3 weeks was well tolerated. Good response occurred after 1 cycle and after 2 more courses the tumors had resolved.
Mwaka, Amos Deogratius; Okello, Elialilia Sarikiaeli; Wabinga, Henry; Walter, Fiona M
Symptomatic cervical cancer patients in low- and middle-income countries usually present with late stage disease and have poor survival. We explored the views of cervical cancer patients on their symptom appraisal and interpretations, and their help-seeking including lay consultations. We conducted an in-depth interview study in two northern Ugandan hospitals. Theoretical models underpinned the study guide for data collection and analysis. We used thematic analysis techniques, informed by the theoretical concepts in the Model of Pathways to Treatment. Sub-themes and themes were identified through consensus among investigators. Eighteen women aged 35-56 years, recently diagnosed with cervical cancer were interviewed. Their first symptoms included abnormal vaginal bleeding, offensive vaginal discharge and lower abdominal pain. Most participants did not perceive themselves to be at risk for cervical cancer and they usually attributed the initial symptoms to normal bodily changes or common illnesses such as sexually transmitted diseases. Lay consultations with husbands, relatives and friends were common and often influenced decisions and timing for seeking care. Prompt help-seeking was frequently triggered by perceived life threatening symptoms such as heavy vaginal bleeding or lower abdominal pain; symptom burden sufficient to interfere with patients' work routines; and persistence of symptoms in spite of home-based treatments. Participants did not promptly seek care when they perceived symptoms as mild; interpreted symptoms as due to normal bodily changes e.g. menopause; and attributed symptoms to common illnesses they could self-manage. Their cancer diagnosis was often further delayed by long help-seeking processes including repeated consultations. Some healthcare professionals at private clinics and lower level health facilities failed to recognize symptoms of cervical cancer promptly therefore delayed referring women to the tertiary hospitals for diagnosis and
Kolesar, Robert J; Audibert, Martine; Comfort, Alison B
Cost-effective, innovative approaches are needed to accelerate progress towards ending preventable infant, child and maternal mortality. To inform policy decisions, we conducted a cost-effectiveness analysis of adding urine pregnancy test kits to the maternal and reproductive services package offered at the community level in Madagascar, Ethiopia and Malawi. We used a decision tree model to compare the intervention with the status quo for each country. We also completed single factor sensitivity analyses and Monte Carlo simulations with 10 000 iterations to generate the probability distribution of the estimates and uncertainty limits. Among a hypothetical cohort of 100 000 women of reproductive age, we estimate that over a 1-year period, the intervention would save 26, 35 and 48 lives in Madagascar, Ethiopia, and Malawi, respectively. The Incremental Cost Effectiveness Ratio (ICER) for the cost per life saved varies by country: $2311 [95% Uncertainty Interval (UI): $1699; $3454] in Madagascar; $2969 [UI: $2260; $5041] in Ethiopia and $1228 [UI: $918; $1777] in Malawi. This equates to an average cost per Disability Adjusted Life Year (DALY) averted of $36.28, $47.95 and $21.92, respectively. Based on WHO criteria and a comparison with other maternal, newborn, and child health interventions, we conclude that the addition of urine pregnancy tests to an existing community health worker maternal and reproductive services package is highly cost-effective in all three countries. To optimize uptake of family planning and antenatal care services and, in turn, accelerate the reduction of mortality and DALYs, decision makers and program planners should consider adding urine pregnancy tests to the community-level package of services. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Kongnyuy, Eugene J; Mlava, Grace; van den Broek, Nynke
Conventionally standards for maternity care are developed by a panel of experts (usually obstetricians) and then implemented by a multidisciplinary team. The present study concerns the feasibility of involving health professionals of all grades in the establishment standards for obstructed labour in Malawi. Standards for obstructed labour were developed by a multidisciplinary team involving all cadres of health professionals working in maternity units, as well as hospital managers and policy makers, using evidence from Malawi national guidelines, World Health Organisation manuals and peer-reviewed journals. Each standard consisted of a clear objective with structure, process and outcome criteria. Seven objectives were agreed, and structure, process and outcome criteria were developed for each objective. The standards addressed different aspects of the management of obstructed labour, namely early recognition of prolonged labour by labouring women and traditional birth attendants, early arrival of women to health facilities during labour, proper use of partograph by healthcare providers, proper management of prolonged labour, proper management of obstructed labour, appropriate management of uterine rupture and early delivery of the baby. It is feasible to develop standards of emergency obstetric care in low-income countries using a multidisciplinary team that involves health professionals of all grades. The involvement of all health professionals might promote successful implementation, ownership and sustainability. The involvement of hospital managers and policy makers in the early stages of criteria-based audit might promote support from the hierarchy with regards to the allocation of resources.
Adams, Yenupini Joyce; Stommel, Manfred; Ayoola, Adejoke; Horodynski, Mildred; Malata, Address; Smith, Barbara
The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. Cross-sectional matched-pairs survey design. Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi. Data were collected using an interviewer-administered postpartum care questionnaire from the World Health Organization (WHO) Safe Motherhood Needs Assessment Questionnaires. Data analysis included univariate and multivariate statistics. Women's evaluation of postpartum care assessments received from midwives in rural health facilities prior to discharge included partial assessments of blood pressure (44%), temperature (41%), abdominal examination (50%), vaginal examination/bleeding (46%), breast examination/soreness (34%), and baby examination (77%). Only 16% of the women received all six of these postpartum clinical assessments prior to discharge, while 11% received none. Women also reported that midwives did not: introduce themselves (50%); ask if patients had questions (44%); explain what they were doing (43%); or explain what to expect after delivery (50%). Despite this, 77% of women felt midwives paid close attention to them and 83% gave an overall positive evaluation (3.5-5 on a scale of 1-5). Numbers of postpartum clinical assessments (p = .09) and overall evaluation (p = .71) did not differ between the four health facilities. The top three reasons for husbands' and wives' decisions to return for 1-week postpartum care visits were: being advised to return for care, wanted the mother to be examined, and wanted the baby to
Lowe, R.; Chirombo, J.; Tompkins, A. M.
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
Schulze Schwering, M; Kumar, N; Bohrmann, D; Msukwa, G; Kalua, K; Kayange, P; Spitzer, M S
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 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.
Beston Bille Maonga
Full Text Available Using cross-sectional data, this study analysed the critical and significant socioeconomic factors with high likelihood to determine smallholder farmers’ decision and willingness to adopt jatropha into cropping systems in Malawi. Employing desk study and multi-stage random sampling technique a sample of 592 households was drawn from across the country for analysis. A probit model was used for the analysis of determinants of jatropha adoption by smallholder farmers. Empirical findings show that education, access to loan, bicycle ownership and farmers’ expectation of raising socioeconomic status are major significant factors that would positively determine probability of smallholder farmers’ willingness to adopt jatropha as a biofuel crop on the farm. Furthermore, keeping of ruminant herds of livestock, long distance to market and fears of market unavailability have been revealed to have significant negative influence on farmers’ decision and willingness to adopt jatropha. Policy implications for sustainable crop diversification drive are drawn and discussed.
Jason C Brophy
Full Text Available Pediatric uptake and outcomes in antiretroviral treatment (ART programmes have lagged behind adult programmes. We describe outcomes from a population-based pediatric ART cohort in rural southern Malawi.Data were analyzed on children who initiated ART from October/2003 -September/2011. Demographics and diagnoses were described and survival analyses conducted to assess the impact of age, presenting features at enrolment, and drug selection.The cohort consisted of 2203 children <15 years of age. Age at entry was <1 year for 219 (10%, 1-1.9 years for 343 (16%, 2-4.9 years for 584 (27%, and 5-15 years for 1057 (48% patients. Initial clinical diagnoses of tuberculosis and wasting were documented for 409 (19% and 523 (24% patients, respectively. Median follow-up time was 1.5 years (range 0-8 years, with 3900 patient-years of follow-up. Over the period of observation, 134 patients (6% died, 1324 (60% remained in the cohort, 345 (16% transferred out, and 387 (18% defaulted. Infants <1 year of age accounted for 19% of deaths, with a 2.7-fold adjusted mortality hazard ratio relative to 5-15 year olds; median time to death was also shorter for infants (60 days than older children (108 days. Survival analysis demonstrated younger age at ART initiation, more advanced HIV stage, and presence of tuberculosis to each be associated with shorter survival time. Among children <5 years, severe wasting (weight-for-height z-score = -3.0 was also associated with reduced survival.Cumulative incidence of mortality was 5.2%, 7.1% and 7.7% after 1, 3, and 5 years, respectively, with disproportionate mortality in infants <1 year of age and those presenting with tuberculosis. These findings reinforce the urgent need for early diagnosis and treatment in this population, but also demonstrate that provision of pediatric care in a rural setting can yield outcomes comparable to more resourced urban settings of poor countries.
Background: Traumatic injuries represent a growing portion of the global burden of disease (GBD), implying death and disability for millions of persons. Injuries cause an unmet need for trauma care, treatment and rehabilitation, in particular in low- and middle-income countries (LMIC). This study explored patients´ and professionals´ experiences with lower limb fracture management by skeletal traction in Malawi. This method has been obsolete in high-income countries for decades...
Life history traits, including age, growth, reproduction and diet of Bathyclarias nyasensis from Lake Malawi were studied between December 1996 and November 1998. Owing to reabsorp tion of pectoral spines with increasing fish size, and the relatively low number of spines that could be aged reliably, only otoliths were ...
The paper argues that the maltreatment/cruelty and destruction of animals common in Malawi is rooted in an African form of utilitarian ethics and a biased conception of animals that is promoted by Umunthu/Ubuntu ethical discourse. It explores the possibility of developing or discovering a moral ground for animal ethics ...
Malawi has the highest preterm delivery rate in the world. This, paired with inadequate newborn care at health facilities, results in high rates of infant mortality. Managing the healthcare needs of preterm infants remains a challenge. They face complications during and after birth, and they have an increased risk of death, ...
Journal of Humanities. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 16 (2002) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Music education in Malawi. Robert Chanunkha. Full Text: EMAIL FREE FULL TEXT EMAIL ...
Indigenous knowledge of rural communities in Malawi on socio-economic use, propagation, biology, biodiversity and ecology of Uapaca kirkiana Muell. ... the main non-timber products that contribute to demand for domestication and the attributes preferred by the rural communities for improvement are mainly related to fruit ...
No Abstract Malawi Medical Journal Vol. 20 (1) 2008 pp. 23. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/mmj.v20i1.10952 · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors ...
consists of adding bismuth chelate to the current regime. There have been reports of sequential dosing regimes but most of these make use of more expensive antibiotics not available in Malawi15. 'Functional' dyspepsia. Although there is an association between H pylori and epigastric pain, eradication does not necessarily ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 17, No 1 (2005) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 22, No 1 (2010) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Dec 9, 2010 ... In 2000 Ekwendeni Hospital in northern Malawi set out to improve the child nutrition, food security, and soil fertility of poor farm households. How? By intercropping protein-rich legumes like pigeon pea, soybeans, and groundnuts that fix nitrogen in the soil, thus boosting crop yields while reducing the need ...
Advanced medical imaging technologies are generally unavailable in low income, tropical settings despite the reality that neurologic disorders are disproportionately common in such environments. Through a series of donations as well as extramural research funding support, an MRI facility opened in Blantyre, Malawi in ...
Background: 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 ...
Despite having a well-documented avifauna, some areas of Malawi, such as Vwaza Marsh Wildlife Reserve (986 km²), are still poorly known ornithologically. We spent 12 days in October 2009, before the wet season, and two days in November 2009, after the first rains, documenting the birds of Vwaza. We found six new ...
: small fish, in particular, are a vital source of calcium, vi- tamin A, iron, and zinc. Once caught, most fish are sun-dried, smoked, parboiled, or pan roasted. However, peak fish catch- es in Malawi coincide with seasonal rains and high humidity,.
Abstract. The paper argues that the maltreatment/cruelty and destruction of animals common in Malawi is rooted in an. African form of utilitarian ethics and a biased conception of animals that is promoted by Umunthu/Ubuntu ethical discourse. It explores the possibility of developing or discovering a moral ground for animal ...
A national survey was carried out in all the 103 public sector and 38 private sector facilities in Malawi providing antiretroviral therapy (ART) to determine uptake of ART and subsequent treatment outcomes in police force personnel. All patients registered for ART and their subsequent treatment outcomes were censored on ...
Background: Motivation of health workers is a critical component of performance and is shaped by multiple factors. This study explored factors that influence motivation of health surveillance assistants (HSAs) in Malawi, with the aim of identifying interventions that can be applied to enhance motivation and performance of ...
Music education in primary schools in Malawi is faced with challenges related to its marginalisation, inappropriate policy and implementation, teacher training and motivation. There are curriculum-related problems and a shortage of qualified teachers. In this article a philosophical solution is proposed, as the field of ...
Background Provider initiated testing and counselling (PITC) is recommended for all inpatients in Malawi if they have not been tested in the previous 3 months. However testing rates remain low among children. We audited the effect of implementing a bedside diagnostic HIV testing service to determine if it would improve ...
cruitment, support and supervision, working conditions, and hours for village health volunteers. There is a sound public health policy established in Malawi although there are not enough trained people (or other resources) to teach, counsel, treat, and motivate the community to good health. It has been shown elsewhere that ...
Data for this study were collected using two semi-structured questionnaires. One for journalists and the second for media owners of each the 21 radio stations, six newspapers regular newspapers, and the Ministry of Information which is responsible for the welfare of district information officers and Malawi News Agency staff.
medical, nursing, and physiotherapy students in addition to postgraduate surgical trainees. Between April 2002 and. 2009 BCIH provided a high quality training program for. Orthopaedic Clinical Officers (OCO) in Malawi. Currently, the hospital also offers several international postgraduate opportunities including two annual ...
Introduction This qualitative and quantitative exploratory study was conducted to assess patients'/customers' knowledge, beliefs and practices about antibiotics and other prescription only medication (POM) in 10 community pharmacies in Blantyre, Malawi. Method 5 out of 10 pharmacies were selected by simple random ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 3 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Departmental Snap-shots. Professor BC Msamati. Article Metrics. Metrics Loading .
: small fish, in particular, are a vital source of calcium, vi- tamin A, iron, and zinc. Once caught, most fish are sun-dried, smoked, parboiled, or pan roasted. However, peak fish catches in Malawi coincide with seasonal rains and high humidity,.
May 25, 2017 ... Centre for Medical Education, Queens University Belfast, Belfast, United Kingdom. Introduction. HIV prevalence in children under the age of 15 in Malawi in 2015 was estimated to be 84,000.1 Sixty-one percent of children eligible for antiretroviral therapy (ART) actually received this intervention, compared ...
shapes (1) vulnerability to TB, HIV/AIDS and malaria, (2) access and ... Malawi has a population of about 10 million people'. It is one of .... We stayed at home... ” (in-depth interview, male guardian) . Financial and opportunity costs of accessing care have been identified to be major barriers to early diagnosis and treatment.
ABSTRACT. Background: Antenatal care has been identified as pivotal to improving maternal and child health in Malawi. Though Malawian women consistently seek antenatal care, they rarely do so during their first trimester. The purpose of this study was to identify barriers to antenatal care uptake among Malawian women ...
Malawi faith communities responding to HIV/AIDS: preliminary findings of a knowledge translation and participatory-action research (PAR) project. ... For example, FC leaders wish to know how the message of condom promotion (a behavioural and technical argument) might be grafted onto what they would posit as a moral ...
Hybridisation in learning goes back to medieval times when peripatetic .... Education in Science from Chancellor College. In the 1994 set, a female ... GG Adelola Adeloye. University of Malawi. Bsc Hons. Biology. Chemistry. (4). Bachelor of Education. Science. (4). University of London. Physiology. Bsc Hons. Microbiology.
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...
Hyperolius spinigularis sp. nov. from Mlanje district of Malawi at ca. 6SS metres, characterised by presence of prominent black asperities on male venter and particularly on gular disc. Descriptions and variations of external morphology, colour patterning, sexual dimorphism and dimensions. Juveniles described and ...
Utilization of family members to provide hospital care in Malawi: the role of hospital guardians · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. M Hoffman, I Mofolo, C Salima, I Hoffman, S Zadrozny, F Martinson, C Van Der Horst, 74-78 ...
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 13, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...
MDS in 8110 years. There is some evidence that poor ... by PCR. In resource poor sel tings, none of these tests are .... represent the 27 districts and 4 urban centres of Malawi. ...... h'linistry of Education, Sports and Culture (MQHiSC) Sexuality.
Malawi Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 20, No 1 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load ...
Malawi Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 15, No 1 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your Web ...
(14); Eritrea (1); Ethiopia (30); Ghana (27); Kenya (29); Lesotho (1); Libya (2); Madagascar (1); Malawi (4); Mauritius (3); Mozambique (1); Nigeria (221); Rwanda (3); Senegal (6); Sierra Leone (1); South Africa (96); South Sudan (1); Sudan (3); Swaziland (3); Tanzania (19); Togo (1); Tunisia (2); Uganda (12); Zambia (2) ...
Costing of Community Health Service Packages - The Malawi Social Action Fund (MASAF) Experience · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. B Kalanda, C Mandala, M Maoni, 7-14. http://dx.doi.org/10.4314/mmj.v20i1.10948 ...
Jul 18, 2008 ... considerably to livelihood as a food supplement and for income generation among local communities. However, U. kirkiana trees are not widely ... In Malawi, food shortage period. (October to February) precedes the ... important in order to fulfil aims of conservation and satisfy claims of utilization by the local ...
May 2, 2007 ... In addition, issues of love and companionship, discrimination and the future. Twenty-three ... Keywords: orphans, HIV/AIDS, discrimination, living situation, Malawi ..... things for self. More that half of the children felt that they were treated in a bad or different way within the family or within the household they.
The desire to achieve political stability and economic development, against a changed international political order demanding human rights and good governance in the 1990s, explains the current 'diplomatic' hostility in Malawi's industrial relations. The role of the international donor community in exporting democratic ...
The developmental patterns of carcass traits were studied in _ and 3/4 Boer x Malawi crossbred goats slaughtered at 30, 35 and 40 kg live weights. Empty body, hot and cold carclass weights, and head proportions differed among the three slaughter groups. There were no significant differences in carcass and total internal ...
Cholera is endemic in Malawi with seasonal outbreaks during the wet season. People living around Lake Chilwa rely on the lake for their water supply. From May 2009 to May 2010, a cholera outbreak occurred in fishing communities around Lake Chilwa. This paper describes the outbreak response and lessons learned for ...
Elizabeth B Mapoma
Feb 17, 2014 ... Pritchard et al., 2007). GROUNDWATER QUALITY IN MALAWI. Introductory remarks. As mentioned earlier, spatial variation in chemical and physical quality is attributed to the heterogeneity of the aquifer system, groundwater flow regime and weathering processes (Chilton and Foster, 1995). Some shallow.
The study examined the factors affecting agroforestry technology upscaling and identified gaps in scaling up approaches of agroforestry technologies. One hundred and sixty-four farmers in Malawi Agroforestry Extension (MAFE) project districts of Mzimba, Ntcheu and Mangochi were interviewed. Logistic model was used in ...
School girls are also left out of the family planning service. The prevailing belief is that contraceptive use is not morally acceptable for young people. With a 29% teenage fertility rate, unwanted pregnancy is the commonest cause of school dropout for pupils in Malawi; many of these girls go on to procure unsafe abortions, ...
Data from 2004 Malawi Demographic and Health Survey and multinomial logistic regression were used to assess the association between place of delivery and selected socio-economic factors. The study population comprised of 7,218 women, who had at least one child, aged less than five years, at the time the survey.
They face complications during and after birth, and they have an increased risk of death, chronic medical problems, and malnutrition later in life. Many life-saving interventions have been successful in Malawi but they have not been scaled up into routine clinical practice. This project will determine whether a package of ...
Many have shown encouraging interest in pursuing postgraduate education. In September 1994 the epoch of hybridisation was brought to a close with the admission of the first set of students who will train fully here in Malawi and become our first batch of home-grown doctors. Keywords: medical education, medical school, ...
married people whose cultural background was different from that of the rruyority of people in Malawi. It is not surprising, therefore, that these confusing messages resulted in rumours that Govern- ment was intent on stopping people from having more than a certain number of children. This resulted in a political row which ...
Changes in Escherichia coli resistance to co-trimoxazole in tuberculosis patients and in relation to co-trimoxazole prophylaxis in Thyolo, Malawi · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. R Zachariah, AD Harries, MP Spielmann, V Arendt, D Nchingula, ...
In this article, we report and discuss how a mixed qualitative research method was applied for analyzing maternal and child health policies in Malawi. For the purposes of this article, we do not report research findings; instead we focus our dicussion on the methodology of the study and draw lessons for policy analysis ...
Social work training in Malawi started with a community development certificate in 1964 and later a certificate in social welfare in 1978. In 2006, the first degree programme was introduced. As of 2016, three universities offered degree programmes. Despite this long history, social work has not been fully professionalised.
These regulations directed at minimizing human exposure to aflatoxins results in severe economic loss to producers, processors and marketers of the contaminated crop. A study was conducted in Malawi and Zambia to assess the level of fungal and mycotoxins' contamination in commonly processed cassava products.
This paper highlights the quality of groundwater in basement and alluvial aquifers of Malawi through literature assessment. Groundwater in these aquifers serves about 60% of Malawian population. Alluvial aquifers yield high groundwater in excess of 10 L/s and more mineralized than basement aquifers. The values from ...
INLEIDING. Die vermoede dat daar onder wit send- ingwerkers van die Nederduits Gere- formeerde Kerk (NGK) in Malawi, en op sekere sendingstasies in die besonder,. 'n verhoogde voorkoms van Parkinson- isme is, het gelei tot hierdie navorsing, waartydens 'n ondersoek geloods is na die voorkoms van Parkinsonisme ...
This article provides an account of how the Malawi Library Association (MALA) and its small band of graduate professional librarians (numbering no more than ten in 2005) have provided training at non-graduate certificate level for over 600 Malawians since 1979. MALA was founded in 1976 and inaugurated in 1977.
Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve the quality of health services. Similar initiatives have proven ...
In 2004, the Wellcome Trust and the United Kingdom Department for International Development (DFID) agreed to commit GB £10 million each to a joint program, the Kenya-Malawi Health Research Capacity Strengthening Initiative (HRCS Initiative). IDRC was invited to join the HRCS Initiative as both funder and ...
increase in the number of people living with HIV (PLWH)4-7. In addition, ARVs have decreased perinatal HIV transmission. Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies? B Chimphamba Gombachika2*, E Chirwa2 ,. A Malata3, J Sundby1, H Fjeld1. 1.
Access to land among land-poor households has always been contentious. In Malawi, the government, aware of this, started Community Based Rural Based Land Development Project. (CBRLDP), financed by the World Bank. The project brought to the fore the latent antagonistic relationship between immigrants and host ...
The vulnerability of orphans in Thyolo District, southern Malawi. Å Funkquist, B Eriksson, AS Muula. Abstract. No Abstract. Tanzania Health Research Bulletin Vol. 9(2) 2007: pp.102-109. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Article Metrics. Metrics ...
Contraceptive Knowledge, Beliefs and Attitudes in Rural Malawi: Misinformation, Misbeliefs and Misperceptions. ... The objective of the study was to find out factors that affect the intentions of men and women to use family planning methods. Methods The study was conducted in Mangochi district, the southern region
Background Pregnant women in Malawi consume soil, but the nutritive potential of these soils is uncertain. Methods We collected 'edible' Malawian soil samples from Ndirande, Mpingwe and Soche hills and bought an Indian soil sample from a shop in Limbe and tested them for iron, calcium, zinc, magnesium, lead, pH, ...
ownership of ITNs. In Malawi, ITNs are distributed through the social marketing program. By definition, social marketing dis- criminates against the poor Who may not have disposable income needed to afford health products“. Not surprisingly, by. 2004, only 24% of households in the poorest socio-economic group had ITNs ...
of Accountancy, World University College of. Switzerland ancl the Lester B Pearson College of. Canada. Ben Chosamata of the 1997 group left. Kamuzu Academy for the Malawi College of. Accountancy in Blantyre from where, after spending two terms he was selected to study medicine. The student from Worlcl University.
As a medical student of St Bartholomew's Hospital in. London, I spent my 1967 paediatric elective period in Zululand. (now Kwazulu-Natal), and then travelled northwards with my fellow student John Barrett (now a professor of haematology in ... After spending 30 of the last 40 years working in Malawi's health service, I am ...
Kamwendo, Gregory Hankoni
In 1996, the Ministry of Education in Malawi directed that in future Standards 1 to 4 would be taught through mother tongues. It took eight years before the pilot phase of the language policy could begin. The paper critically analyses this situation using Bamgbose's framework which says that, in Africa, language policies tend to follow one or more…
Genetic diversity and relationships were assessed in 141 locally named banana cultivars growing in five districts of Malawi at 12 microsatellite loci. High allelic diversity (174 alleles) attributable to high frequency of duplicated alleles was observed. Primers discriminating power was high with mean polymorphism information ...
Access to land among land-poor households has always been contentious. In Malawi, the government, aware of this, started Community Based Rural Based Land Development Project (CBRLDP), financed by the World Bank. The project brought to the fore the latent antagonistic relationship between immigrants and host ...
Full Text Available Abstract Background Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals. Methods We obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions. Results There were 610 clinicians (396 clinical officers and 214 physicians, 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7–31.4% of all physicians and clinical officers, 66.5–199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of
Kazembe Lawrence N
Full Text Available Abstract Background Current malaria control initiatives aim at reducing malaria burden by half by the year 2010. Effective control requires evidence-based utilisation of resources. Characterizing spatial patterns of risk, through maps, is an important tool to guide control programmes. To this end an analysis was carried out to predict and map malaria risk in Malawi using empirical data with the aim of identifying areas where greatest effort should be focussed. Methods Point-referenced prevalence of infection data for children aged 1–10 years were collected from published and grey literature and geo-referenced. The model-based geostatistical methods were applied to analyze and predict malaria risk in areas where data were not observed. Topographical and climatic covariates were added in the model for risk assessment and improved prediction. A Bayesian approach was used for model fitting and prediction. Results Bivariate models showed a significant association of malaria risk with elevation, annual maximum temperature, rainfall and potential evapotranspiration (PET. However in the prediction model, the spatial distribution of malaria risk was associated with elevation, and marginally with maximum temperature and PET. The resulting map broadly agreed with expert opinion about the variation of risk in the country, and further showed marked variation even at local level. High risk areas were in the low-lying lake shore regions, while low risk was along the highlands in the country. Conclusion The map provided an initial description of the geographic variation of malaria risk in Malawi, and might help in the choice and design of interventions, which is crucial for reducing the burden of malaria in Malawi.
Full Text Available As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD of health care workers (HCWs remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD.Qualitative evaluations in Malawi, Tanzania and South Africa (RSA were conducted using key informant interviews (KIIs and focus group discussions (FGDs in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach.Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings.To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation
Richard M Chunga
Full Text Available This paper presents the results of a mixed-methods study examining adaptation strategies that property owners in low-income, rapidly urbanizing areas in Malawi adopt to address the limitations of pit latrines, the most common method of disposing human excreta. A particular challenge is lack of space for constructing new latrines as population density increases: traditional practice has been to cap full pits and simply move to a new site, but increasing demands on space require new approaches to extend the service life of latrines. In this context, we collected data on sanitation technology choices from January to September 2013 through 48 in-depth interviews and a stated preference survey targeting 1,300 property owners from 27 low-income urban areas. Results showed that property owners with concern about space for replacing pit latrines were 1.8 times more likely to select pit emptying service over the construction of new pit latrines with a slab floor (p = 0.02 but there was no significant association between concern about space for replacing pit latrines and intention to adopt locally promoted, novel sanitation technology known as ecological sanitation (ecosan. Property owners preferred to adapt existing, known technology by constructing replacement pit latrines on old pit latrine locations, reducing the frequency of replacing pit latrines, or via emptying pit latrines when full. This study highlights potential challenges to adoption of wholly new sanitation technologies, even when they present clear advantages to end users. To scale, alternative sanitation technologies for rapidly urbanising cities should offer clear advantages, be affordable, be easy to use when shared among multiple households, and their design should be informed by existing adaptation strategies and local knowledge.
Chunga, Richard M; Ensink, Jeroen H J; Jenkins, Marion W; Brown, Joe
This paper presents the results of a mixed-methods study examining adaptation strategies that property owners in low-income, rapidly urbanizing areas in Malawi adopt to address the limitations of pit latrines, the most common method of disposing human excreta. A particular challenge is lack of space for constructing new latrines as population density increases: traditional practice has been to cap full pits and simply move to a new site, but increasing demands on space require new approaches to extend the service life of latrines. In this context, we collected data on sanitation technology choices from January to September 2013 through 48 in-depth interviews and a stated preference survey targeting 1,300 property owners from 27 low-income urban areas. Results showed that property owners with concern about space for replacing pit latrines were 1.8 times more likely to select pit emptying service over the construction of new pit latrines with a slab floor (p = 0.02) but there was no significant association between concern about space for replacing pit latrines and intention to adopt locally promoted, novel sanitation technology known as ecological sanitation (ecosan). Property owners preferred to adapt existing, known technology by constructing replacement pit latrines on old pit latrine locations, reducing the frequency of replacing pit latrines, or via emptying pit latrines when full. This study highlights potential challenges to adoption of wholly new sanitation technologies, even when they present clear advantages to end users. To scale, alternative sanitation technologies for rapidly urbanising cities should offer clear advantages, be affordable, be easy to use when shared among multiple households, and their design should be informed by existing adaptation strategies and local knowledge.
Munjanja Stephan P
Full Text Available Abstract Background Verbal autopsy (VA is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deaths from verbal autopsy questionnaires, using data from Malawi, Zimbabwe, and Nepal. Methods We obtained 734 stillbirth and neonatal VAs from recent community studies in rural areas: 169 from Malawi, 385 from Nepal, and 180 from Zimbabwe. Initial refinement of the InterVA model was based on 100 physician-reviewed VAs from Malawi. InterVA indicators and matrix probabilities for cause of death were reviewed for clinical and epidemiological coherence by a pediatrician-researcher and an epidemiologist involved in the development of InterVA. The modified InterVA model was evaluated by comparing population-level cause-specific mortality fractions and individual agreement from two methods of interpretation (physician review and InterVA for a further 69 VAs from Malawi, 385 from Nepal, and 180 from Zimbabwe. Results Case-by-case agreement between InterVA and reviewing physician diagnoses for 69 cases from Malawi, 180 cases from Zimbabwe, and 385 cases from Nepal were 83% (kappa 0.76 (0.75 - 0.80, 71% (kappa 0.41(0.32-0.51, and 74% (kappa 0.63 (0.60-0.63, respectively. The proportion of stillbirths identified as fresh or macerated by the different methods of VA interpretation was similar in all three settings. Comparing across countries, the modified InterVA method found that proportions of preterm births and deaths due to infection were higher in Zimbabwe (44% than in Malawi (28% or Nepal (20%. Conclusion The modified InterVA method provides plausible results for stillbirths and newborn deaths, broadly comparable to physician review but with the advantage of internal consistency. The method allows standardized cross-country comparisons and eliminates the inconsistencies of physician review in such comparisons.
Full Text Available This costing study in Malawi is a first evaluation of a Maternal Influenza Immunization Program Costing Tool (Costing Tool for maternal immunization. The tool was designed to help low- and middle-income countries plan for maternal influenza immunization programs that differ from infant vaccination programs because of differences in the target population and potential differences in delivery strategy or venue.This analysis examines the incremental costs of a prospective seasonal maternal influenza immunization program that is added to a successful routine childhood immunization and antenatal care program. The Costing Tool estimates financial and economic costs for different vaccine delivery scenarios for each of the major components of the expanded immunization program.In our base scenario, which specifies a donated single dose pre-filled vaccine formulation, the total financial cost of a program that would reach 2.3 million women is approximately $1.2 million over five years. The economic cost of the program, including the donated vaccine, is $10.4 million over the same period. The financial and economic costs per immunized pregnancy are $0.52 and $4.58, respectively. Other scenarios examine lower vaccine uptake, reaching 1.2 million women, and a vaccine purchased at $2.80 per dose with an alternative presentation.This study estimates the financial and economic costs associated with a prospective maternal influenza immunization program in a low-income country. In some scenarios, the incremental delivery cost of a maternal influenza immunization program may be as low as some estimates of childhood vaccination programs, assuming the routine childhood immunization and antenatal care systems are capable of serving as the platform for an additional vaccination program. However, purchasing influenza vaccines at the prices assumed in this analysis, instead of having them donated, is likely to be challenging for lower-income countries. This result
Behrman, Julia Andrea
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 adult) sexual behavior. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.
Kerr, Rachel Bezner; Chilanga, Emmanuel; Nyantakyi-Frimpong, Hanson; Luginaah, Isaac; Lupafya, Esther
In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi. A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions. Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders
Rachel Bezner Kerr
Full Text Available Abstract Background In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi. Methods A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions. Results Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men’s family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new ‘emergent’ masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on
Tavory, Iddo; Poulin, Michelle
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.
Lindgren, T G; Deutsch, K; Schell, E; Bvumbwe, A; Hart, K B; Laviwa, J; Rankin, S H
The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services. This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools. In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on
Chikowe, Ibrahim; Osei-Safo, Dorcas; Harrison, Jerry J E K; Konadu, Daniel Y; Addae-Mensah, Ivan
The growing concern over the extent of anti-malarial medicine resistance in sub-Saharan Africa, driven largely by administration of sub-therapeutic doses derived from falsified and substandard medicines necessitates regular monitoring of the quality of these medicines to avert any potential public health disaster. This study aimed at determining the active pharmaceutical ingredient (API) content of anti-malarial medicines available in Malawi with respect to the manufacturers' label claim and pharmacopoeia specifications. Samples of anti-malarial medicines (112) collected from both licensed and unlicensed markets throughout Malawi were subjected to visual inspection of dosage form and packaging, and registration verification with the regulatory body. Basic (colourimetric) tests were employed to establish the presence and identity of the requisite APIs. Semi-quantitative thin layer chromatography (SQ-TLC) was employed as a quick assay for the verification of identity and estimation of the API content while HPLC assays were used to quantify the APIs. The results were compared with pharmacopoeia specifications and manufacturers' label claims. For combination therapies, a sample was considered to have failed if one or more of its component APIs did not meet pharmacopoeia specifications. There was 86.6% registration status and 100% compliance with visual inspection and basic tests confirming the presence of requisite APIs. The identification test was confirmed by the SQ-TLC assay. API quantification by HPLC assay however, showed that 88.4% (99/112) of the samples failed the quality tests due to the presence of either insufficient or excessive API. The results suggest the existence of substandard anti-malarial medicines in Malawi. The presence of both excessive and insufficient artemisinin-based and non-artemisinin-based API, clearly points to poor adherence to GMP and improper handling during storage or distribution. The country relies heavily on imported anti
Full Text Available Abstract Background Cancer is a leading cause of morbidity and mortality worldwide with a majority of cases and deaths occurring in developing countries. While cancer of the lung, breast, colorectum, stomach and prostate are the most common types of cancer globally, in east and southern Africa these are less common and comprehensive data to inform policies are lacking. Methods Nationwide cancer registry was conducted between September and October 2010 in Malawi. New cancer cases registered from 2007 to 2010 were identified from hospital and clinic registers of 81 out of 84 health facilities providing cancer diagnosis, treatment or palliative care services. Demographic and cancer data were extracted from registers and case notes using a standard form. Results A total of 18,946 new cases of cancer were registered in Malawi from 2007-2010. Of these 55.9% were females, 7.2% were children aged less than 15 years, 76.5% were adults aged 15-59 years and 16.4% were elderly aged 60 years or more. Only 17.9% of the cases had histologically verified diagnosis, 33.2% were diagnosed clinically and 49.6% based on clinical and some investigations. Amongst females, cancer of the cervix was the commonest accounting for 45.4% of all cases followed by Kaposi sarcoma (21.1%, cancer of the oesophagus (8.2%, breast (4.6% and non-Hodgkin lymphoma (4.1%. In males, Kaposi sarcoma was the most frequent (50.7% then cancer of oesophagus (16.9%, non-Hodgkin lymphoma (7.8, prostate (4.0% and urinary bladder (3.7%. Age-standardised incidence rate per 100,000 population for all types of cancer in males increased from 31 in 1999-2002 to 56 in 2007-2010. In females it increased from 29 to 69. Kaposi sarcoma and cancer of the oesophagus, cervical cancer and Kaposi sarcoma were the main causes for the increased incidence in males and females respectively. It was estimated that, annually at least 8,151 new cases of cancer (all types occur in Malawi. Conclusions This study provided
Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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
Health service and resource gaps are described but not quantified in the Botswana, Gambia, Malawi, Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally, countries' plans had clear indicators. Matching service and outcome targets to available resources was ...
Fuller, Colin W.; Junge, Astrid; Amaning, Jacob; Kaijage, Rogasian R.; Kaputa, John; Magwende, George; Pambo, Prince; Dvorak, Jiri
Objective: To assess the effectiveness of the FIFA 11 for Health programme in increasing children's knowledge about communicable and non-communicable diseases in five countries of Sub-Saharan Africa. Method: A prospective five-cohort study was implemented in schools in Ghana (17), Malawi (12), Namibia (11), Tanzania (18) and Zambia (11). The…
Herzog, S. P.; Mtethiwa, A.; Ghambi, C.; Lusangasi, B.
Unsafe drinking water is a problem faced by millions of people in sub-Saharan Africa and in developing nations around the world. While effective water treatments exist, their generally high costs preclude their use by the low-income populations that need them most. Surfactant modified zeolite (SMZ) is a low-cost filter medium that has previously been demonstrated to efficiently remove bacteria and viruses in laboratory settings. The first known field test of SMZ as a drinking water filter was conducted in rural villages near Lilongwe, Malawi. Water was drawn from hand-dug wells and filtered through SMZ packs constructed from local materials. This filtration step was repeated over a period of several weeks to determine the effective lifetime of the filters. Pre-filtration and post-filtration samples were analyzed for E. coli and fecal coliforms by culturing and colorimetric presence/absence tests. All unfiltered water samples were contaminated with E. coli and fecal coliforms. The aforementioned pathogens were not detected in any of the initial filtered samples. After filtering an average of approximately 40 liters, E. coli and fecal coliforms were found to be present in the filtered water, presumably indicating that the filters had become saturated with the pathogens. The results demonstrate that SMZ could serve as an effective, affordable filter medium for treatment of drinking water in rural settings and developing countries. It is anticipated that the design of the filters could be further enhanced, leading to an increase in their effective lifespan.
The present, past and future of the study of intellectual disability: challenges in developing countries Pasado, presente y futuro del estudio de la discapacidad intelectual: desafíos en los países en desarrollo
Trevor R Parmenter
Full Text Available There is strong evidence that socio-cultural factors largely determine what is seen as competent behaviour. Within western high income countries, driven by the values of utilitarian individualism, the construct of intellectual disability has been largely determined to meet the needs of urban, industrialised societies. In contrast, competence in non-industrialised societies may be more reflected in collaborative, interpersonal problem solving skills such as those found among Nigerian students labelled as intellectually disabled. However, people who are judged to be incompetent or "obtrusive" in countries deficient in support services, are often neglected and consigned to a life in poorly managed segregated institutions, as is the case in China, Russia and some countries in Eastern Europe. Non western countries that have a long history of a globalised economy, such as Taiwan and Japan also remain committed to segregated institutional provisions for people with an intellectual disability, despite a notional acceptance of inclusionary policies enunciated by the United Nations’ Declarations and Conventions. In this paper is concluded that it must be recognised that the population of people with an intellectual disability, regardless of how the condition is defined and classified, is quite heterogeneous. Their needs are also varied and not at all dissimilar to those of the general population. As developing countries adopt western style consumer-driven economies, there is an extreme danger that they, too, will follow the same trajectory of exclusion and impose the culture of "otherness" for a group whose contribution to that society will be devalued. Good science is futile unless it benefits all peoples.Existe amplia evidencia de que los factores socioculturales determinan en gran medida la percepción de conducta competitiva. En los países occidentales de altos ingresos, dominados por los valores del individualismo utilitario, las necesidades de
Landes, Megan; van Lettow, Monique; Cataldo, Fabian; Chan, Adrienne K; Tippett Barr, Beth; Harries, Anthony D; Bedell, Richard
In 2011, Malawi initiated an ambitious program for the prevention of maternal to child transmission (PMTCT) of HIV, called 'Option B+,' which employs a universal test and life-long treatment strategy for all pregnant women. Priority setting should take place in defining a national research agenda for evaluating Option B + rollout in Malawi. In April 2011, a three-day workshop took place for all major stakeholders in PMTCT aiming to provide an update on current PMTCT operational research in Malawi, find consensus on key questions not yet being addressed, identify opportunities for collaboration, and develop multi-partner research proposals. Overall, 24 participants attended the workshop including representatives from the Ministry of Health, the National AIDS Commission and 12 multilateral, non-governmental organizations and academic partners.Three interrelated clusters emerged as priorities for research: i) pregnancy intentions and family planning needs; ii) evaluation of models of care; and iii) determinants of uptake, adherence, and retention of women for Option B+. In addition, two cross-cutting themes arose: partner involvement in PMTCT services and cost-effectiveness as a guide to priority setting. Within each cluster a coordinator was designated and a proposed plan for research and potential collaborators were discussed. The results of the workshop were presented to the national technical working groups and the National AIDS Commission. Several large-scale, collaborative proposals have been developed and funded to address the research areas defined. Option B + represents a significant change in PMTCT policy in Malawi and the process for evaluation of the Malawi PMTCT strategy is outlined. This workshop contributed to defining and coordinating the national agenda for research priorities.
Kanyerere, Henry; Harries, Anthony D; Tayler-Smith, Katie; Jahn, Andreas; Zachariah, Rony; Chimbwandira, Frank M; Mpunga, James
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.
Lowe, R.; Chadza, T.; Chirombo, J.; Fonda, C.; Muyepa, A.; Nkoloma, M.; Pietrosemoli, E.; Radicella, S. M.; Tompkins, A. M.; Zennaro, M.
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.
Yeatman, Sara; Trinitapoli, Jenny
Policies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical eligibility. Despite the rapid expansion of this policy, we know little about how it has been understood and interpreted by the people it affects. We assessed awareness and perceived fairness of the prioritization system for ART among a population-based sample of young women (n = 1440) and their partners (n = 574) in southern Malawi. We use a card-sort technique to elicit understandings of who gets ART under Option B+ and who should be prioritized, and we compare perceptions to actual ART policy using sequence analysis and optimal matching. We then use ordered logistic regression to identify the factors associated with policy awareness. In 2015, only 30.7% of women and 21.1% of male partners understood how ART was being distributed. There was widespread confusion around whether otherwise healthy HIV-positive pregnant women could access ART under Option B + . Nonetheless, more young adults thought that the fairest policy should prioritize such women than believed the actual policy did. Women who were older, more educated or had recently engaged with the health system through antenatal care or ART had more accurate understandings of Option B + . Among men, policy awareness was lower, and was patterned only by education. Although most respondents were unaware that Option B+ afforded ART access to healthy-pregnant women, Malawians support the prioritization of pregnant women. Countries adopting Option B+ or other new ART policies such as universal test-and-treat should communicate the policies and their rationales to the public - such transparency would be more consistent with a fair and ethical process and could additionally serve to clarify confusion and
Masulani-Mwale, C; Mathanga, D; Silungwe, D; Kauye, F; Gladstone, M
Rates of disability are high in resource poor settings with 85% of children with disabilities living in these settings. Long-term caregiving for disabled children is associated with fatigue, financial difficulties, parenting distress and other psychological issues. While such parents of children have repeatedly highlighted their feelings of discrimination, stigma and exclusion, leading to mental health issues, there is little research from the developing world addressing these issues. This study aims to explore psychological experiences of parents caring for children with intellectual disabilities; understand their mechanisms of coping and their psychosocial needs in Malawi. This study used a qualitative phenomenological design. We purposively sampled parents who had children diagnosed with intellectual disability from two clinics in two cities in Malawi. Between January 2015 and March 2015, we conducted 10 focus group discussions and four in-depth interviews. All ethical study procedures were carefully followed. All interviews were tape-recorded, transcribed and translated from vernacular to English. Thematic approach of data analysis was adopted to understand the data. Caring for intellectually disabled children comes with a number of challenges. Parents have limited access to services for their children let alone for their own psychological issues; they experience stigma and discrimination, have mental health issues resulting from the caring role, have suicidal ideas and in some cases have even been coerced by neighbours to kill their disabled child. To manage these issues, most parents cope through their spirituality. Apart from suicide and filicide, the findings of this study are similar to those performed in other countries. It is recommended that parents' psychological issues be managed concurrently when providing services for their children. There is also a need to develop psychosocial training interventions to address the needs of the parents of these
The Rural Fuel-wood and Poles Research Project was initiated to provide information about afforestation in the dry silvicultural zones. Plantation forestry in Malawi has concentrated on production of timber, poles, and pulpwood. It is estimated that 90% of Malawi's population of 5.5 million live in rural communities, and that the purely domestic wood requirement is 4.05 cubic m per family (of five) annually. In addition, wood is required for agricultural purposes such as tobacco curing. The remaining indigenous forest cannot meet the demand. There is an urgent need for plantations. Rather than simply planting trees, the aim is to make local communities self-sufficient in forest products. In view of the shortage of land, great emphasis is placed on trying species which have many end-uses-- e.g., poles, fuel-wood, mulch, fodder, and shade--and those which can be grown together with farm crops, a concept known as ''agroforestry.'' Over 20 ha of trials were established at locations in the three regions of the country. Acacia albida allows maize and other farm crops to grow under it, provides good shade and fodder, and--as legume--enriches the soil with nitrogen. Eucalypts were included because most produce straight poles for construction, are drought-hardy, and are rated higher than Gmelina arborea in calorific value, durability, and strength. Another tree favored for its multiple uses is Leucaena leucocephala (Hawaiian giant), but it appears that there is considerable mixture of varieties in the seeds. With the exception of one trial at Bwanje, trials have not included farm crops, but the agroforestry element will be a very important consideration in future trials.
Wachira, Catherine; Ruger, Jennifer Prah
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
Hundalani, Shilpa G; Richards-Kortum, Rebecca; Oden, Maria; Kawaza, Kondwani; Gest, Alfred; Molyneux, Elizabeth
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.
Full Text Available Background: Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries.Objectives: To describe how Tanzanian and Malawian graduates’ of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates.Methods: Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data.Results: Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment.Conclusions: Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.Keywords: orthotic; prosthetic; education; Malawi; Tanzania; assistive device; assistive technology; developing countries; low-income country
A prospective survey of post-operative wound infection rates was undertaken at the Queen Elizabeth Central Hospital, Blantyre, Malawi over a three-month period from April to June, 1985. The methods whereby wound sepsis data were obtained are presented. The results show an overall infection rate of 25.8% and that for ...
Brooten, D; Thompson, J; Makoza, J; Kaponda, C; Mede, E; Kachapila, L; Phoya, A
To describe a collaborative research effort by a U.S. school of nursing, an African school of nursing, and the Malawian Ministry of Health. Providing assistance to women leaders in Malawi to develop and conduct research to improve the health of women and infants in villages is necessary. This 5-year project, 1990-1995, included organizing a workshop on the research process, developing and testing pilot projects, developing and conducting two full-scale studies, and disseminating findings. Two full-scale studies, one examining maternal mortality and one examining the effects of teen pregnancy, were completed with important health policy implications for Malawi. Successful international collaborative research yields increased knowledge for all participants and important health information. International research requires continuous communication, people skilled in group work, sensitivity to cultural differences, patience, persistence, and commitment.
Environmental risk factors for oesophageal cancer in Malawi: A case-control study. ... Results Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and 6.6 ...
Hrapcak, S; Kuper, H; Bartlett, P.; Devendra, A; Makawa, A; Kim, M; Kazembe, P.; Ahmed, S.
Introduction With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. Methods This was a cross-sectional survey of 380 HIV-infected children aged 4?14 years attending ART clinic in Lilongwe betwe...
Msonda, K. W. M.; Masamba, W. R. L.; Fabiano, E.
A study was carried out to determine fluoride concentration in groundwaters of Nathenje area situated in Lilongwe District in the central region of Malawi. Water samples were collected from 176 boreholes and shallow wells during different months in 2001 and 2002. Samples were then analysed for fluoride by using a fluoride electrode and an ion selective meter. The results showed that fluoride concentrations for the rainy season varied from dental fluorosis in areas where the fluoride concentration was high.
Sally H. Rankin
Full Text Available 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.
Full Text Available Abstract 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
This monograph describes contrasting classroom methods and experiences teaching reading in Malawi (where reading is taught through the medium of a local language) and in Zambia (where the medium used is English). In describing research carried out in Malawi and Zambia, the monograph specifically discusses the importance of the research for those…
Objective: To study the socio-economic support for good health among subsistence farmers in rural Malawi. Design: A cross-sectional survey. Setting: Lungwena, a rural area with 17000 inhabitants in southern Malawi. Participants: Seven hundred and ninety five pregnant women who attended the antenatal clinic at ...
Building Food Security and Social Resilience to HIV/AIDS in Malawi. In Malawi, small farmers face many challenges in sustaining a viable food system and are therefore highly vulnerable to climate change. Previous work in Ekwendi and Kasungu (projects 100670 and 101829) identified knowledge gaps and social equity ...
Andrew T. Hudak; Carol A. Wessman
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 high incidence of oesophageal cancer in both Scotland and Malawi can be attributed to a combination of environmental and lifestyle factors. The aim of this study is to give a perspective on the comparative epidemiology of oesophageal cancer in these two very different populations (Blantyre, Malawi and Aberdeen, ...
Bignami-Van Assche, S; Chao, L-W; Anglewicz, P; Chilongozi, D; Bula, A
Understanding HIV risk perception is important for designing appropriate strategies for HIV/AIDS prevention, because these interventions often rely on behaviour modification. A key component of HIV risk perception is the individual's own assessment of HIV status, and the extent to which this assessment is correct. However, this issue has received limited attention. To examine the validity of self-reported likelihood of current HIV infection among the general population in rural Malawi. As part of a panel household survey, data on behaviour and biomarkers were collected for a population-based sample of approximately 3000 respondents in rural Malawi aged > or = 15 years. Information on self-assessed likelihood of currently having HIV was collected by survey interview. Saliva was obtained from all consenting respondents to assess actual HIV status. Of 2299 survey respondents who assessed their likelihood of being infected with HIV at the time of the survey, 71% were accurate. Most incorrect assessments (88%) were due to respondents overestimating (rather than underestimating) their likelihood of being infected with HIV. Women were less likely than men to correctly assess their HIV status. The two most important predictors of false-positive responses were marital status and self-reported health. Self-reports of HIV infection were generally valid. Most invalid self-reports were due to overestimating the risk of having HIV. The implications of this finding are highlighted, as they pertain to the design of HIV prevention interventions and the expansion of HIV counselling, testing and treatment programmes in developing countries.
Kaufman, Michelle R; Rimal, Rajiv N; Carrasco, Maria; Fajobi, OlaOluwa; Soko, Anthony; Limaye, Rupali; Mkandawire, Glory
While overall HIV prevalence in Malawi has decreased, it is still high in the southern region of the country. Behavioral prevention activities are crucial to continue the reduction in HIV prevalence. Behavior change is influenced by many factors. Previous work indicates knowledge about HIV transmission, self-efficacy to protect oneself from exposure, and accurate risk perception of one's susceptibility all impact sexual behavior. The current study looks at the effects of a behavior change communication program in Malawi called the BRIDGE II Project on psychosocial and behavioral variables. The program sought to address barriers to individual action and confront societal norms related to sexual risk behavior through a mix of community-based activities and mass media messages delivered through local radio stations. Using cohort data (n = 594), we examined the effect of BRIDGE exposure on three variables that affect HIV behaviors: knowledge, self-efficacy, and risk perception, as well as two behavioral outcomes: HIV testing and condom use at last sex. Data were collected at baseline and for a midterm evaluation. Regression analyses showed exposure to BRIDGE was significantly associated with knowledge level (β = 0.20, p communication intervention may play an important role in not only affecting HIV-related behaviors themselves, but also critical factors that affect HIV behaviors, including knowledge and self-efficacy. It is recommended that communication efforts around HIV risk reduction be increased.
Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer
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.
Kohler, Racquel E; Gopal, Satish; Lee, Clara N; Weiner, Bryan J; Reeve, Bryce B; Wheeler, Stephanie B
Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.
Scotland is one of four constituent countries that make up the United Kingdom, situated to the North of ... (excluding non melanoma skin cancer), accounting for 6.5% of newly diagnosed cancers.2 Furthermore, .... home-made alcoholic beverages include Kachasu, Chibuku and Chikokeyani which are often prepared in pots ...
Full Text Available As part of the project to update the Malawian Directorate of Road Transport and Safety Services’ (DRTSS) 2005 Axle Load Control Strategy and to provide a five-year implementation plan, a country-wide axle load survey was undertaken to assess...
Barnett, Brian; Gokhale, Runa H; Krysiak, Robert; Kanyemba, Creto; Chikaonda, Tarsizio; Bokosi, Mphatso; Mukuzunga, Cornelius; Saidi, Friday; Phiri, Sam; Hoffman, Irving F; Hosseinipour, Mina C
We sought to determine the prevalence of drug resistant TB among outpatients initiating TB treatment in Lilongwe, Malawi. This was a prospective cohort study of patients 18 years and older initiating TB treatment at Martin Preuss Centre, the primary integrated HIV/TB clinic in Lilongwe, Malawi, from April 2011 to July 2012. Procedures included questionnaires, physical exam, chest x-ray, full blood count and sputum collection. Sputum samples underwent acid-fast bacilli (AFB) smear testing and culture by Lowenstein-Jensen (LJ) and liquid Mycobacteria Growth Indicator Tube (MGIT) methods. Drug sensitivity was investigated using the Hain GenoType MTBDRplus line probe assay. Of the 702 patients, 219 (31.2%) were female and 653 (93.0%) were presenting for first-time TB treatment. HIV co-infection was present in 420 (59.8%) cases, with 137 (32.6%) of those patients receiving antiretroviral therapy at presentation. TB was culture-confirmed in 375 (53.4%) patients, 349 of which were first time treatment and 26 retreatment. Ten cases of isoniazid-resistant TB (2.9% of culture confirmed cases of newly treated TB), one of rifampin-resistant TB (0.3% culture confirmed cases of newly treated TB) and one of multi-drug resistant TB (MDR-TB) (3.8% of culture confirmed cases of retreatment TB) were detected. MDR-TB prevalence is low among outpatients initiating TB treatment in Lilongwe. © 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: email@example.com.
Grant, Liz; Brown, Judith; Leng, Mhoira; Bettega, Nadia; Murray, Scott A
Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics. We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks. Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.
Full Text Available Abstract Background Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. Methods Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics. Results We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home. In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks. Conclusions Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.
Hagen, L; Munkhondya, B; Myhre, K
A Malawian nursing college and a Norwegian university college have agreed to cooperate in facilitating clinical exchanges for nursing students at their respective institutions. This study describes the experiences of students in an innovative exchange. Norwegian and Malawian nursing students shared clinical placement in pairs of two in Malawi for 8 weeks. This study shows that both host and guest students benefit from the clinical placement as it enhances development of clinical competence. The design of the study is phenomenological/hermeneutical. The theoretical foundation is based upon Campinha-Bacote's model for the development of cultural competence. All participating nursing students were interviewed. Their stories provided the rationale for the three main categories that are discussed. Students experience both similarities and differences in practice, but similarities are regarded as the stronger impression. Learning relational skills is the primary learning outcome, but learning how to nurse patients is also an important outcome. During the exchange period all students developed cultural competence. This way of organizing shared placements for guest and host students from different countries is valuable for all students. It also met the curricular demands in both countries.
Full Text Available BACKGROUND: Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. METHODS: We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. FINDINGS: 87 neonates (62 bCPAP, 25 controls were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62 compared with 44.0% (11/25 for controls. 65.5% (19/29 of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13 of controls. 64.6% (31/48 of neonates with respiratory distress syndrome (RDS receiving bCPAP survived to discharge, compared to 23.5% (4/17 of controls. 61.5% (16/26 of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. INTERPRETATION: Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.
Drew, Laura B; Wilkinson, Jeffrey P; Nundwe, William; Moyo, Margaret; Mataya, Ronald; Mwale, Mwawi; Tang, Jennifer H
Obstetric fistula affects a woman's life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman's quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula. In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis. About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women's concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities. Nearly all women believed their quality of life had improved
Full Text Available Abstract Background Quality of life measurement is a useful addition to measurement of health outcomes in evaluation of the benefits of many health and welfare interventions. The WHOQOL-BREF measures quality of life from a broad multi-dimensional perspective but was not used in Malawi. The objective of this study was to translate the WHOQOL-BREF questionnaire into the main local language of Malawi: Chichewa; and to validate it quantitatively with respect to internal consistency, domain structure, and discriminant validity for this context. Methods WHO-mandated guidelines were followed for translation, adaptation, pre-testing (focus groups, piloting (patient interviews and data coding. Analyses using descriptive statistics, correlation and regression were undertaken to investigate the validity of the WHOQOL-BREF in the ways described above. Additional regression analyses examined the impact of socio-demographic variables on the domain scores. Results 309 respondents completed the questionnaire (with >98% response rates for all questions except Q21 (sex life. 259 were sick with a variety of health problems, and 50 were considered healthy. All domains showed adequate internal consistency (Cronbach’s alpha > =0.7 with all item scores also most highly correlated with the scores of their assigned domain. All domain scores varied by health problem, and more depressed respondents had significantly lower scores in all domains than those less depressed. Domain scores and their associations with socio-demographic variables are presented and discussed. Conclusion This study demonstrates that the new Chichewa WHOQOL-BREF questionnaire is acceptable and comprehensible to respondents in Malawi. The questionnaire also passed a number of tests of the validity of its psychometric properties. In the pilot population we found that older age was associated with lower Physical domain scores. Conversely, higher levels of educational attainment were found to be
Colbourn, Tim; Masache, Gibson; Skordis-Worrall, Jolene
Quality of life measurement is a useful addition to measurement of health outcomes in evaluation of the benefits of many health and welfare interventions. The WHOQOL-BREF measures quality of life from a broad multi-dimensional perspective but was not used in Malawi. The objective of this study was to translate the WHOQOL-BREF questionnaire into the main local language of Malawi: Chichewa; and to validate it quantitatively with respect to internal consistency, domain structure, and discriminant validity for this context. WHO-mandated guidelines were followed for translation, adaptation, pre-testing (focus groups), piloting (patient interviews) and data coding. Analyses using descriptive statistics, correlation and regression were undertaken to investigate the validity of the WHOQOL-BREF in the ways described above. Additional regression analyses examined the impact of socio-demographic variables on the domain scores. 309 respondents completed the questionnaire (with >98% response rates for all questions except Q21 (sex life)). 259 were sick with a variety of health problems, and 50 were considered healthy. All domains showed adequate internal consistency (Cronbach's alpha > =0.7) with all item scores also most highly correlated with the scores of their assigned domain. All domain scores varied by health problem, and more depressed respondents had significantly lower scores in all domains than those less depressed. Domain scores and their associations with socio-demographic variables are presented and discussed. This study demonstrates that the new Chichewa WHOQOL-BREF questionnaire is acceptable and comprehensible to respondents in Malawi. The questionnaire also passed a number of tests of the validity of its psychometric properties. In the pilot population we found that older age was associated with lower Physical domain scores. Conversely, higher levels of educational attainment were found to be associated with higher quality of life in all domains except for
Dougill, Andrew; Stringer, Lindsay; Whitfield, Stephen; Wood, Ben; Chinseu, Edna
Conservation agriculture is a key set of actions within the growing body of climate-smart agriculture activities being advocated and rolled out across much of the developing world. Conservation agriculture has purported benefits for environmental quality, food security and the sustained delivery of ecosystem services. In this paper, new multi-level analyses are presented, assessing the current barriers to adoption of conservation agriculture practices in Malawi. Despite significant donor initiatives that have targeted conservation agriculture projects, uptake rates remain low. This paper synthesises studies from across 3 levels in Malawi: i.) national level- drawing on policy analysis, interviews and a multi-stakeholder workshop; ii.) district level - via assessments of development plans and District Office and extension service support, and; iii) local level - through data gained during community / household level studies in Dedza District that have gained significant donor support for conservation agriculture as a component of climate smart agriculture initiatives. The national level multi-stakeholder Conservation Agriculture workshop identified three areas requiring collaborative research and outlined routes for the empowerment of the National Conservation Agriculture Task Force to advance uptake of conservation agriculture and deliver associated benefits in terms of agricultural development, climate adaptation and mitigation. District level analyses highlight that whilst District Development Plans are now checked against climate change adaptation and mitigation criteria, capacity and knowledge limitations exist at the District level, preventing project interventions from being successfully up-scaled. Community level assessments highlight the need for increased community participation at the project-design phase and identify a pressing requirement for conservation agriculture planning processes (in particular those driven by investments in climate
Simek, Pavel; Vanek, Jiri; Cervenkova, Eva; Jarolimek, Jan; Vogeltanzova, Tereza
The present paper brings an overview of both technological and functional upgrade of the agrarian web portal AGRIS (http://www.agris.cz). Agris 4.0 version has been developed, tested and launched in the course of 2010. Agris 4.0 is built and runs on Microsoft technologies within the framework of MS IIS web server. Model-View- Controller (MVC) architectural pattern, an inherent part of the technology .NET framework 3.5, has been used.
following the course of ibuprofen mentioned. Twelve days after admission he started to complain of increasing pain and tightness in his left thigh. Sensation and motor function. Ward Round - Late Presentation of Acute. Compartment Syndrome in the Thigh. University of Malawi, College of Medicine, Department of Surgery,.
Objective Primary open angle glaucoma (POAG) is the most common type of glaucoma in Africa. We carried out a study to determine the clinical presentation pattern of patients with primary open angle glaucoma (POAG) at a tertiary hospital in Malawi. Design A cross-sectional study. Setting Lions Sight First Eye Hospital—a ...
Samuel, JC; Campbell, ELP; Mjuweni, S; Muyco, AP; Cairns, BA; Charles, AG
This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were < 15 years old and 56.2% were male. The most frequent cause was scalding (51.4%). Burns occurred most frequently in the cool, dry season and in the ev...
Full Text Available The Icelandic International Development Agency (Iceida supported the health services in the Monkey Bay area in Mangochi district in Malawi in southern Africa in the period 2000-2011. It included construction of physical structures, logistic, training of health staff, and community health activities. One additional feature included support for the national electronic Health Monitoring Information System (HMIS in place, with extraction and analysis of data generated by the health services in the area. In this paper, the development of the services will be analysed and discussed. Further, difficulties to find appropriate indicators to monitor health services, in Monkey Bay and elsewhere, will be presented and elaborated upon.
Fujisawa, Mariko; Kanamaru, Hideki
Many existing climate change impact studies, carried out by academic researchers, are disconnected from decision making processes of stakeholders. On the other hand many climate change adaptation projects in developing countries lack a solid evidence base of current and future climate impacts as well as vulnerabilities assessment at different scales. In order to fill this information gap, FAO has developed and implemented a tool "MOSAICC (Modelling System for Agricultural Impacts of Climate Change)" in several developing countries such as Morocco, the Philippines and Peru, and recently in Malawi and Zambia. MOSAICC employs a multi-disciplinary assessment approach to addressing climate change impacts and adaptation planning in the agriculture and food security sectors, and integrates five components from different academic disciplines: 1. Statistical downscaling of climate change projections, 2. Yield simulation of major crops at regional scale under climate change, 3. Surface hydrology simulation model, 4. Macroeconomic model, and 5. Forestry model. Furthermore MOSAICC has been developed as a capacity development tool for the national scientists so that they can conduct the country assessment themselves, using their own data, and reflect the outcome into the national adaptation policies. The outputs are nation-wide coverage, disaggregated at sub-national level to support strategic planning, investments and decisions by national policy makers. MOSAICC is designed in such a way to promote stakeholders' participation and strengthen technical capacities in developing countries. The paper presents MOSAICC and projects that used MOSAICC as a tool with case studies from countries.
Joo, Deokjin; Kwan, Ye-seul; Song, Jongwoo; Pinho, Catarina; Hey, Jody; Won, Yong-Jin
Background The explosively radiating evolution of cichlid fishes of Lake Malawi has yielded an amazing number of haplochromine species estimated as many as 500 to 800 with a surprising degree of diversity not only in color and stripe pattern but also in the shape of jaw and body among them. As these morphological diversities have been a central subject of adaptive speciation and taxonomic classification, such high diversity could serve as a foundation for automation of species identification of cichlids. Methodology/Principal Finding Here we demonstrate a method for automatic classification of the Lake Malawi cichlids based on computer vision and geometric morphometrics. For this end we developed a pipeline that integrates multiple image processing tools to automatically extract informative features of color and stripe patterns from a large set of photographic images of wild cichlids. The extracted information was evaluated by statistical classifiers Support Vector Machine and Random Forests. Both classifiers performed better when body shape information was added to the feature of color and stripe. Besides the coloration and stripe pattern, body shape variables boosted the accuracy of classification by about 10%. The programs were able to classify 594 live cichlid individuals belonging to 12 different classes (species and sexes) with an average accuracy of 78%, contrasting to a mere 42% success rate by human eyes. The variables that contributed most to the accuracy were body height and the hue of the most frequent color. Conclusions Computer vision showed a notable performance in extracting information from the color and stripe patterns of Lake Malawi cichlids although the information was not enough for errorless species identification. Our results indicate that there appears an unavoidable difficulty in automatic species identification of cichlid fishes, which may arise from short divergence times and gene flow between closely related species. PMID:24204918
Michael J. Pauers
Full Text Available While sexual selection on male coloration has been important in haplochromine cichlid speciation, few studies to date have examined potential environmental influences on color pattern evolution. Data from multiple sources on male nuptial coloration of the Lake Malawi endemic genus Labeotropheus were used to examine the relationship between color patterns and the environments in which these patterns were found. Red- or carotenoid-pigmented males were concentrated in the northwestern portion of Lake Malawi and were also associated with increasing depth. Further, the presence or absence of L. fuelleborni influenced the coloration of L. trewavasae populations; when L. fuelleborni was present, L. trewavasae males were more likely to exhibit some degree of red coloration. While these results support the idea that sexual selection on male coloration is an important factor in the haplochromine speciation, they also underscore the importance of environmental influences on the evolution of color patterns.
Steinhardt, Laura C.; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek
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
Kamiyango, M. W.; Masamba, W. R. L.; Sajidu, S. M. I.; Fabiano, E.
Earlier work on stream water and effluent from wastewater treatment plants in Blantyre, Malawi, has revealed high phosphate levels ranging from 0.63 to 5.50 mg/L. These phosphate levels would stimulate excessive growth of plants and toxic cyanobacteria in stagnant receiving water bodies hence posing a threat to aquatic life and water quality. Phosphate removal by kaolinite obtained from Linthipe, Malawi, was investigated as a function of pH, contact time, clay dosage, competing ions and initial phosphate concentration by means of jar tests. Phosphate uptake was pH dependent with adsorption mechanisms on kaolinite and iron oxide surfaces dominant generally below pH 7 and precipitation by calcium ions dominant above pH 7. Maximum phosphate removal occurred at high pH values of 11.22 (97.1%) and 10.96 (100%) for raw and treated kaolinite, respectively. Acid treated kaolinite indicated higher phosphate removal efficiency than the raw one at the normal working pH of 9.0 ± 0.2. This was attributed to release of extra calcium ions from CaCO 3 present in the kaolinite samples during acid treatment. At the maximum dosage of 80 g/L, percent phosphate removal was 69.7 ± 0.100% and 98.5 ± 0.0577% for raw and treated kaolinite, respectively. This indicates requirement for high dosages to effect phosphate removal from the aqueous solutions. Studies on the effects of competing ions indicate that phosphate uptake decreased in the presence of CO32-, was little affected by SO42-, and increased in the presence of Ca 2+, and Mg 2+ ions. Furthermore, phosphate uptake approached equilibrium slowly at 20 °C and was faster at 40 °C.
Chasimpha, Steady J D; Parkin, D Maxwell; Masamba, Leo; Dzamalala, Charles P
In this paper, we present incidence rates of different cancers calculated for the population of Blantyre, Malawi for the period 2008-2010, using data from the Malawi Cancer Registry. Active methods were used for case finding, with standard checks for accuracy and validity performed in CanReg 4. During this 3-year period, a total of 3,711 cases were registered comprising 1,643 men (an estimated age-standardized incidence rate (ASR) of 169.8 per 100,000) and 2,068 women (ASR 238.7 per 105 ). Kaposi sarcoma (KS) was the most common cancer in men (40.5% of all cancers in men; ASR 54.0 per 105 ) while cervical cancer was the commonest in women (33.3%; ASR 88.6 per 105 ). The incidence rates for esophageal cancer remain one of the highest in the world (ASR 30.9 per 100,000 in men, 22.1 per 100,000 in women). Incidence of cancer of the prostate is relatively low in Blantyre (5.1%; ASR 16.4 per 105 ), compared with elsewhere in Africa. In childhood, the cancer spectrum is dominated by Burkitt lymphoma (32.5% ASR 90.9 per 106 ) followed by Wilms tumor (11.3%; ASR 35.9 per 106 ) and pediatric KS (11.0%; ASR 31.1 per 106 ). The overall percentage of cases with histological verification was 47.5%, a slight improvement from 42.4% in late 1990s also indicating successful case finding outside laboratories. © 2017 UICC.
Full Text Available Abstract Background The sector wide approach (SWAp used in many developing countries is difficult to assess. One way is to consider the essential health package (EHP which is commonly the vehicle for a SWAp's policies and plans. It is not possible to measure the impact of an EHP by measuring health outcomes in countries such as Malawi. But it is possible to assess the choice of interventions and their delivery in terms of coverage. This paper describes an attempt to assess the Malawi SWAp through its EHP using these available measures of technical efficiency. Methods A burden of disease model was used to identify the priority diseases and their estimated incidence. Data from the health management information system (HMIS were used to measure the coverage of these interventions. A review of the cost-effectiveness of the chosen and potential interventions was undertaken to assess the appropriateness of each intervention used in the EHP. Expenditure data were used to assess the level of funding of the EHP. Results 33 of the 55 EHP interventions were found to be potentially cost-effective ($150/DALY and cost-effective estimates were not available for ten. 15 potential interventions, which were cost-effective and tackling one of the top 20 ranked diseases, were identified. Provision had increased in nearly all EHP services over the period of the SWAp. The rates of out patient attendances and inpatient days per 1000 population had both increased from 929 attendances in 2002/3 to 1135 in 2007/08 and from 124 inpatient days in 2002/03 to 179 in 2007/08. However, by 2007/08 the mean gap between what was required and what was provided was 0.68 of the estimated need. Two services involving the treatment of malaria were overprovided, but the majority were underprovided, with some such as maternity care providing less than half of what was required. The EHP was under-funded throughout the period covering on average 57% of necessary costs. By 2007/08 the
Msukwa, Gerald; Batumba, Nkume; Drucker, Mitchell; Menezes, Lynette; Ranjit, Roshni
Neonatal conjunctivitis is associated with poor prenatal care worldwide. 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. 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. 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. 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.
Cook, Sinead; de Kok, Bregje; Odland, Maria Lisa
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
Osorio, Luiz Eduardo; Boechat, Maria Ines; Mirochnick, Mark; Kumwenda, Newton; Kreitchmann, Regis; Emel, Lynda; Pinto, Jorge; Joao, Esau; Santos, Breno; Swenson, Molly; George, Kathleen; Sato, Paul; Mofenson, Lynne; Nielsen-Saines, Karin
Tenofovir disoproxil fumarate (TDF) use during pregnancy has been increasing, and studies linking bone toxicity with exposure to TDF have raised concern for its use in infants. Hand/wrist and spine radiographs were obtained at 3 days and 12 weeks of age in infants born to HIV-infected pregnant women enrolled in the HIV Prevention Trials Network 057 pharmacokinetic study of TDF conducted in Malawi and Brazil assigned to 3 TDF dosing cohorts. In cohort 1, mothers received 600 mg of TDF during labor. In cohort 2, infants received 4 mg/kg dose on days 0, 3 and 5. In cohort 3, a 900 mg maternal dose was given during labor, followed by a 6 mg/kg infant dose on days 0, 3 and 5 of life. Across all 3 cohorts, 89 infants had radiographs performed at either time point, and 85 had radiographs performed at both time points. Metaphyseal lucency was present in 1 case in Brazil and 2 in Malawi. Fifteen percent of infants from Brazil and 9% of infants from Malawi presented bone age discrepancies. No other abnormalities were identified in Brazil, whereas in Malawi, there were 7 more cases of wrist osteopenia, 2 of spine osteopenia and 3 other abnormalities. Bone abnormalities were not uncommon in the overall cohort of HIV-exposed infants. Because of very limited study drug exposure at the time of birth, it is unlikely that TDF was associated with these findings. Untreated maternal HIV disease and/or maternal nutritional status could potentially be related to fetal bone development. This association should be explored in future cohort studies.
Onyango, E. A.; Shillington, D. J.; Accardo, N. J.; Scholz, C. A.; Ebinger, C. J.; Gaherty, J. B.; McCartney, T.; Nyblade, A.; Chindandali, P. R. N.; Kamihanda, G.; Ferdinand, R.; Salima, J.; Mruma, A. H.
The East African Rift System (EARS) is actively extending as evidenced by seismicity and volcanic activity, and it is a great example of continental rifting. The western branch of the EARS consists of a series of rift basins bound by 100-km-long border faults, with Lake Malawi being the southernmost. Previous studies on Lake Malawi suggest that the border faults accommodate most of the crustal extension and account for most of the seismicity. However, the 2009 Karonga earthquake sequence and other seismicity on intrabasinal faults suggest that they may also be important for crustal extension and hazards. This study uses seismic reflection and wide-angle refraction data from the Study of Extension and maGmatism in Malawi and Tanzania (SEGMeNT) experiment to constrain detailed basin architecture, shallow velocities, and fault structures of the North Basin of the Malawi Rift. We present results from the main reflection/refraction dip line across the North Basin. Seven lake bottom seismometers (LBS) were spaced at 7 km and recorded shots from a 2580 cu in air gun array fired every 250 m. We recorded multichannel seismic data (MCS) along the same line with a 1500-m-long streamer and a source of 1540 cu in fired every 37.5 m. The LBS also recorded the small volume shots along this line. We picked sedimentary and crustal refractions and reflections using recordings from both shot volumes. We used the First Arrival Seismic Tomography (FAST) code to obtain a smooth velocity model using the first arrivals, and iterative forward modeling was done using the RAYINVR code to produce layered model using both first and later arrivals. Concurrently, the coincident seismic reflection profile was processed using the SeisSpace software package. Preliminary results show sediments in the North basin are thickening Eastward, reaching a thickness of over 4 km adjacent to the Livingstone border fault. Sediments have velocities of 2-3 km/s. The largest intra-basin fault has a substantial
Funk, Christopher C.; Verdin, James; Adams Chavula,; Gregory J. Husak,; Harikishan Jayanthi,; Tamuka Magadzire,
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.
Kaphagawani, Nanzen Caroline; Kalipeni, Ezekiel
This study explores sociocultural and other risk factors associated with unplanned teenage pregnancy in Zomba district of Malawi. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews held at five antenatal clinics. The data were analysed using descriptive statistics, frequency tables and chi-square analysis which allowed comparative understanding of the sociocultural risk factors for planned and unplanned teenage pregnancy in Zomba district. The findings revealed that teenage pregnancy is a major health and social problem. Over 76% of the teenage respondents in the study had experienced unplanned pregnancy. Among the prominent factors that stood out in the analysis for this high rate of teenage pregnancy were early sex and marriage, low contraceptive use, low educational levels, low socio-economic status, lack of knowledge of reproductive and sexual health, gender inequity, and physical/sexual violence. The consequences on teenage mothers of unplanned pregnancy have been tragic and have compromised their physical, psychological and socioeconomic wellbeing, not just on them but also their families and society at large. The findings point to the need for a multi-sectoral approach to tackle the problem on teenage pregnancy in this district, and likely throughout Malawi.
Dasgupta, Aisha Nandini Zoe; Zaba, Basia; Crampin, Amelia C
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. 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. 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. 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.
Dougill, Andrew J; Whitfield, Stephen; Stringer, Lindsay C; Vincent, Katharine; Wood, Benjamin T; Chinseu, Edna L; Steward, Peter; Mkwambisi, David D
Conservation agriculture (CA) practices of reduced soil tillage, permanent organic soil coverage and intercropping/crop rotation, are being advocated globally, based on perceived benefits for crop yields, soil carbon storage, weed suppression, reduced soil erosion and improved soil water retention. However, some have questioned their efficacy due to uncertainty around the performance and trade-offs associated with CA practices, and their compatibility with the diverse livelihood strategies and varied agro-ecological conditions across African smallholder systems. This paper assesses the role of key institutions in Malawi in shaping pathways towards more sustainable land management based on CA by outlining their impact on national policy-making and the design and implementation of agricultural development projects. It draws on interviews at national, district and project levels and a multi-stakeholder workshop that mapped the institutional landscape of decision-making for agricultural land management practices. Findings identify knowledge gaps and institutional barriers that influence land management decision-making and constrain CA uptake. We use our findings to set out an integrated roadmap of research needs and policy options aimed at supporting CA as a route to enhanced sustainable land management in Malawi. Findings offer lessons that can inform design, planning and implementation of CA projects, and identify the multi-level institutional support structures required for mainstreaming sustainable land management in sub-Saharan Africa. Copyright © 2016 Elsevier Ltd. All rights reserved.
Simona Bignami-Van Assche
Full Text Available AIDS morbidity and mortality are expected to have a large impact on households' labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women's time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores to cash-generating tasks (such as casual labor.
Michael K. Hole
Full Text Available 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.
Kamwendo, Gregory Hankoni
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 learning to read and write) in English, a language they have not had any contact with before their first day at school. Moreover, some of the teachers themselves struggle to use English as a medium of instruction. The results of this policy are devastating, and the fact that the school system is poorly resourced in terms of infrastructure, materials and teachers is further thwarting positive learning outcomes. On the strength of ample empirical evidence which supports the mother tongue as the best medium of instruction in the initial phases of primary education, the author of this research note argues that the new language policy stands on a shaky foundation, and that it cannot serve as a strategy for eradicating low English proficiency among Malawian learners.
Muula Adamson S
Full Text Available Abstract Background HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV. Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment. Methods A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city. Results 102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were Conclusion HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection.
Hyvärinen, O.; Mtilatila, L.; Pilli-Sihvola, K.; Venäläinen, A.; Gregow, H.
We assess the probabilistic seasonal precipitation forecasts issued by Regional Climate Outlook Forum (RCOF) for the area of two southern African countries, Malawi and Zambia from 2002 to 2013. The forecasts, issued in August, are of rainy season rainfall accumulations in three categories (above normal, normal, and below normal), for early season (October-December) and late season (January-March). As observations we used in-situ observations and interpolated precipitation products from Global Precipitation Climatology Project (GPCP), Global Precipitation Climatology Centre (GPCC), and Climate Prediction Centre (CPC) Merged Analysis of Precipitation (CMAP). Differences between results from different data products are smaller than confidence intervals calculated by bootstrap. We focus on below normal forecasts as they were deemed to be the most important for society. The well-known decomposition of Brier score into three terms (Reliability, Resolution, and Uncertainty) shows that the forecasts are rather reliable or well-calibrated, but have a very low resolution; that is, they are not able to discriminate different events. The forecasts also lack sharpness as forecasts for one category are rarely higher than 40 % or less than 25 %. However, these results might be unnecessarily pessimistic, because seasonal forecasts have gone through much development during the period when the forecasts verified in this paper were issued, and forecasts using current methodology might have performed better.
Full Text Available This paper reviews some major challenges experienced in the implementation of fisheries co-management initiatives in response to governance reforms being advocated in various countries. Lessons are drawn from Malawi's experiences on the implementation of co-management arrangements. Appropriate policy and legal frameworks that govern management of the fisheries resources in decentralised structures should be formulated as attributes to community empowerment. Defining clear objectives and incentives for fisheries co-management becomes a challenge where appropriation of the commons is for survival especially in areas where poverty is persistent. There are limited resilient co-management institutions due to unclear definition of roles for various stakeholders and limited participation of civil society groups in the management of the commons as part of the governance system. Traditional institutions play a role either in support of or against sustainable resource management is response to inducements of various forms especially from migrants which challenges exclusion of non-members from appropriating the commons. The principles of good governance that include participation and accountability of the representative committees are limited in some areas. The initiation process as to whether the co-management was introduced by government or by the user community affects resilience of the co-management institutions. However, adoption of broad-based co-management regimes with various empowered stakeholders including the civil society, non-governmental organisations and government agencies are a positive step towards achievement of a sustainable fish resource management.
Stephenson, Rob; Winter, Amy; Elfstrom, Miriam
Transactional sex, or the exchange of sex for material goods or money, is a risky sexual behavior that has been linked to HIV/AIDS and gender-based violence. Throughout sub-Saharan Africa, transactional sex remains a common practice, putting men and women at risk of HIV. However, little is known of how community environments shape men's participation in risky transactional sex. This analysis examines community-level influences on participation in risky transactional sex among sexually active men in three African countries (Malawi, Tanzania, and Nigeria). The analysis uses Demographic and Health Survey (DHS) data to examine the association between men's report of risky transactional sex and community characteristics including economic, gender norms, HIV behavior and knowledge, and demographic factors. The results show that men residing in communities with more female education and later age of first birth are less likely to report risky transactional sex, while men who live in communities where men report higher number of sexual partners are more likely to report risky transactional sex. While programmatic interventions should continue to improve women's status individually and relative to men, such efforts should be extended to recognize that many community and cultural influences also affect men's sexual behavior. Programs that understand, discuss, and challenge community factors that influence men's sexual behavior may be able to provide a more effective intervention resulting in opportunities for communities to initiate behavioral change.
Lana A. Repar
Full Text Available Contract farming remains one of the most efficient tools for integrating small-scale farmers into modern food markets. However, the literature lacks evidence on best practices in designing contracts for food supply chains in developing countries. The purpose of this study is to analyse the design of an existing contract in the emerging Malawian paprika sector using a qualitative analytical approach. The study compared a contract design in Malawi’s paprika supply chain with four similar contracts from the horticultural sector in Malawi, India, Zambia and Cape Verde. This study employed a thematic qualitative analysis and developed 17 categories for analysing contracts. The findings showed that the Malawian contract contained in total eleven defined clauses. There were missing clauses that influenced the risk and power distribution between parties in the contract. The comparison of the Malawian contract with other contracts revealed that none of the analysed contracts included all clauses necessary for a sustainable and fair relationship. The study proposed improved contract design and future actions to contribute to decreasing inequalities between parties engaged in the Malawi’s paprika supply chain. The implications of the study include initiation of changes in public policies related to contract farming strategies as the findings suggest that vulnerable small-scale farmers might be left unprotected and generate low gains through supply contracts due to poorly formulated contract clauses.
Dixon, Jimmy-Gama; Gibson, Sarah; McPake, Barbara; Maleta, Ken
The World Health Organization (WHO) staging is a commonly used rationing mechanism for highly active antiretroviral therapy (HAART) among various HIV infected populations including youths in most developing countries. Rationing is defined as any policy or practice that restricts consumption of or access to certain goods due to its limited supply. However, as HIV prevalence is rapidly increasing among youth, understanding the capacity of the staging approach to achieve HAART uptake in youth is of considerable importance. This study aimed to explore how HAART rationing and access mechanisms impact on youth's utilization of HAART in Malawi. The study used mixed methods with quantitative analysis of existing Ministry of Health Clinical HIV Unit data used to determine existing levels of youth HAART use. Qualitative methods employed in-depth interviews that interviewed nine ART providers, nine HIV positive youth on HAART and nine HIV positive youth not on HAART; and field observations to nine ART clinics were used to understand HAART rationing and access mechanisms and how such mechanisms impact youth uptake of HAART. The findings revealed that ART providers use both explicit rationing mechanisms like WHO clinical staging and implicit rationing mechanisms like use of waiting lists, queues and referral in ART provision. However, the WHO staging approach had some challenges in its implementation. It was also observed that factors like non-comprehensive approach to HAART provision, costs incurred to access HAART, negative beliefs and misconceptions about HAART and HIV were among the key factors that limit youth access to HAART. The study recommends that while WHO staging is successful as a rationing mechanism in Malawi, measures should be put in place to improve access to CD4 assessment for clients who may need it. ART providers also need to be made aware of the implicit rationing mechanisms that may affect HAART access. There is also need to improve monitoring of those HIV
Msyamboza Kelias P
Full Text Available Abstract Background Although leprosy was eliminated globally in 2000, the disease continues to be the significant cause of peripheral neuropathy, disability and disfigurement in some developing countries. However, recent population-based prevalence data are lacking to inform evidence-based renewed commitment for the final push for leprosy elimination at national and sub-national levels. Methods Community camp-based cross-sectional descriptive study was conducted in four selected districts. World Health Organisation guidelines and tools for leprosy elimination monitoring were used to evaluate the Malawi National Leprosy Programme. Results A total of 6,338 people (60% females, 35% children aged less than 15 years were examined for leprosy and other skin diseases. Prevalence of skin diseases was 18%, the commonest being fungal (9%, eczema/dermatitis (3% and leprosy (1%. Of the fungal skin conditions, pityriasis versicolor and Tinea capatis were the commonest (22% and 21% respectively then Tinea corporis (9%, Tinea cruris (6% and Tinea pedis (2%. A total of 66 leprosy cases were detected out of 6,338 people screened giving a prevalence of 104.1 per 10,000 population (range by district 67.1 to 194.1. Of the leprosy cases, 37 were new, 6 were defaulters and 23 were on treatment, 30 were females and 9 were children aged less than 15 years old. Of the 37 new leprosy cases, 9 (24.3% were children, 25 (67.6% had 1–5 leprosy lesions and 8 (21.6% had grade 2 disability. The most frequent location of leprosy lesions was the head and neck (24.1%, arms (24.1%, chest (17.2%, legs (13.8%, back (13.8% and abdomen (7.0%. Between 2006 and 2011, trends of leprosy prevalence and detection increased, prevalence/detection ratios were over 1 and cure rates by cohort analysis of 2009 multibacillary and 2010 paucibacillary cases were 33% and 63% respectively far below the expected 80% although the national prevalence remained at less than 1 case per 10
de Paoli Marina
Full Text Available Abstract Background When and how to wean breastfed infants exposed to HIV infection has provoked extensive debate, particularly in low-income countries where safe alternatives to breastfeeding are rarely available. Although there is global consensus on optimal infant-feeding practices in the form of guidelines, practices are sub-optimal in much of sub-Saharan Africa. Policy-makers and health workers face many challenges in adapting and implementing these guidelines. Methods This paper is based on in-depth interviews with five policy-makers and 11 providers of interventions to prevent mother-to-child transmission (PMTCT of HIV, participant observations during clinic sessions and site visits. Results The difficulties with adapting the global infant-feeding guidelines in Malawi have affected the provision of services. There was a lack of consensus on HIV and infant-feeding at all levels and general confusion about the 2006 guidelines, particularly those recommending continued breastfeeding after six months if replacement feeding is not acceptable, feasible, affordable, sustainable and safe. Health workers found it particularly difficult to advise women to continue breastfeeding after six months. They worried that they would lose the trust of the PMTCT clients and the population at large, and they feared that continued breastfeeding was unsafe. Optimal support for HIV-infected women was noted in programmes where health workers were multi-skilled; coordinated their efforts and had functional, multidisciplinary task forces and engaged communities. The recent 2009 recommendations are the first to support antiretroviral (ARV use by mothers or children during breastfeeding. Besides promoting maternal health and providing protection against HIV infection in children, the new Rapid Advice has the potential to resolve the difficulties and confusion experienced by health workers in Malawi. Conclusions The process of integrating new evidence into
Pell, C; Meñaca, A; Were, F; Afrah, N.A; Chatio, S; Manda-Taylor, L; Hamel, M.J; Hodgson, A; Tagbor, H; Kalilani, L; Ouma, P; Pool, R
... (Ghana, Kenya and Malawi) with varying levels of ANC attendance. Methods: Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy...
Full Text Available The seismic risk potential for Malawi is high because traditional adobe and earthen structures are seismically vulnerable and large earthquakes of Mw7.0 or greater can be originated from the Malawi Rift. To assess seismic risk of the Malawian communities quantitatively, data and models for exposure, hazard, and vulnerability modules that are suitable for Malawi are integrated. The developed risk model is applied to a retrospective appraisal of the past damaging 2009 Karonga earthquake sequence and to the future earthquake scenarios for long-term risk management purposes. The earthquake impact assessment results highlight that the collapse risk predictions of the Malawian settlements are particularly dependent on the inclusion of large-magnitude earthquakes from the active faults around Lake Malawi and the selection and combination of seismic vulnerability models.
Patients presenting with the symptoms of oesophageal cancer almost always have advanced ... and reviewed for the relevant information. The data available .... Obesity is a major issue in Scotland with 44% of adult men being overweight and ...
Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusions 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
Schier, Joshua G.; Sejvar, James J; Lutterloh, Emily; Likaka, Andrew; Katsoudas, Eugenia; Karaseva, Yelena D.; Barr, Beth Tippett; Redwood, Yanique; Monroe, Stephan
An outbreak of typhoid fever in rural Malawi triggered an investigation by the Malawi Ministry of Health and the Centers for Disease Control and Prevention in July 2009. During the investigation, villagers were directly consuming washed, donated, pesticide-treated wheat seed meant for planting. The objective of this study was to evaluate the potential for pesticide exposure and health risk in the outbreak community. A sample of unwashed (1430 g) and washed (759 g) wheat seed donated for plant...
Chandani, Yasmin; Andersson, Sarah; Heaton, Alexis; Noel, Megan; Shieshia, Mildred; Mwirotsi, Amanda; Krudwig, Kirstin; Nsona, Humphreys; Felling, Barbara
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. 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. 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. 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
Chandani, Yasmin; Andersson, Sarah; Heaton, Alexis; Noel, Megan; Shieshia, Mildred; Mwirotsi, Amanda; Krudwig, Kirstin; Nsona, Humphreys; Felling, Barbara
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
Wetlands provide many ecosystem goods and services which include fish production. The sustainability of small-scale fisheries (SSF) has received considerable attention in recent years because fish is one of the major sources of animal protein to a considerable fraction of the global population which
Shieshia, Mildred; Noel, Megan; Andersson, Sarah; Felling, Barbara; Alva, Soumya; Agarwal, Smisha; Lefevre, Amnesty; Misomali, Amos; Chimphanga, Boniface; Nsona, Humphreys; Chandani, Yasmin
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
During the 1980s and 1990s least developed countries (LDCs) encountered increasing difficulties in maintaining national food security. By the turn of the century commercial food import bills reached unprecedented heights in terms of domestic food consumption. The already precarious state of food
Full Text Available There are two main types of models of behavioral change. What are collectively referred to as "individual models" are the predominant frameworks for studying risk behaviors including those related to HIV/AIDS. Individual models focus on risk perceptions, attitudes, outcome expectations, perceived norms, and self-efficacy. Models of risk behavior that focus on social or community factors have more recently been developed in response to criticisms of individual models. I use longitudinal data from the Malawi Diffusion and Ideational Change Project to study worry about HIV/AIDS. Specifically, I ask, what factors determine how much a person worries about HIV/AIDS, and are the predominant factors those that individual models would suggest, or are there are other determinants that have a greater impact on worry? I find that levels of network worry and suspected spousal infidelity have the strongest and most robust influence on respondent worry, providing support for the importance of social factors.
Chidya, Russel C. G.; Mulwafu, Wapulumuka O.; Banda, Sembeyawo C. T.
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.
Kelias P Msyamboza
Full Text Available BACKGROUND: Chronic non-communicable diseases (NCDs are becoming significant causes of morbidity and mortality, particularly in sub-Saharan African countries, although local, high-quality data to inform evidence-based policies are lacking. OBJECTIVES: To determine the magnitude of NCDs and their risk factors in Malawi. METHODS: Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25-64 years. Socio-demographic and behaviour risk factors were collected in Step 1. Physical anthropometric measurements and blood pressure were documented in Step 2. Blood cholesterol and fasting blood glucose were measured in Step 3. RESULTS AND CONCLUSION: A total of 5,206 adults (67% females were surveyed. Tobacco smoking, alcohol drinking and raised blood pressure (BP were more frequent in males than females, 25% vs 3%, 30% vs 4% and 37% vs 29%. Overweight, physical inactivity and raised cholesterol were more common in females than males, 28% vs 16%, 13% vs 6% and 11% vs 6%. Tobacco smoking was more common in rural than urban areas 11% vs 7%, and overweight and physical inactivity more common in urban than rural areas 39% vs 22% and 24% vs 9%, all with p<0.05. Overall (both sexes prevalence of tobacco smoking, alcohol consumption, overweight and physical inactivity was 14%, 17%, 22%, 10% and prevalence of raised BP, fasting blood sugar and cholesterol was 33%, 6% and 9% respectively. These data could be useful in the formulation and advocacy of NCD policy and action plan in Malawi.
Racquel E. Kohler
Full Text Available Purpose: Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. Methods: We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. Results: Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE; few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both was the most important attribute of an intervention, followed by the encounter setting and travel time. Conclusion: Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.
Bwijo, B; Kaneko, A; Takechi, M; Zungu, I L; Moriyama, Y; Lum, J K; Tsukahara, T; Mita, T; Takahashi, N; Bergqvist, Y; Björkman, A; Kobayakawa, T
Malawi changed its national policy for malaria treatment in 1993, becoming the first country in Africa to replace chloroquine by sulfadoxine and pyrimethamine combination (SP) as the first-line drug for uncomplicated malaria. Seven years after this change, we investigated the prevalence of dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr) mutations, known to be associated with decreased sensitivity to SP, in 173 asymptomatic Plasmodium falciparum infections from Salima, Malawi. A high prevalence rate (78%) of parasites with triple Asn-108/Ile-51/Arg-59 dhfr and double Gly-437/Glu-540 dhps mutations was found. This 'quintuple mutant' is considered as a molecular marker for clinical failure of SP treatment of P. falciparum malaria. A total of 11 different dhfr and dhps combinations were detected, 3 of which were not previously reported. Nineteen isolates contained the single Glu-540 mutant dhps, while no isolate contained the single Gly-437 mutant dhps, an unexpected finding since Gly-437 are mostly assumed to be one of the first mutations commonly selected under sulfadoxine pressure. Two isolates contained the dhps single or double mutant coupled with dhfr wild-type. The high prevalence rates of the three dhfr mutations in our study were consistent with a previous survey in 1995 in Karonga, Malawi, whereas the prevalences of dhps mutations had increased, most probably as a result of the wide use of SP. A total of 52 P. falciparum isolates were also investigated for pyrimethamine and sulfadoxine/pyrimethamine activity against parasite growth according to WHO in vitro standard protocol. A pyrimethamine resistant profile was found. When pyrimethamine was combined with sulfadoxine, the mean EC(50) value decreased to less than one tenth of the pyrimethamine alone level. This synergistic activity may be explained by sulfadoxine inhibition of dhps despite the double mutations in the dhps genes, which would interact with pyrimethamine acting to block the
Full Text Available Medium-scale farms have become a major force in Malawi’s agricultural sector. Malawi’s most recent official agricultural survey indicates that these account for over a quarter of all land under cultivation in Malawi. This study explores the causes and multifaceted consequences of the rising importance of medium-scale farms in Malawi. We identify the characteristics and pathways of entry into farming based on surveys of 300 medium-scale farmers undertaken in 2014 in the districts of Mchinji, Kasungu and Lilongwe. The area of land acquired by medium-scale farmers in these three districts is found to have almost doubled between 2000 and 2015. Just over half of the medium-scale farmers represent cases of successful expansion out of small-scale farming status; the other significant proportion of medium-scale farmers are found to be urban-based professionals, entrepreneurs and/or civil servants who acquired land, some very recently, and started farming in mid-life. We also find that a significant portion of the land acquired by medium-scale farmers was utilized by others prior to acquisition, that most of the acquired land was under customary tenure, and that the current owners were often successful in transferring the ownership structure of the acquired land to a long-term leaseholding with a title deed. The study finds that, instead of just strong endogenous growth of small-scale famers as a route for the emergence of medium-scale farms, significant farm consolidation is occurring through land acquisitions, often by urban-based people. The effects of farmland acquisitions by domestic investors on the country’s primary development goals, such as food security, poverty reduction and employment, are not yet clear, though some trends appear to be emerging. We consider future research questions that may more fully shed light on the implications of policies that would continue to promote land acquisitions by medium-scale farms.
Full Text Available Advising women on , haemorrhage in pregnancy could, be viewed, as an integral aspect of maternal health care in M alawi. The WHO (1999 confirmed, that haemorrhage in pregnancy was not only a direct reason for maternal mortality but also a major cause of maternal death. The question on the nature of information that midwives and traditional birth attendants (referred to as TBA’s in the Chiradzulu district in Malawi gave with regard to haemorrhage in pregnancy, therefore arose. Research available focused on the women’s knowledge about the complications of pregnancy but not on the nature of information women received from midwives and TBA’s. This study explored and described the nature of information that was given to rural women in the Chiradzulu district by the midwives and TBA’s regarding haemorrhage in pregnancy. The findings revealed that although both the midwives and TBA’s included important information about haemorrhage in pregnancy, there were deficiencies in some critical areas. Examples of these deficiencies were the definition of haemorrhage in pregnancy; the predisposing factors for antepartum and postpartum haemorrhage and deficiencies in the nature of information on the management and referral of haemorrhaging patients. The findings provided insights into the nature of the information that was provided to the women regarding haemorrhage in pregnancy in the Chiradzulu district in Malawi. Thereafter guidelines were developed for the provision of this information. Finally a follow-up study was recommended after implementation of these guidelines in the district to evaluate the change in the nature of the information communicated to patients regarding haemorrhage by midwives and TBA’s. In this study, haemorrhage during pregnancy referred to the perinatal phase, including antepartum, intrapartum and postpartum haemorrhage.
Joy, Edward J M; Broadley, Martin R; Young, Scott D; Black, Colin R; Chilimba, Allan D C; Ander, E Louise; Barlow, Thomas S; Watts, Michael J
Food supply and composition data can be combined to estimate micronutrient intakes and deficiency risks among populations. These estimates can be improved by using local crop composition data that can capture environmental influences including soil type. This study aimed to provide spatially resolved crop composition data for Malawi, where information is currently limited. Six hundred and fifty-two plant samples, representing 97 edible food items, were sampled from >150 sites in Malawi between 2011 and 2013. Samples were analysed by ICP-MS for up to 58 elements, including the essential minerals calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), selenium (Se) and zinc (Zn). Maize grain Ca, Cu, Fe, Mg, Se and Zn concentrations were greater from plants grown on calcareous soils than those from the more widespread low-pH soils. Leafy vegetables from calcareous soils had elevated leaf Ca, Cu, Fe and Se concentrations, but lower Zn concentrations. Several foods were found to accumulate high levels of Se, including the leaves of Moringa, a crop not previously been reported in East African food composition data sets. New estimates of national dietary mineral supplies were obtained for non-calcareous and calcareous soils. High risks of Ca (100%), Se (100%) and Zn (57%) dietary deficiencies are likely on non-calcareous soils. Deficiency risks on calcareous soils are high for Ca (97%), but lower for Se (34%) and Zn (31%). Risks of Cu, Fe and Mg deficiencies appear to be low on the basis of dietary supply levels. Copyright © 2014. Published by Elsevier B.V.
Full Text Available In 2007, the World Health Organization (WHO recommended scaling up voluntary medical male circumcision (VMMC in priority countries with high HIV prevalence and low male circumcision (MC prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS, an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region.We used the Decision Makers' Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS.Over a fifteen-year period, circumcising males ages 10-29 would avert 75% of HIV infections, and circumcising males ages 10-34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15-49. The Ministry of Health's South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO's definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban areas would be both cost
This thesis is based on three published papers about complications after intramedullary (IM) nailing of fractures of the long bones in low- and middle-income countries (LMICs). The first two studies were register studies using data from the SIGN online surgical database (SOSD). The third study was a prospective study of patients treated for femoral fractures at Kamuzu Central Hospital in Malawi. The SOSD is, to my knowledge, currently the largest database in the world containin...
Arndt, Channing; Chinowsky, Paul; Fant, Charles
We consider the interplay of climate change impacts, global mitigation policies, and the interests of developing countries to 2050. Focusing on Malawi, Mozambique, and Zambia, we employ a structural approach to biophysical and economic modeling that incorporates climate uncertainty and allows...... for rigorous comparison of climate, biophysical, and economic outcomes across global mitigation regimes. We find that effective global mitigation policies generate two sources of benefit. First, less distorted climate outcomes result in typically more favourable economic outcomes. Second, successful global...... mitigation policies reduce global fossil fuel producer prices, relative to unconstrained emissions, providing a substantial terms of trade boost to structural fuel importers. Combined, these gains are on the order of or greater than estimates of mitigation costs. These results highlight the interests of most...
Samuel, J C; Campbell, E L P; Mjuweni, S; Muyco, A P; Cairns, B A; Charles, A G
This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were Burns occurred most frequently in the cool, dry season and in the evening. The mean burn surface area (second/third degree) was 14.1% and most burns (74%) presented within 8 h. The commonest procedure was debridement and/or amputation. The mean hospital stay was 21.1 days, in-hospital mortality was 27% and wound infection rate was 31%. Available interventions (intravenous fluids, nutrition therapy, physiotherapy) were misapplied in 59% of cases. It is concluded that primary prevention should address paediatric and scald burns, and secondary prevention should train providers to use available interventions appropriately.
Prevalence of HIV after age 50 is considerable, especially in southern Africa. Negative social constructions of HIV in older age, and the health consequences of ageing with the virus, mean that having HIV presents a challenge for many people's roles and social memberships, threatening to disrupt their sense of self. Using constructivist grounded theory and qualitative data from rural Malawi, this paper describes how older men and women deal with these identity challenges. Drawing on a symbolic interactionist framework, it uses identity control theory to explore how the study's participants presented their post-diagnosis behaviours in ways that maintained their most significant pre-diagnosis identities as 'adults', a label they gave to the core identity of being a person who belongs in the social world. Considering the processes through which older people with HIV navigated challenges to their identities in light of the intersectional influences of HIV and age-related stigma and illness, provides insight into how older people might experience HIV, as well as informing theoretical understandings of identity formation and maintenance in light of chronic and/or stigmatising illness more broadly. © 2016 The Author. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
Full Text Available In the early months of 2015, destructive floods hit Malawi, causing deaths and economic losses. Flood risk assessment outcomes can be used to increase scientific-supported awareness of risk. The recent increase in availability of high resolution data such as TanDEM-X at 12m resolution makes possible the use of detailed physical based flood hazard models in risk assessment. Nonetheless the scale of hazard modelling still remains an issue, which requires a compromise between level of detail and computational efforts. This work presents two different approaches on hazard modelling. Both methods rely on 32-years of numeric weather re-analysis and rainfall-runoff transformation through a fully distributed WFLOW-type hydrological model. The first method, applied at national scale, uses fast post-processing routines, which estimate flood water depth at a resolution of about 1×1km. The second method applies a full 2D hydraulic model to propagate water discharge into the flood plains and best suites for small areas where assets are concentrated. At the 12m resolution, three hot spots with a model area of approximately 10×10 km are analysed. Flood hazard maps obtained with both approaches are combined with flood impact models at the same resolution to generate indicators for flood risk. A quantitative comparison of the two approaches is presented in order to show the effects of modelling scale on both hazard and impact losses.
Full Text Available The aim of this study was to screen for selected parasites and antibody levels against vectorborne pathogens in owned dogs in Lilongwe, Malawi. The study population consisted of 100 dogs; 80 participating in vaccination–spaying campaigns and 20 visiting a veterinary clinic as paying clients. All dogs went through a general physical examination including visual examination for signs of ectoparasites. A total of 100 blood samples were analysed using commercial snap tests and 40 faecal samples by egg flotation in saturated sodium chloride. The sampled dogs had a seroprevalence of 12% for Anaplasma spp., 22% for Ehrlichia spp., 4% for Dirofilaria immitis and 1% for Leishmania spp. Eggs from Ancylostoma spp. were found in 80% of the faecal samples, whereas eggs of Trichuris vulpis, Toxocara canis and Toxascaris leonina were only present in 3%, 8% and 13% of the samples, respectively. Ectoparasites such as Ctenocephalides sp., Trichodectes sp. and ticks were present on 98%, 25% and 11%, respectively, of the campaign dogs. Among client dogs, 35% had Ctenocephalides fleas, 10% had Trichodectes lice and none had ticks. Public education and prophylactic treatment could be used to improve the animal welfare of dogs; this would most likely also have positive impact on public health.
Mzuza, Maureen Kapute; Yudong, Yang; Kapute, Fanuel
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…
Hjartarson, Freida; And Others
This collection of 5 bilingual papers on day care programs in foreign countries (China, the Soviet Union, and 3 Scandinavian countries) is part of a series of papers on various aspects of day care published by the Canadian Department of Health and Welfare. Each paper is presented in both English and French. Paper I considers day care services in…
Glaser, Nicola; Phiri, Sam; Bruckner, Tom; Nsona, Dominic; Tweya, Hannock; Ahrenshop, Nomeda; Neuhann, Florian
Chronic kidney disease (CKD) poses a major health threat to people living in low- and middle-income countries, especially when it is combined with HIV, antiretroviral treatment (ART) or communicable and non-communicable diseases. Data about the prevalence of CKD and its association with other diseases is scarce, particularly in HIV-negative individuals. This study estimated the prevalence of CKD in individuals who were either HIV-positive (and ART-naïve) or HIV-negative in an urban Malawian population. This cross-sectional study was conducted at a HIV Testing and Counselling Centre in Lilongwe, Malawi. Consecutive clients who were ≥18 years and consented to participate were enrolled over a 3-month period. Clients were screened for potential renal disease and other conditions. Their blood pressure was measured, urine examined via dipstick and albumin/creatinine ratio and blood drawn for creatinine, cystatin C and sero-markers for schistosomiasis. Estimated glomerular filtration (eGFR) rate was calculated using a cystatin C-based formula and classified according to the matching CKD stages by K/DOQI (The National Kidney Foundation Kidney Disease Outcome Quality Initiative). We performed a descriptive analysis and compared differences between HIV-positive (and ART naïve) and -negative participants. Out of 381 consecutive clients who were approached between January and March 2012, 366 consented and 363 (48% female; 32% HIV-positive) were included in the analysis. Reasons for exclusion were missing samples or previous use of ART. HIV-positive and negative clients did not differ significantly with regard to age, sex or medical history, but they did differ for BMI-21.3 (±3.4) vs. 24 (±5.1), respectively (p < 0.001). Participants also differed with regard to serum cystatin C levels, but not creatinine. Reduced kidney function (according to CKD stages 2-5) was significantly more frequent 15.5 vs. 3.6%, respectively (p < 0.001) among HIV-positive clients
Brown, E R S; Bartlett, J; Chalulu, K; Gadama, L; Gorman, D; Hayward, L; Jere, Y; Mpinganjira, M; Noah, P; Raphael, M; Taylor, F; Masamba, L
The Edinburgh Malawi Breast Cancer Project, a collaborative partnership project between the Queen Elizabeth Central Hospital (QECH) Oncology Unit, Blantyre, Malawi and the Edinburgh Cancer Centre, UK, was established in 2015. The principal objective of the project is to help to develop high quality multi-disciplinary breast cancer care in Malawi. A needs assessment identified three priority areas for further improvement of breast cancer services: multi-disciplinary working, development of oestrogen receptor (ER) testing and management of clinical data. A 3-year project plan was implemented which has been conducted through a series of reciprocal training visits. Key achievements to date have been: (1) Development of a new specialist breast care nursing role; (2) Development of multi-disciplinary meetings; (3) Completion of a programme of oncology nursing education; (4) Development of a clinical database that enables prospective collection of data of all new patients with breast cancer; (5) Training of local staff in molecular and conventional approaches to ER testing. The Edinburgh Malawi Breast Cancer Project is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will include the development of a breast cancer diagnostic clinic and a breast cancer registry. © 2017 John Wiley & Sons Ltd.
Mubaya, C. P.; Ngepah, N.; Seyama, W.
Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR) have similar aims and mutual benefits, and there is a very strong rationale for adopting a more integrated approach to these issues rather than analysing each of them as distinct from the other. One of the gaps that have been noted in this context is the lack of evidence in systematic integration of CCA and DRR in Southern Africa. In this regard, this study builds on understanding CCA and DRR policies from the perspectives of vulnerable groups- women and smallholder farmers, and conducts institutional and policy analysis of CCA and DRR in southern Africa, with specific focus on Malawi and Zimbabwe. Both quantitative and qualitative methodologies were employed to collect data for this study in the two countries. The analysis is centred on the conceptualization of DRR in the context of recovery time and CCA on livelihood changes. Findings of the study show that drought is no longer viewed as a hazard as it is a perennial and chronic occurrence in selected climate hotspots, with heightened intensity in certain identified years. Households are able to quickly recover from slow onset hazards such as droughts and dry spells more than they are able to recover from sudden onset floods, implying more capacity towards CCA than DRR. Government programmes and policies are also focused more on CCA than on DRR efforts that appear not to be a priority. Findings point towards female vulnerability from perceptions and practice where males tend to dominate where they are set to benefit from external assistance. We need to strengthen government capacity in implementation of DRR programmes, which is currently limited and development initiatives must deliberately target building the resilience of women.
Schouten, Erik J; Jahn, Andreas; Ben-Smith, Anne; Makombe, Simon D; Harries, Anthony D; Aboagye-Nyame, Francis; Chimbwandira, Frank
The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This system for ARVs, paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bypassing the government Central Medical Stores, is in place, using the United Nations Children's Fund's (UNICEF's) procurement services. The system, managed by a handful of people who spend limited time on supply management, is characterized by a centrally coordinated quantification based on verified data from all national ART clinics, parallel procurement through UNICEF, and direct distribution to ART clinics. The model worked well in the first years of the ART programme with a single first-line ARV regimen, but with more regimens becoming available (e.g., alternative first-line, second-line and paediatric regimens), it has become more difficult to administer. Managing supplies through a parallel system has the advantage that weaknesses in the national system have limited influence on the ARV procurement and supply chain management system. However, as the current system operates without a central warehouse and national buffer stock capacity, it diminishes the ability to prevent ARV stock outs. The process of ordering ARVs, from the time that estimates are made to the arrival of supplies in health facilities, takes approximately one year. Addressing the challenges involved in maintaining ARVs through an efficient procurement and supply chain management system that prevents ARV stock outs through the establishment of a dedicated procurement team, a central warehouse and/or national buffer stock is a
Bunyani, A; Mtimuni, B; Kalimbira, A; Kamalo, P
Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings. A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher's exact test. There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients-mainly enteral. The most commonly used formulations were the "ready-to-use therapeutic feeds," followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified. Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and
Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard
Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.
Full Text Available BACKGROUND: Antenatal care (ANC is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi with varying levels of ANC attendance. METHODS: Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. RESULTS: Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care - checking the foetus' position or monitoring its progress - motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women's timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures - in spite of policies of free ANC - combined with ideas about the compulsory nature of follow-up appointments. CONCLUSION: In these socially and culturally diverse sites, the findings suggest that 'supply' side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation.