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Journal articles on the topic 'Human Malawi Mzimba District'

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Published: 11 December 2022
Last updated: 29 January 2023

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1

Pollard, R. "Ethnic Variation of Twinning Rates in Malawi." Acta geneticae medicae et gemellologiae: twin research 45, no. 3 (July 1996): 361–65. http://dx.doi.org/10.1017/s0001566000000957.

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AbstractMalawi is a country in South-East Africa with a population of approximately 10 million, over 95% of whom are negro of Bantu origin. The country is divided into 24 administrative districts, each of which provides details of births which are compiled centrally at the Ministry of Health. Using data reported annually by health facilities from 1987-1990, most districts had twinning rates in the range 16 to 24 per 1000 maternities, figures consistent with those of other negro populations in Africa. Two adjoining districts (Rumphi and Mzimba) had rates which were considerably higher, almost 30 per 1000. Although ethnic origin is not recorded in the latest Malawi census, language spoken in the home, which was last recorded in 1966, can be used as a proxy. Rumphi and Mzimba are the only districts with an overwhelming majority of Tumbuka speaking population. These people, who are of both Tumbuka and Ngoni ethnic origin, therefore have an unusually high twinning rate (29.57 per 1000 maternities). The rate for the main ethnic group in Malawi, the Chewa people, was 21.21 per 1000. The district of Thyolo, with a mixed ethnic population, had by far the lowest rate (13.75 per 1000).
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2

Andersson, Jens A. "Informal moves, informal markets: International migrants and traders from Mzimba District, Malawi." African Affairs 105, no. 420 (April 20, 2006): 375–97. http://dx.doi.org/10.1093/afraf/adi128.

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3

Sekani, Yoram Kateta, Kabambe Vernon, William Lowole Max, and Cleopus Nalivata Patson. "Production practices of potato (Solanum tuberosum L.) by farmers in Mzimba District, Northern Malawi." African Journal of Agricultural Research 10, no. 8 (February 19, 2015): 797–802. http://dx.doi.org/10.5897/ajar2014.9081.

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4

Kretzer, M. M., S. Engler, J. Gondwe, and E. Trost. "Fighting resource scarcity – sustainability in the education system of Malawi – case study of Karonga, Mzimba and Nkhata Bay district." South African Geographical Journal 99, no. 3 (October 17, 2016): 235–51. http://dx.doi.org/10.1080/03736245.2016.1231624.

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5

Funsani, Priscilla, Hong Jiang, Xiaoguang Yang, Atupele Zimba, Thokozani Bvumbwe, and Xu Qian. "Why pregnant women delay to initiate and utilize free antenatal care service: a qualitative study in theSouthern District of Mzimba, Malawi." Global Health Journal 5, no. 2 (June 2021): 74–78. http://dx.doi.org/10.1016/j.glohj.2021.04.001.

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6

Gumma, Murali Krishna, Takuji W. Tsusaka, Irshad Mohammed, Geoffrey Chavula, N. V. P. R. Ganga Rao, Patrick Okori, Christopher O. Ojiewo, Rajeev Varshney, Moses Siambi, and Anthony Whitbread. "Monitoring Changes in the Cultivation of Pigeonpea and Groundnut in Malawi Using Time Series Satellite Imagery for Sustainable Food Systems." Remote Sensing 11, no. 12 (June 21, 2019): 1475. http://dx.doi.org/10.3390/rs11121475.

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Malawi, in south-eastern Africa, is one of the poorest countries in the world. Food security in the country hinges on rainfed systems in which maize and sorghum are staple cereals and groundnut and pigeonpea are now major grain legume crops. While the country has experienced a considerable reduction in forest lands, population growth and demand for food production have seen an increase in the area dedicated to agricultural crops. From 2010, pigeonpea developed into a major export crop, and is commonly intercropped with cereals or grown in double-up legume systems. Information on the spatial extent of these crops is useful for estimating food supply, understanding export potential, and planning policy changes as examples of various applications. Remote sensing analysis offers a number of efficient approaches to deliver spatial, reproducible data on land use and land cover (LULC) and changes therein. Moderate Resolution Imaging Spectroradiometer (MODIS) products (fortnightly and monthly) and derived phenological parameters assist in mapping cropland areas during the agricultural season, with explicit focus on redistributed farmland. Owing to its low revisit time and the availability of long-term period data, MODIS offers several advantages, e.g., the possibility of obtaining cloud-free Normalized Difference Vegetation Index (NDVI) profile and an analysis using one methodology applied to one sensor at regular acquisition dates, avoiding incomparable results. To assess the expansion of areas used in the production of pigeonpea and groundnut resulting from the release of new varieties, the spatial distribution of cropland areas was mapped using MODIS NDVI 16-day time-series products (MOD13Q1) at a spatial resolution of 250 m for the years 2010–2011 and 2016–2017. The resultant cropland extent map was validated using intensive ground survey data. Pigeonpea is mostly grown in the southern dry districts of Mulanje, Phalombe, Chiradzulu, Blantyre and Mwanza and parts of Balaka and Chikwawa as a groundnut-pigeonpea intercrop, and sorghum-pigeonpea intercrop in Mzimba district. By 2016, groundnut extent had increased in Mwanza, Mulanje, and Phalombe and fallen in Mzimba. The result indicates that the area planted with pigeonpea had increased by 29% (75,000 ha) from 2010–2011 to 2016–2017. Pigeonpea expansion in recent years has resulted from major export opportunities to Asian countries like India, and its consumption by Asian expatriates all over the world. This study provides useful information for policy changes and the prioritization of resources allocated to sustainable food production and to support smallholder farmers.
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7

Wezzie Khomera, Sphiwe, Moses Fayiah, and Simeon Gwayi. "Challenges Faced by Learners with Hearing Impairments in a Special School Environment: A Case Study of Embangweni Primary School for the Deaf, Mzimba District, Malawi." World Journal of Vocational Education and Training 2, no. 1 (2020): 21–36. http://dx.doi.org/10.18488/journal.119.2020.21.21.36.

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8

Rieger, Kerstin, Rochelle H. Holm, and Helen Sheridan. "Access to groundwater and link to the impact on quality of life: A look at the past, present and future public health needs in Mzimba District, Malawi." Groundwater for Sustainable Development 2-3 (August 2016): 117–29. http://dx.doi.org/10.1016/j.gsd.2016.07.002.

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9

Chilima, Benson Z., Ian M. Clark, Sian Floyd, Paul E. M. Fine, and Penny R. Hirsch. "Distribution of Environmental Mycobacteria in Karonga District, Northern Malawi." Applied and Environmental Microbiology 72, no. 4 (April 2006): 2343–50. http://dx.doi.org/10.1128/aem.72.4.2343-2350.2006.

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ABSTRACT The genus Mycobacterium includes many species that are commonly found in the environment (in soil and water or associated with plants and animals), as well as species that are responsible for two major human diseases, tuberculosis (Mycobacterium tuberculosis) and leprosy (Mycobacterium leprae). The distribution of environmental mycobacteria was investigated in the context of a long-term study of leprosy, tuberculosis, Mycobacterium bovis BCG vaccination, and the responses of individuals to various mycobacterial antigens in Karonga District, northern Malawi, where epidemiological studies had indicated previously that people may be exposed to different mycobacterial species in the northern and southern parts of the district. A total of 148 soil samples and 24 water samples were collected from various locations and examined to determine the presence of mycobacteria. The detection method involved semiselective culturing and acid-fast staining, following decontamination of samples to enrich mycobacteria and reduce the numbers of other microorganisms, or PCR with primers specific for the mycobacterial 16S rRNA gene, using DNA extracted directly from soil and water samples. Mycobacteria were detected in the majority of the samples, and subsequent sequence analysis of PCR products amplified directly from soil DNA indicated that most of the products were related to known environmental mycobacteria. For both methods the rates of recovery were consistently higher for dry season samples than for wet season samples. All isolates cultured from soil appeared to be strains of Mycobacterium fortuitum. This study revealed a complex pattern for the environmental mycobacterial flora but identified no clear differences between the northern and southern parts of Karonga District.
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10

Dewa, Ozius, Donald Makoka, and Olalekan A. Ayo-Yusuf. "Assessing Capacity and Implementation Status of the Disaster Risk Management Strategy for Health and Community Disaster Resilience in Malawi." International Journal of Disaster Risk Science 12, no. 5 (October 2021): 673–88. http://dx.doi.org/10.1007/s13753-021-00369-z.

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AbstractFloods are among the most frequently occurring natural hazards in Malawi, often with public health implications. This mixed methods study assessed the capacity for and implementation status of the disaster risk management (DRM) strategy for the health sector in Malawi, using flooding in the Nsanje District as a case. Data were collected using desk review and a workshop methodology involving key officials from government ministries, national and international development partners, and the academia. The results show that Malawi had recently strengthened its DRM institutional frameworks, with a pronounced policy shift from reactive to proactive management of disasters. Health sector personnel and structures were key contributors in the design and implementation of DRM activities at all levels. Development partners played a significant role in strengthening DRM coordination and implementation capacity. Lack of funding and the limited availability, and often fragmented nature, of vulnerability and risk assessment data were identified as key challenges. Limited human resource capacity and inadequate planning processes at district level impeded full implementation of DRM policies. These findings call for community-level interventions for improved coordination, planning, and human resource capacity to strengthen community disaster resilience and improve public health. The approach used in this study can serve as a model framework for other districts in Malawi, as well as in other low- and middle-income countries in the context of Sendai Framework implementation.
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11

Kaponda, Prince, Suresh Muthukrishnan, Rory Barber, and Rochelle H. Holm. "Drinking water quality and human dimensions of cholera patients to inform evidence-based prevention investment in Karonga District, Malawi." Water Supply 19, no. 7 (June 5, 2019): 2079–87. http://dx.doi.org/10.2166/ws.2019.086.

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Abstract Cholera remains a problem in sub-Saharan Africa, especially in Malawi. Our aim was to investigate drinking water source quality compared with water treatment, risk perception and cholera knowledge for patients who had reported to a health center for treatment in the 2017–2018 outbreak in Karonga District, Malawi. The study analyzed 120 drinking water samples linked to 236 cholera patients. Nearly 82% of the samples met the national criteria for thermotolerant coliforms of 50 cfu/100 ml, while 50% met the more stringent World Health Organization criteria of 0 cfu/100 ml. In terms of the human dimensions, 68% of survey respondents reported that they treated their water, while knowledge of prevention, transmission and treatment of cholera was also generally high. However, of the 32 patients whose drinking water sources had thermotolerant coliforms of 200+ cfu/100 ml, seven reported they felt a low or no personal risk for contracting cholera in the future and their community was extremely well prepared for another outbreak. The cost of a reactive response to cholera outbreaks puts a burden on Malawi, providing an opportunity for investment in innovative and localized preventive strategies to control and eliminate the risk of cholera while acknowledging social and cultural norms.
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12

McCormack, Grace P., Judith R. Glynn, Amelia C. Crampin, Felix Sibande, Dominic Mulawa, Lyn Bliss, Philip Broadbent, et al. "Early Evolution of the Human Immunodeficiency Virus Type 1 Subtype C Epidemic in Rural Malawi." Journal of Virology 76, no. 24 (December 15, 2002): 12890–99. http://dx.doi.org/10.1128/jvi.76.24.12890-12899.2002.

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ABSTRACT We have tracked the early years of the evolution of the human immunodeficiency virus type 1 (HIV-1) epidemic in a rural district of central east Africa from the first documented introductions of subtypes A, D, and C to the present predominance of subtype C. The earliest subtype C sequences ever reported are described. Blood samples were collected on filter papers from 1981 to 1984 and from 1987 to 1989 from more than 44,000 individuals living in two areas of Karonga District, Malawi. These samples included HIV-1-positive samples from 200 people. In 1982 to 1984, HIV-1 subtypes A, C, and D were all present, though in small numbers. By 1987 to 1989, 152 (90%) of a total of 168 sequences were subtype C and AC, AD, and DC recombinants had emerged. Four of the subtype C sequences from 1983 to 1984 were closely related and were found at the base of a large cluster of low diversity that by the late 1980s accounted for 40% of C sequences. The other two early C sequences fell into a separate and more diverse cluster. Three other clusters containing sequences from the late 1980s were identified. Each cluster contained at least one sample from a person who had recently arrived in the district. From 18 HIV-1-positive spouse pairs, 12 very closely related pairs of sequences were identified. We conclude that there were multiple introductions of HIV-1 with limited spread, followed by explosive growth of a subtype C cluster, probably arising from a single introduction in or before 1983.
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13

Adeyanju, Gbadebo Collins, Philipp Sprengholz, Cornelia Betsch, and Tene-Alima Essoh. "Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi." Vaccines 9, no. 11 (October 22, 2021): 1231. http://dx.doi.org/10.3390/vaccines9111231.

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Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husband’s positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husband’s approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.
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14

Jailos, Philip, Peter J. Chimtali, and Ephraim Vunain. "Assessment of Groundwater Quality in Areas Surrounding Thundulu Phosphate Mine, Phalombe District, Malawi." Tanzania Journal of Science 47, no. 3 (August 31, 2021): 1310–21. http://dx.doi.org/10.4314/tjs.v47i3.38.

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Water is one of the renewable resources essential for sustaining all forms of life and quality of drinking water is very fundamental for human health. Human activities such as mining act as sources of water contamination which consequently lead to ecological, environmental and health problems. To the best of our knowledge, no study has been conducted around the Thundulu Phosphate Mine to establish the quality of drinking water. In this regard, this study was carried out to evaluate the physico-chemical water quality parameters of areas surrounding the Thundulu Phosphate Mine in Phalombe District. Groundwater samples from the villages surrounding the Phosphate Mine were collected both during the wet and dry seasons for analysis of physico-chemical water quality parameters (pH, electrical conductivity, turbidity, nitrate, chloride, sulphate, fluoride, iron, calcium and magnesium). The study also investigated microbiological water characteristics mainly Escherichia coli and faecal coliforms. Results showed that pH, electrical conductivity, turbidity, nitrate, chloride, sulphate, phosphate, calcium and magnesium complied with the national and international standards set by Malawi Bureau of Standards (MBS) and World Health Organization (WHO). As regards to microbiological characteristics, it was revealed that water from three sources (B2, B3 and B4) was contaminated with Escherichia coli and faecal coliforms. Keywords: Physico-chemical; Groundwater; Phalombe; Borehole; Electrical Conductivity; Turbidity; Phosphate;
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15

Mwamtobe, Peter M., Shirley Abelman, J. Michel Tchuenche, and Ansley Kasambara. "Optimal (Control of) Intervention Strategies for Malaria Epidemic in Karonga District, Malawi." Abstract and Applied Analysis 2014 (2014): 1–20. http://dx.doi.org/10.1155/2014/594256.

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Malaria is a public health problem for more than 2 billion people globally. About 219 million cases of malaria occur worldwide and 660,000 people die, mostly (91%) in the African Region despite decades of efforts to control the disease. Although the disease is preventable, it is life-threatening and parasitically transmitted by the bite of the femaleAnophelesmosquito. A deterministic mathematical model with intervention strategies is developed in order to investigate the effectiveness and optimal control strategies of indoor residual spraying (IRS), insecticide treated nets (ITNs) and treatment on the transmission dynamics of malaria in Karonga District, Malawi. The effective reproduction number is analytically computed, and the existence and stability conditions of the equilibria are explored. The model does not exhibit backward bifurcation. Pontryagin’s Maximum Principle which uses both the Lagrangian and Hamiltonian principles with respect to a time dependent constant is used to derive the necessary conditions for the optimal control of the disease. Numerical simulations indicate that the prevention strategies lead to the reduction of both the mosquito population and infected human individuals. Effective treatment consolidates the prevention strategies. Thus, malaria can be eradicated in Karonga District by concurrently applying vector control via ITNs and IRS complemented with timely treatment of infected people.
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16

Mwalwimba, I. N. K. "Assessing Vulnerability Trends and Magnitudes in Light of Human Responses to Floods in Karonga District, Malawi." International Journal of Science and Research (IJSR) 9, no. 4 (April 5, 2020): 938–45. http://dx.doi.org/10.21275/sr20411180826.

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17

Travers, Simon A. A., Jonathan P. Clewley, Judith R. Glynn, Paul E. M. Fine, Amelia C. Crampin, Felix Sibande, Dominic Mulawa, James O. McInerney, and Grace P. McCormack. "Timing and Reconstruction of the Most Recent Common Ancestor of the Subtype C Clade of Human Immunodeficiency Virus Type 1." Journal of Virology 78, no. 19 (October 1, 2004): 10501–6. http://dx.doi.org/10.1128/jvi.78.19.10501-10506.2004.

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ABSTRACT Human immunodeficiency virus type 1 (HIV-1) subtype C is responsible for more than 55% of HIV-1 infections worldwide. When this subtype first emerged is unknown. We have analyzed all available gag (p17 and p24) and env (C2-V3) subtype C sequences with known sampling dates, which ranged from 1983 to 2000. The majority of these sequences come from the Karonga District in Malawi and include some of the earliest known subtype C sequences. Linear regression analyses of sequence divergence estimates (with four different approaches) were plotted against sample year to estimate the year in which there was zero divergence from the reconstructed ancestral sequence. Here we suggest that the most recent common ancestor of subtype C appeared in the mid- to late 1960s. Sensitivity analyses, by which possible biases due to oversampling from one district were explored, gave very similar estimates.
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18

Mahata, Cynthia, and Peter Mhagama. "Factors affecting adoption of mobile phone applications among farmers in Lilongwe, Malawi: The case of Mchikumbe 212." 2018 International Conference on Multidisciplinary Research 2022 (December 30, 2022): 359–73. http://dx.doi.org/10.26803/myres.2022.28.

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The Ministry of Agriculture, through the Department of Agriculture Extension Services, intensified the use of ICTs in Agriculture extension as one way of mitigating the high extension worker to farmer ratio in Malawi. ICT-based agricultural extension in Malawi has evolved from using traditional ICT tools to modern ones. Of interest to this study is the Mchikumbe 212 platform. This service was launched by Airtel Malawi, in partnership with the Human Network International (HNI) in September 2015. The service aims to transform farming by increasing farmers’ access to information and advisory services. It provides farmers with access to practical information about agriculture via interactive voice response and short messaging services, where farmers listen to agriculture extension advisory services on a crop of their choice on their mobile phones by dialing 212. However, the adoption of the Mchikumbe 212 platform has not been satisfactory as the number of registered users has decreased since its launch. The study, therefore, aimed at analysing the factors affecting the adoption or rejection of the Mchikumbe 212 platform among farmers in Malawi. Data was collected using face-to-face interviews with both adopter and non-adopter farmers of the technology drawn from Lilongwe district. Key informant interviews were also conducted with officials from Airtel Malawi, Ministry of Agriculture and Human Network International. The study finds that there are several factors that both positively and negatively affect the adoption of the technology. Farmers who adopted the Mchikumbe 212 platform found it easy to use and navigate, convenient, affordable and accessible, and that it gave timely and relevant information for direct application in their gardens. Non-adopters showed preference for face-to-face extension over the Mchikumbe 212 platform citing absence of instant feedback as the main reason for non-adoption. Further, very little was done to promote the platform by the Ministry of Agriculture and Airtel Malawi. As a result, farmers did not associate Mchikumbe 212 platform with the government extension system. This is one of the factors that have negatively affected its adoption.
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19

Majamanda, James, Mangani Katundu, Victoria Ndolo, and David Tembo. "A Comparative Study of Physicochemical Attributes of Pigmented Landrace Maize Varieties." Journal of Food Quality 2022 (November 2, 2022): 1–10. http://dx.doi.org/10.1155/2022/6294336.

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Maize has been cultivated and continues to be cultivated for its usability in calorie supply to humans and livestock. There has been great interest in pigmented landrace maize varieties (PLMVs) due to their importance in the pharmaceutical industry. Landraces are to a large extent a repository of the gene pool that enriches biodiversity and maintains but also stabilizes the ecosystem in a sustainable way. PLMVs are still being cultivated by smallholder farmers in smaller portions of their fields and home surroundings despite the high adoption of white hybrid maize. This study examined the ash, moisture, mineral, crude protein, fat, and carbohydrate content of three different PLMVs from central (Ntcheu and Dedza districts) and northern (Mzimba district) Malawi. The mineral content of soils from fields where PLMVs were grown was also analyzed. The study areas experience a warm temperate climate and higher rainfall in summer than in winter but they differ in that Ntcheu has the highest average annual temperature of 20.3°C while Dedza receives the highest annual precipitation of about 1010 mm. Mzimba’s average annual temperature and precipitation are 20.1°C and 915 mm, respectively. The study showed that orange maize from Dedza had a significantly higher content of calcium (71.00 ± 0.58 mg·kg−1), magnesium (819.00 ± 0.58 mg·kg−1), and phosphorus (2720.35 ± 0.03 mg·kg−1). Significantly higher contents of zinc (54.61 ± 0.43 mg·kg−1) and potassium (808.58 ± 0.27 mg·kg−1) were observed in purple maize from Dedza and Ntcheu, respectively. Red maize from Dedza had a significantly higher content of iron (59.80 ± 0.26 mg·kg−1). Purple maize from Dedza has significantly higher carbohydrate content (65.52 ± 0.07%). The findings also revealed that red maize from Dedza provenance had a high content of crude protein (12.57 ± 0.07%) and fat (10.73 ± 0.14%). Moisture (17.30 ± 0.21%) and ash (2.28 ± 0.02%) were significantly higher in orange maize from Dedza. Dedza’s provenance revealed a high content of the analyzed attributes in PLMVs. Mineral analysis showed different levels of mineral bioavailability in different PLMVs and in the soils where maize was grown. It can, therefore, be concluded that production location and maize variety have an influence on the attributes of PLMVs. Understanding the physicochemical attributes of PLMVs and its maximum utilization have the potential of improving food and nutrition security in Sub-Saharan African countries and globally.
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20

Dunbar, Elizabeth L., Emily B. Wroe, Basimenye Nhlema, Chiyembekezo Kachimanga, Ravi Gupta, Celia Taylor, Annie Michaelis, et al. "Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial." BMJ Open 8, no. 7 (July 2018): e019473. http://dx.doi.org/10.1136/bmjopen-2017-019473.

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IntroductionThis protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a ‘Household Model’ where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).Methods and analysisUsing a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model’s impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health’s District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.Ethics and disseminationEthics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017–2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.Trial registration numberNCT03106727.Primary sponsorPartners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.
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Nkhonjera, Joe, Leticia C. Suwedi-Kapesa, Benjamin Kumwenda, and Alinane Linda Nyondo-Mipando. "Factors Influencing Loss to Follow-up among Human Immunodeficiency Virus Exposed Infants in the Early Infant Diagnosis Program in Phalombe, Malawi." Global Pediatric Health 8 (January 2021): 2333794X2110041. http://dx.doi.org/10.1177/2333794x211004166.

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The efforts to prevent mother to child transmission of HIV in Malawi are impeded by the loss to follow-up of HIV-exposed infants (HEI) in care. Early infant diagnosis (EID) of HEI and linkage to care reduces morbidity and mortality. There has been limited attention to infants who are lost to follow up despite their mothers being compliant to the PMTCT program. This study explored factors that influence loss-to-follow up among HEI in the EID program whose mothers were retained in care for up to 24 months in Phalombe district, Malawi. We conducted a descriptive phenomenological qualitative study from May 2017 to July 2018. We purposively conducted 18 in-depth interviews among HIV positive mothers whose HEI were enrolled in the follow-up program and 7 key informant interviews among healthcare workers (HCW). All interviews were digitally recorded, transcribed, and translated verbatim. Data were analyzed manually using a thematic step-by-step approach. Results showed that retention in care is facilitated by aspirations to have a healthy infant and linkage to a nearer facility to a mother’s place of residency. The barriers to retention were non-disclosure of HIV status, inadequate resources, and support, suboptimal guidelines for, a lack of privacy, and unsynchronized hospital visits between a mother and her baby. The study has shown that successful implementation of EID services requires concerted efforts from various contextualized stakeholders whilst focusing on family-centered care. To maximize retention in EID and innovative ways of reaching mothers and babies through flexible guidelines are urgently needed.
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22

Jere, Gibson Mapopa, GO Abong’, LG Njue, K. Masamba, and DG Omayio. "Exposure of school children to aflatoxins and fumonisins through maize-based diets in school meals programme in Salima district, Malawi." African Journal of Food, Agriculture, Nutrition and Development 20, no. 06 (October 31, 2020): 16793–809. http://dx.doi.org/10.18697/ajfand.94.20110.

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Exposure to aflatoxins and fumonisins contaminated food poses threats to human health,including causation of cancer, immunosuppression, impaired growth, respiratory problems, diarrhea, among others.This study was carried out to evaluate the levels of aflatoxins and fumonisins in maize-based porridge and the estimated intake levels of the contaminants among school going children in selected primary schools in Salima District,Malawi.A total of 496 children and 124 food handlers from 31 primary schools within three Extension Planning Areas(EPAs) under the School Meals Programmes were involved. Consumption and meal preparation data were collected from the respondents using pre-tested questionnaires. Reveal Q+ Kits were used to quantify aflatoxins and fumonisins in sampled meals. Monte Carlo risk simulation using @RiskPalisade software(UK)was used to generate exposure data.All porridge samples had varying detectable levels of mycotoxins. However,there were no significant (P<0.05) differences in the aflatoxins and fumonisins levels for samples from different EPAs indicating the endemic presence of mycotoxins within the district. Over 95% of the schools used maize as the main ingredient in preparing the porridge with relatively high quantities consumed 610 grams/child/day equivalent to 0.019 kg/kg body weight/day regardless of the gender (χ2 = 5.624, P = 0.286)or the age (r = 0.033, P = 0.459)of the respondents. The levels of aflatoxins and fumonisins in the samples ranged from 2.13 to 33.37 μg/kg and <0.3to1.0 ng/kg, respectively.The mean and the 95thpercentile intake levels for aflatoxins ranged from0.2 -0.60ng/kg body weight/dayand6 –9.2 μg/kg body weight/day for fumonisins,which exceeded the recommended safety levels for children according to standards of European Food Safety Authority (2007) and Joint Food and Agriculture Organization/World Health Organization Committee on Food Additives (2008), respectively.The consumption of maize-based porridge was found to expose school-going children to unacceptable levels of mycotoxins whose effects on their health, education and well-being remain unknown. There is a need to educate food handlers on mycotoxins intoxication and proper postharvest handling practices of maize-based foods to prevent exposure.Furthermore, diversification to reduce over reliance on maize-based diets should be promoted.
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Swarthout, Todd D., Ana Ibarz-Pavon, Gift Kawalazira, George Sinjani, James Chirombo, Andrea Gori, Peter Chalusa, et al. "A pragmatic health centre-based evaluation comparing the effectiveness of a PCV13 schedule change from 3+0 to 2+1 in a high pneumococcal carriage and disease burden setting in Malawi: a study protocol." BMJ Open 11, no. 6 (June 2021): e050312. http://dx.doi.org/10.1136/bmjopen-2021-050312.

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IntroductionStreptococcus pneumoniae (the pneumococcus) is commonly carried as a commensal bacterium in the nasopharynx but can cause life-threatening disease. Transmission occurs by human respiratory droplets and interruption of this process provides herd immunity. A 2017 WHO Consultation on Optimisation of pneumococcal conjugate vaccines (PCV) Impact highlighted a substantial research gap in investigating why the impact of PCV vaccines in low-income countries has been lower than expected. Malawi introduced the 13-valent PCV (PCV13) into the national Expanded Programme of Immunisations in 2011, using a 3+0 (3 primary +0 booster doses) schedule. With evidence of greater impact of a 2+1 (2 primary +1 booster dose) schedule in other settings, including South Africa, Malawi’s National Immunisations Technical Advisory Group is seeking evidence of adequate superiority of a 2+1 schedule to inform vaccine policy.MethodsA pragmatic health centre-based evaluation comparing impact of a PCV13 schedule change from 3+0 to 2+1 in Blantyre district, Malawi. Twenty government health centres will be randomly selected, with ten implementing a 2+1 and 10 to continue with the 3+0 schedule. Health centres implementing 3+0 will serve as the direct comparator in evaluating 2+1 providing superior direct and indirect protection against pneumococcal carriage. Pneumococcal carriage surveys will evaluate carriage prevalence among children 15–24 months, randomised at household level, and schoolgoers 5–10 years of age, randomly selected from school registers. Carriage surveys will be conducted 18 and 33 months following 2+1 implementation.AnalysisThe primary endpoint is powered to detect an effect size of 50% reduction in vaccine serotype (VT) carriage among vaccinated children 15–24 months old, expecting a 14% and 7% VT carriage prevalence in the 3+0 and 2+1 arms, respectively.Ethics and disseminationThe study has been approved by the Malawi College of Medicine Research Ethics Committee (COMREC; Ref: P05.19.2680), the University College London Research Ethics Committee (Ref: 8603.002) and the University of Liverpool Research Ethics Committee (Ref: 5439). The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration numberNCT04078997.
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Tizifa, Tinashe A., Steven Gowelo, Alinune N. Kabaghe, Robert S. McCann, Tumaini Malenga, Richard M. Nkhata, Asante Kadama, et al. "Community-based house improvement for malaria control in southern Malawi: Stakeholder perceptions, experiences, and acceptability." PLOS Global Public Health 2, no. 7 (July 14, 2022): e0000627. http://dx.doi.org/10.1371/journal.pgph.0000627.

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House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.
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Chopra, Mickey, Tanya Doherty, Saba Mehatru, and Mark Tomlinson. "Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia." Public Health Nutrition 12, no. 12 (April 30, 2009): 2323–28. http://dx.doi.org/10.1017/s1368980009005606.

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AbstractObjectiveThe possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints.DesignField teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries – eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers.SettingA rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007.ResultsInfant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources – human, financial and time – for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources.ConclusionsIn order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival – not just minimization of HIV transmission – and hence the need for integrating MTCT prevention.
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Kainga, Hamilton Wales, Steven Ssendagire, Jacquellyn Nambi Ssanyu, Sarah Nabukeera, Noel Namuhani, and Fred Wabwire Mangen. "Proportion of children aged 9–59 months reached by the 2017 measles supplementary immunization activity among the children with or without history of measles vaccination in Lilongwe district, Malawi." PLOS ONE 16, no. 1 (January 11, 2021): e0243137. http://dx.doi.org/10.1371/journal.pone.0243137.

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Background The measles Supplementary Immunization Activity (SIA) was implemented in June, 2017 to close immunity gaps by providing an additional opportunity to vaccinate children aged between 9 months and up to 14 years in Lilongwe District, Malawi. This study was conducted to determine the proportion of eligible children that were reached by the 2017 measles SIA among those children with or without history of measles vaccination, and possible reasons for non-vaccination. Methods A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 19 households from each of the 25 clusters (villages) that were randomly selected in Lilongwe District. A child was taken to have been vaccinated if the caretaker was able to explain when and where the child was vaccinated. Eight Key Informant Interviews (KIIs) were conducted with planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between non-vaccination and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with non-vaccination of eligible children in this study. Results A total of 476 children and their caretakers were surveyed. The median age of the children was 52.0 months. Overall, 41.2% [95% CI 36.8–45.7] of the children included in the study were not vaccinated during the SIA. Only 59.6% of children with previous measles doses received SIA dose; while 77% of those without previous measles vaccination were reached by the SIA. Low birth order, vaccination history under routine services, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the SIA were significantly associated with non-vaccination among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers’ perspectives), poor delivery of health education, logistical and human resource challenges as possible reasons for non-vaccination. Conclusion Many children (41%) were left unvaccinated during the SIA and several factors were found to be associated with this finding. The Lilongwe District Health Team should endeavor to optimize routine immunization program; and community mobilization should be intensified as part of SIA activities.
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Latham, Tom, Dikani Salema, and Steven Mlenga. "Peripheral Blood Film Examination In Malawi: The Maximum Diagnostic Information for the Least Resources?." Blood 116, no. 21 (November 19, 2010): 3799. http://dx.doi.org/10.1182/blood.v116.21.3799.3799.

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Abstract Abstract 3799 Introduction: Malawi is the 23th least developed country according to the 2009 UN human development index and has a per capita health expenditure of $17 per year. In common with most of sub-Saharan Africa, severe haematological abnormalities are common in hospital patients, both contributing to ill health and reflecting the nature of underlying illnesses. Facilities for investigating abnormal results are limited and there are chronic problems with supply and maintenance of equipment and reagents. Examination of peripheral blood films provides extensive diagnostic information and can be performed with equipment routinely available even in district laboratories but there are few data on the feasibility and utility of routine blood film examination in this setting. Methods: Routine preparation of thin blood films stained with reverse Field's stain was introduced as a laboratory standard operating procedure for all FBC results meeting predetermined criteria [Hb<7.0 or >16.5 g/dl; MCV<60 or>100 fl; WBC <3.5 or >17.0 ×109/L; PLT <70 or >650 ×109/L] in the major teaching hospital. Films were reported by an experienced haematologist. Handwritten laboratory records of FBC and blood film reports over a 12 month period were reviewed retrospectively. Results: From 35449 FBC samples received 9543(26.9%) met criteria for film preparation. 3745 (39.2% of samples meeting criteria) were prepared. The proportion of films made improved during the study period; films were less likely to be prepared at weekends or late in the day. High day-to-day variability suggests that compliance levels may reflect staff on duty on individual days; workload on a given day did not appear negatively correlated with compliance. 69.5% of film reports gave added diagnostic information (other than simply confirming automated counts); many of the features found were not evident from the patient's clinical condition. Important findings included 33 new cases of leukaemia (14 acute leukemia, 6 CML and 13 CLL or other lymphoid disorders). 6.5% of films showed features suggesting haemolysis or increased red cell production. 2.2% showed specific features (not just macrocytosis) suggesting megaloblastic anaemia, 4.7% showed malaria parasites or other evidence of malaria such as pigment. 2.5% of films showed features raising the possibility of error in the automated counts. Reactive features were very common (57% of films). The 10 most common classes of film findings [see table 1] accounted for 75.8% of informative blood film reports. Conclusions: Routine peripheral blood film examination in a sub-Saharan African context provides a high yield of diagnostic information with minimal extra equipment requirement. A small number of common findings account for the majority of reports, suggesting that focussed training to identify these common abnormalities could have substantial benefits and could be implemented in a brief training programme. The variable compliance with the standard operating procedure suggests that staff confidence and enthusiasm may be the most important barriers to the incorporation of film reporting into routine practice. Disclosures: No relevant conflicts of interest to declare.
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van Lettow, M., C. E. West, J. W. M. van der Meer, F. T. Wieringa, and R. D. Semba. "Low plasma selenium concentrations, high plasma human immunodeficiency virus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi." European Journal of Clinical Nutrition 59, no. 4 (March 2, 2005): 526–32. http://dx.doi.org/10.1038/sj.ejcn.1602116.

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Mwale, Marisen. "Factors Determining Voluntary Counseling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) among Low Income Women: Focus Group Findings from Rural, Urban, and Peri-Urban Women Groups in Lilongwe District-Malawi." Journal of Basic & Applied Sciences 10 (July 18, 2014): 306–16. http://dx.doi.org/10.6000/1927-5129.2014.10.40.

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Manda, Tiwonge Davis, and Jo Herstad. "Enacting technology." Information Technology & People 28, no. 3 (August 3, 2015): 442–65. http://dx.doi.org/10.1108/itp-02-2014-0045.

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Purpose – The purpose of this paper is to discuss implications of human-technology interaction in organizational change, especially where mobile phones are introduced to replace paper-based reporting. Design/methodology/approach – The paper employs a case study approach, focusing on implementation of mobile technology for health (mHealth) solutions to support remote data communication, between health facilities and a district health office (DHO), in Malawi. Findings – The findings suggest that mobile phones are relevant to parts of multi-stage tasks such as data reporting, which comprise compilation, transportation, and digitization of data, and delivery of feedback. Consequently, innovation due to the introduction of mobile phones, is found in their interaction with other artefacts (paper, desktop computers, etc.), and existing paper-centric and emerging work practices. Research limitations/implications – Although lessons from this study could be transported across contexts, practitioners, and researchers should pay particular attention to contextual differences. Practical implications – In accounting for the mutual shaping between technology and context/work practices the paper demonstrates that mHealth innovation demands significant practical work. Originality/value – mHealth research is often preoccupied with capabilities of mobile devices. First, the authors account for interaction between artefacts, existing, and emerging use contexts, and the use process, at multiple levels of organization. Through this, the authors argue for a need to seriously consider idiosyncrasies of artefacts and tasks at hand, as well as distributed affordances across artefacts, in mHealth implementations. Second, the authors argue that contrary to the general focus on mobile phones as tools for supporting people on the move, their relevance might actually be found in reducing people’s mobility.
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Chintalapudi, Nainisha, Gloria Hamela, Innocent Mofolo, Suzanne Maman, Mina C. Hosseinipour, Irving F. Hoffman, and Valerie L. Flax. "Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers’ and Fathers’ Roles in the Context of HIV." Journal of Human Lactation 34, no. 1 (August 25, 2017): 68–76. http://dx.doi.org/10.1177/0890334417719245.

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Background: Few studies in low- and middle-income countries have examined the roles of couples in infant and young child feeding decision making and practices, and there is no corresponding data in the context of human immunodeficiency virus (HIV). Research aim: This study aimed to explore mothers’ and fathers’ perceptions of their roles in feeding decision making and practices. Methods: The authors conducted in-depth interviews with 15 mothers and their male partners, recruited from the catchment areas of two urban and two rural government clinics in Lilongwe District, Malawi. The mothers were ≥ 18 years of age, were HIV positive, and had a child < 24 months of age. Twelve of the 15 fathers were also HIV positive. The interviews were analyzed using content analysis. Results: Mothers were responsible for child care, including breastfeeding and complementary feeding. Fathers provided monetary support for purchasing food and offered verbal support to encourage mothers to implement recommended feeding practices. Many fathers found it difficult to support adequate complementary feeding because of household food insecurity. Mothers were advised on child feeding during prevention of mother-to-child transmission clinic visits. No fathers in this study accompanied women to clinic appointments, so they were less well-informed about feeding than mothers. Fathers usually deferred to mothers in feeding decision making. One-third of mothers wanted fathers to be more involved in child feeding. Conclusion: Malawian mothers’ and fathers’ roles in feeding decision making in the context of HIV align with local gender norms. Strategies are needed to improve fathers’ knowledge of and involvement in child feeding, as desired by mothers.
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Devi Artanti, Guspri, Fidesrinur, and Meyke Garzia. "Stunting and Factors Affecting Toddlers in Indonesia." JPUD - Jurnal Pendidikan Usia Dini 16, no. 1 (April 30, 2022): 172–85. http://dx.doi.org/10.21009/jpud.161.12.

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ABSTRACT: Asia is the second region after Africa to have the tallest prevalence of stunting in the world. Indonesia is one of the countries in Southeast Asia with the fifth highest prevalence of stunting in the world at 37%, or nearly 9 million children who experience stunting. This study aims to examine the factors that influence and risk the occurrence of stunting in children in Indonesia. The research method uses a type of qualitative research with a traditional literature review. This study found that stunting is influenced by several complex factors not only at the individual level but also at the family and community levels. A comprehensive synthesis of the available evidence on the determinants of stunting in children in Indonesia outlines who is most vulnerable to stunting, which interventions are successful, and what new research is needed to fill knowledge gaps. Keywords: Indonesian toddlers, stunting factors References: Adair, L. S., & Guilkey, D. K. (1997). Age-specific Determinants of Stunting in Filipino Children. The Journal of Nutrition, 127(2), 314–320. https://doi.org/10.1093/jn/127.2.314 Akombi, B. J., Agho, K. E., Hall, J. J., Merom, D., Astell-Burt, T., & Renzaho, A. M. N. (2017). Stunting and Severe Stunting Among Children Under-5 Years in Nigeria: A Multilevel Analysis. BMC Pediatrics, 17(1), 1–16. https://doi.org/10.1186/s12887-016-0770-z Asfaw, M., Wondaferash, M., Taha, M., & Dube, L. (2015). Prevalence of Undernutrition and Associated Factors Among Children Aged Between Six to Fifty Nine Months in Bule Hora District, South Ethiopia. BMC Public Health,15(1), 41. https://doi.org/10.1186/s12889-015-1370-9 Badan Penelitian dan Pengembangan Kesehatan. (2018). Hasil Utama RISKESDAS 2018. Bardosono, S., Sastroamidjojo, S., & Lukito, W. (2007). Determinants of Child Malnutrition During the 1999 Economic Crisis in Selected Poor Areas of Indonesia. Asia Pacific Journal of Clinical Nutrition, 16(3), 512–526. Best, C. M., Sun, K., De Pee, S., Sari, M., Bloem, M. W., & Semba, R. D. (2008). Paternal Smoking and Increased Risk of Child Malnutrition Among Families in Rural Indonesia. Tobacco Control, 17(1), 38–45. https://doi.org/10.1136/tc.2007.020875 Biadgilign, S., Shumetie, A., & Yesigat, H. (2016). Does Economic Growth Reduce Childhood Undernutrition in Ethiopia? PLoS ONE, 11(8), 1–14. https://doi.org/10.1371/journal.pone.0160050 Black, R. E., Victoria, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., Onis, M. de, Ezzati, M., McGregor, S. G., Katz, J., Martorell, R., Uauy, R., & The Maternal and Child Nutrition Study Group. (2013). Maternal and Child Undernutrition and Overweight in Low-income and Middle-income Countries. The Lancet, 382, 396. Budge, S., Parker, A. H., Hutchings, P. T., & Garbutt, C. (2019). Environmental Enteric Dysfunction and Child Stunting. Nutrition Reviews, 77(4), 240–253. https://doi.org/10.1093/nutrit/nuy068 Burchi, F. (2010). Child Nutrition in Mozambique in 2003: The Role of Mother’s Schooling and Nutrition Knowledge. Economics and Human Biology, 8(3), 331–345. https://doi.org/10.1016/j.ehb.2010.05.010 Casale, D., Espi, G., & Norris, S. A. (2018). Estimating the pathways through which maternal education affects stunting: Evidence from an urban cohort in South Africa. 21(10), 1810–1818. https://doi.org/10.1017/S1368980018000125 Casanovas, M. del C., Lutter, C. K., Mangasaryan, N., Mwadime, R., Hajeebhoy, N., Aguilar, A. M., Kopp, C., Rico, L., Ibiett, G., Andia, D., & Onyango, A. W. (2013). Multi-sectoral Intervensions for Healthy Growth. Matern Child Nutrition, 2, 46–57. https://doi.org/10.1111/mcn.12082 Chirande, L., Charwe, D., Mbwana, H., Victor, R., Kimboka, S., Issaka, A. I., Baines, S. K., Dibley, M. J., & Agho, K. E. (2015). Determinants of Stunting and Severe Stunting Among Under-Fives in Tanzania: Evidence from The 2010 Cross-sectional Household Survey. 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Mother’s Education as A Determinant of Stunting among Children of Age 24 to 59 Months in North Sumatera Province of Indonesia. IOSR Journal of Humanities and Social Science, 22, 58–64. https://doi.org/10.9790/0837-2206095864 Hendraswari, C. A., Purnamaningrum, Y. E., Maryani, T., Widyastuti, Y., & Harith, S. (2021). The Determinants of Stunting for Children Aged 24-59 Months in Kulon Progo District 2019. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 16(2), 71–77. https://doi.org/10.21109/kesmas.v16i2.3305 Hoddinott, J., Alderman, H., Behrman, J. R., Haddad, L., & Horton, S. (2013). The Economic Rationale For Investing In Stunting Reduction. Maternal & Child Nutrition, 9, 69–82. https://doi.org/10.1111/mcn.12080 Horrell, S., Humphries, J., & Voth, H.-J. (2001). Destined for Deprivation: Human Capital Formation and Intergenerational Poverty in Nineteenth-Century England. 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Seasonal Variation In The Proximal Determinants Of Undernutrition During The First 1000 Days Of Life In Rural South Asia: A Comprehensive Review.Global Food Security, 19, 11–23. https://doi.org/10.1016/j.gfs.2018.08.008 McGregor, S. G., Cheung, Y. B., Cueto, S., Glewwe, P., Ritcher, L., Strupp, B., & International Child Development Steering Group. (2007). Developmental Potential in The First 5 Years for Children in Developing Countries. The Lancet, 369, 60–70. https://doi.org/10.1016/S0140-6736(07)60032-4 Mugianti, S., Mulyadi, A., Anam, A. K., & Najah, Z. L. (2018). Faktor Penyebab Anak Stunting Usia 25-60 Bulan di Kecamatan Sukorejo Kota Blitar. Jurnal Ners Dan Kebidanan (Journal of Ners and Midwifery), 5(3), 268–278. https://doi.org/10.26699/jnk.v5i3.art.p268-278 Ntenda, P. A. M., & Chuang, Y.-C. (2018). Analysis of Individual-level and Community-level Effects on Childhood Undernutrition in Malawi. Pediatr Neonatol, 59(4), 380–389. https://doi.org/10.1016/j.pedneo.2017.11.019 Oddo, V. M., Rah, J. H., Semba, R. D., Sun, K., Akhter, N., Sari, M., De Pee, S., Moench-Pfanner, R., Bloem, M., & Kraemer, K. (2012). Predictors of Maternal and Child Double Burden of Malnutrition in Rural Indonesia and Bangladesh. American Journal of Clinical Nutrition, 95(4), 951–958. https://doi.org/10.3945/ajcn.111.026070 Prado, E. L., & Dewey, K. G. (2014). Nutrition and brain development in early life. Nutrition Reviews, 72(4), 267–284. https://doi.org/10.1111/nure.12102 Prakhasita, R. C. (2019). Hubungan Pola Pemberian Makan Dengan Kejadian Stunting Pada Balita Usia 12-59 Bulan di Wilayah Kerja Puskesmas Wedi Surabaya. Universitas Airlangga. Reynaldo, Martorell., & Young, M. F. (2012). Patterns of Stunting and Wasting: Potential Explanatory Factors. Advances in Nutrition, 3(2), 227–233. https://doi.org/10.3945/an.111.001107 Rosiyati, E., Pratiwi, E. A. D., Poristinawati, I., Rahmawati, E., Nurbayani, R., Lestari, S., Wardani, P. S., & Nugroho, M. R. (2019). Determinants of Stunting Children (0-59 Months) in Some Countries in Southeast Asia. Jurnal Kesehatan Komunitas, 4(3), 88–94. https://doi.org/10.25311/keskom.vol4.iss3.262 Sari, M., De Pee, S., Bloem, M. W., Sun, K., Thorne-Lyman, A. L., Moench-Pfanner, R., Akhter, N., Kraemer, K., & Semba, R. D. (2010). Higher Household Expenditure on Animal-Source and Nongrain Foods Lowers the Risk of Stunting Among Children 0-59 Months Old in Indonesia: Implications of Rising Food Prices. Journal of Nutrition, 140(1), 195–200. https://doi.org/10.3945/jn.109.110858 Satriawan, E. (2018). Strategi Nasional Percepatan Pencegahan Stunting 2018-2024. [National Strategy for the Acceleration of Stunting Prevention] Semba, R. D., Kalm, L. M., De Pee, S., Ricks, M. O., Sari, M., & Bloem, M. W. (2007). Paternal Smoking is Associated with Increased Risk of Child Malnutrition Among Poor Urban Families in Indonesia. Public Health Nutrition, 10(1), 7–15. https://doi.org/10.1017/S136898000722292X Semba, R. D., Moench-Pfanner, R., Sun, K., De Pee, S., Akhter, N., Rah, J. H., Campbell, A. A., Badham, J., Bloem, M. W., & Kraemer, K. (2011). Consumption of Micronutrient-fortified Milk and Noodles is Associated with Lower Risk of Stunting in Preschool-Aged Children in Indonesia. Food and Nutrition Bulletin, 32(4), 347–353. https://doi.org/10.1177/156482651103200406 Shieh, S. J., Chen, H. L., Liu, F. C., Liou, C. C., Lin, Y. in H., Tseng, H. I., & Wang, R. H. (2010). The Effectiveness of Structured Discharge Education on Maternal Confidence, Caring Knowledge, and Growth of Premature Newborns. Journal of Clinical Nursing, 19(23–24), 3307–3313. https://doi.org/10.1111/j.1365-2702.2010.03382.x Stewart, C. P., Iannotti, L., Dewey, K. G., Michaelsen, K. F., & Onyango, A. W. (2013). Contextualising Complementary Feeding in a Broader Framework for Stunting Prevention. Matern Child Nutrition, 9(2), 27–45. https://doi.org/10.1111/mcn.12088 Tim Nasional Percepatan Penanggulangan Kemiskinan. (2017). 100 Kabupaten/Kota Prioritas Untuk Intervensi Anak Kerdil (Stunting). Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2013). Determinants of the Stunting of Children in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey. Nutrients, 11, 1160. UNICEF. (2015a). UNICEF’ s Approach to Scaling Up Nutrition for Mothers and Their Children. Programme Division, February 9. UNICEF. (2015b). UNICEF’s Approach to Scalling Up Nutrition For Mothers and Their Children. UNICEF. (2018). Progress For Every Child in The SDG Era. United Nations. (2021). United Nations Sustainable Development Goal 2: Zero Hunger. https://sdgs.un.org/goals/goal2 United Nations Children’s Fund. (2013). Improving Child Nutrition: The Achievable Imperative for Global Progress. Worku, B. N., Abessa, T. G., Wondafrash, M., Vanvuchelen, M., Bruckers, L., & Kolsteren, P. (2018). The Relationship of Undernutrition/Psychosocial Factors and Developmental Outcomes of Children in Extreme Poverty in Ethiopia. BMC Pediatrics, 18(1), 1–9. http://dx.doi.org/10.1186/s12887-018-1009-y World Bank Group. (2016). World Development Report 2016: Digital Dividends. World Health Organization. (2010). Nutrition Landscape Information System (NLIS) Country Profile Indicators: Interpretation Guide. World Health Organization. (2012). The Sixty Fifth World Health Assembly: Maternal, Infant, and Young Child Nutrition. World Health Organization. (2014). Global Nutrition Targets 2025: Stunting Policy Brief (No.WHO/NMH/NHD/14.3).
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Ngulumbu, Benjamin Musembi, and Fanice Waswa. "Abdul, G., A., & Sehar, S. (2015). Conflict management and organizational performance: A case study of Askari Bank Ltd. Research Journal of Finance and Accounting. 6(11), 201. Adhiambo, R., & Simatwa, M. (2011). Assessment of conflict management and resolution in public secondary schools in Kenya: A case study of Nyakach District. International Research Journal 2(4), 1074-1088. Adomi, E., & Anie, S. (2015). Conflict management in Nigerian University Libraries. Journal of Library Management, 27(8), 520-530. https://doi.org/10.1108/01435120610686098 Amadi, E., C., & Urho, P. (2016). Strike actions and its effect on educational management in universities in River State. Kuwait Chapter of Arabian Journal of Business and Management Review, 5(6), 41-46. https://doi.org/10.12816/0019033 Amah, E., & Ahiauzu, A. (2013). Employee involvement and organizational effectiveness. Journal of Management Development, 32(7), 661-674. https://doi.org/10.1108/JMD-09-2010-0064 Amegee, P. K. (2010). The causes and impact of labour unrest on some selected organizations in Accra. University of Ghana Awan, A., G., & Anjum K. (2015). Cost of High Employees turnover Rate in Oil industry of Pakistan, Information and Knowledge Management, 5 (2), 92- 102. Bernards, N. (2017). The International Labour Organization and African trade unions: tripartite fantasies and enduring struggles. Review of African Political Economy, 44(153), 399-414. https://doi.org/10.1080/03056244.2017.1318359 Blomgren Amsler, L., Avtgis, A. B., & Jackman, M. S. (2017). Dispute System Design and Bias in Dispute Resolution. SMUL Rev., 70, 913. Boheim, R., & Booth, A. (2004). Trade union presence and employer provided training in Great Britain industrial relations 43: pp 520-545. https://doi.org/10.1111/j.0019-8676.2004.00348.x Bryson, A., & Freeman, R. B. (2013). Employee perceptions of working conditions and the desire for worker representation in Britain and the US. Journal of Labor Res 34(1), 1–29. https://doi.org/10.1007/s12122-012-9152-y Buccella, D., & Fanti, L. (2020). Do labour union recognition and bargaining deter entry in a network industry? A sequential game model. Utilities Policy, 64, 101025. https://doi.org/10.1016/j.jup.2020.101025 Constitution, K. (2010). Government printer. Kenya: Nairobi. Cortés, P. (Ed.). (2016). The new regulatory framework for consumer dispute resolution. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198766353.001.0001 Creighton, B., Denvir, C., & McCrystal, S. (2017). Defining industrial action. Federal Law Review, 45(3), 383-414. Daud, Z., & Bakar, M. S. (2017). Improving employees' welfare. European Journal of Industrial Relations, 25(2), 147-162. Deery, S., J., Iverson, R., D., & Walsh, J. (2010). Coping strategies in call centers: Work Intensity and the Role of Co-workers and Supervisors. International Journal of employment relations, 48(1), 189-200. https://doi.org/10.1111/j.1467-8543.2009.00755.x Durrani, S. (2018). Trade Unions in Kenya's War of Independence (No. 2). Vita Books. https://doi.org/10.2307/j.ctvh8r4j2 Dwomoh, G., Owusu, E., E., & Addo, M. (2013). Impact of occupational health and safety policies on employees’ performance in the Ghana’s timber industry: Evidence from Lumber and Logs Limited. International Journal of Education and Research, 1 (12), 1-14. Edinyang, S., & Ubi, I. E. (2013). Studies secondary school students in Uyo Local government area of AkwaIbom State, Nigeria. Global Journal of Human Resource Management, 1(2), 1-8. Ewing, K., & Hendy, J. (2017). New perspectives on collective labour law: Trade union recognition and collective bargaining. Industrial Law Journal, 46(1), 23-51. https://doi.org/10.1093/indlaw/dwx001 Fitzgerald, I., Beadle, R., & Rowan, K. (2020). Trade Unions and the 2016 UK European Union Referendum. Economic and Industrial Democracy. https://doi.org/10.1177/0143831X19899483 Gall, G., & Fiorito, J. (2016). Union effectiveness: In search of the Holy Grail. Economic and Industrial Democracy, 37(1) 189211. https://doi.org/10.1177/0143831X14537358 Gathoronjo, S. N. (2018). The Ministry of labour on the causes of labour disputes in the public sector. University of Nairobi. Iravo, M. A. (2011). Effect of conflict management in performance of public secondary schools in Machakos County, Kenya. Kenyatta University. Jepkorir, B. M. (2014). The effect of trade unions on organizational productivity in the cement manufacturing industry in Nairobi. University of Nairobi. Kaaria, J. K. (2019). Trade Liberalization and Export Survival In Kenya. University of Nairobi. Kaburu, Z. (2010). The relationship between terms and conditions of service and motivation of domestic workers in Nairobi. University of Nairobi. Kambilinya, I. (2014). Assessment of performance of trade unions. Master’s Thesis Submitted to University of Malawi. Kamrul, H., Ashraful, I., & Arifuzzaman, M. (2015). A Study on the major causes of labour unrest and its effect on the RMG sector of Bangladesh. International Journal of Scientific & Engineering Research, 6 (11). Kazimoto, P. (2013). Analysis of conflict management and leadership for organizational change. International Journal of Research in Social Sciences, 3(1), 16-25. Khanka, I. (2015). Industrial relations in Tanzania. University of Dar-es-salaam. Kisaka, C. L. (2010). Challenges facing trade unions in Kenya. Master’s Thesis Submitted to University of Nairobi. Kituku, M. N. (2015). Influence of conflict resolution strategies on project implementation. A Case of Titanium Base Limited Kwale County Kenya. University of Nairobi. Kmietowicz, Z. (2016). Ballot on industrial action by GPs averted as government accepts BMA’s demands. https://doi.org/10.1136/bmj.i4619 KNHCR (2020). Key Business and Human Rights Concerns in Kenya. Retrieved from http://nap.knchr.org/NAP-Scope/Key-Business-and-Human-Rights-Concerns-in-Kenya. Magone, J. (2018). Iberian trade unionism: Democratization under the impact of the European Union. Routledge. https://doi.org/10.4324/9781351325684 Menkel-Meadow, C. J., Porter-Love, L., Kupfer-Schneider, A., & Moffitt, M. (2018). Dispute resolution: Beyond the adversarial model. Aspen Publishers. Mlungisi, E. T. (2016). The liability of trade unions for conduct of their members during industrial action. MoLSP (2020). Ministry of Labor and Social Protection, Registrar of Trade Unions. Retrieved from https://labour.go.ke/department-of-trade-unions/ Msila, X. (2018). Trade union density and its implications for collective bargaining in South Africa. University of Pretoria. Mulima, K. J. (2017). Trade Union Practices on Improvement of Teachers Welfare. University of Nairobi). Năstase, A., & Muurmans, C. (2020). Regulating lobbying practices in the European Union: A voluntary club perspective. Regulation & Governance, 14(2), 238-255. https://doi.org/10.1111/rego.12200 Otenyo, E. E. (2017). Trade unions and the age of information and communication technologies in Kenya. Lexington Books. Powell, J. (2018). Towards a Marxist theory of financialised capitalism. https://doi.org/10.1093/oxfordhb/9780190695545.013.37 Razaka, S. S., & Mahmodb, N. A. K. N. (2017). Trade Union Recognition in Malaysia: Transforming State Government’s Ideology. Proceeding of ICARBSS 2017 Langkawi, Malaysia, 2017(29th), 175." Journal of Strategic Management 6, no. 1 (January 22, 2022): 43–58. http://dx.doi.org/10.53819/81018102t2041.

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The Constitution of Kenya specifically recognizes the freedom of association to form and belong to trade unions. However, despite the adoption of the Labour Relations Act, union practice is still hampered by excessive restrictions. The EPZ companies are labor intensive requiring a large amount of labor to produce its goods or service and thus, the welfare of the employees play a key role in their functions. This study sought to determine the effect of trade union practices on employees’ welfare at export processing zones industries in Athi River, Kenya. The specific objectives sought to determine the effect of collective bargaining agreements, industrial action, dispute resolution and trade union representation on employees’ welfare at export processing zones industries in Athi River, Kenya. The study employed a descriptive research design. Primary data was collected by means of a structured questionnaire. The target population of the study was employees in EPZ companies in Athi River, Kenya with large employees enrolled in active trade unions. The unit of observation was the employees in the trade unions. The findings indicated that collective bargaining agreements had a positive and significant coefficient with employees’ welfare at the EPZ industries. Industrial action had a positive but non-significant effect with employees’ welfare at Export Processing Zones industries. Dispute resolution had a positive and significant coefficient with employees’ welfare at the EPZ industries. Trade union representation had a positive and significant coefficient with employees’ welfare at the EPZ industries. The study recommended that trade union should avoid the path of confrontation but continue dialogue through the collective bargaining process and demands should be realistic in nature with what is obtainable in the related industry. An existence of a formal two way communication between management and trade unions will ensure that right message is properly understood and on time too. Keywords: Collective Bargaining Agreements, Industrial Action, Dispute Resolution, Trade Union Representation, Employees Welfare & Export Processing Zones
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Majamanda, James, Mangani Katundu, Victoria Ndolo, and David Tembo. "Impact of Provenance on Phytochemical Attributes of Pigmented Landrace Maize Varieties." Journal of Science and Technology 14, no. 1 (June 28, 2022). http://dx.doi.org/10.30880/jst.2022.14.01.009.

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Maize is one of the most diverse cereal crops that contribute highly in calorie supply to human diet. Pigmented maize secondary metabolites which are phytochemicals of healthy importance include carotenoids and phenolics which act as precursors of vitamin A and antioxidants respectively. Pigmented landrace maize is cultivated by smallholder farmers in their localities. Three different pigmented maize varieties from different growing districts were analysed for total carotenoids content (TCC) and total phenolic content (TPC), using spectrophotometer. The districts experience a warm temperate climate and higher rainfall in summer than in winter but they differ in that Ntcheu has highest average annual temperature of 20.3°C while Dedza receives the highest annual precipitation of about 1010 mm. Mzimba has an average annual temperature of 20.1°C and receives about 915 mm of precipitation annually. Individual carotenoids were analysed using high performance liquid chromatography (HPLC). TCC were significantly higher (p < 0.05) in Ntcheu and Mzimba provenances compared to Dedza. Lutein (22.84 ± 1.25 µg/g) and Zeaxanthin (23.16 ± 2.44 µg/g) were highest in landrace orange maize from Ntcheu. Mzimba provenance showed highest beta-cryptoxanthin (8.60 ± 2.15 µg/g). TPC were not significantly different between Dedza (204.29 ± 0.35 mg/Kg) and Mzimba (207.65 ± 0.22 mg /kg) red maize. Ntcheu provenance showed the least TPC (184.06 ± 0.61 mg/Kg). It seems provenance influenced phytochemical attributes of pigmented landrace maize varieties in some instances. This study also revealed that post-harvest handling of pigmented landrace maize affects phytochemical content. Care should, therefore, be taken in handling pigmented landrace maize to avoid phytochemical loses. Farmers and all other stakeholders in Malawi are encouraged to produce and include pigmented landrace maize varieties in their diets in order to gain the associated health benefits. Further studies are needed for complete characterisation of phenolic compounds of pigmented landrace maize of Malawi.
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"International Labour Out-Migration in Mzimba District, Malawi: Why Persistent?" International Journal of Research in Geography 4, no. 2 (2018). http://dx.doi.org/10.20431/2454-8685.0402002.

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Mwale, M., and A. S. Muula. "The impact of Behaviour Change Intervention (BCI) on adolescent HIV risk reduction in selected schools in Northren Malawi." Afrika Focus 33, no. 2 (December 20, 2020). http://dx.doi.org/10.21825/af.v33i2.17579.

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Introduction: We conducted a study to explore the impact of adolescent exposure to HIV and AIDS behaviour change Interventions (BCI) on their HIV risk reduction and sexual behaviour change in some selected secondary schools in the district of Mzimba, district of Nkhata Bay and Mzuzu city in Northern Malawi. Methods: We used mixed methods in a descriptive survey design triangulating both quantitative and qualitative approaches, with questionnaires and focus groups as instruments for data collection. Adolescent boys and girls [n = 552], were randomly sampled to participate in the quantitative component. For qualitative focus groups we sampled participants purposively. We analyzed quantitative data through multiple regression analysis. On the other hand qualitative data was analyzed through thematic content analysis.Results: Multiple regression analysis indicated that exposure to BCI did not impact risk reduction [Beta = -.082, p= .053, p > .05]. Qualitative focus group findings showed that proximate correlates such as: early sexual debut, lack of condom use, drug related sex, multiple and concurrent partnerships drive infection. Distal structural factors in socio-cultural, gender disparities and poverty were also noted drivers of sexual risk taking in the study area.Conclusion: Studies aimed to inform HIV prevention through top-down design of models involving primary beneficiaries are vital for the registering of positive outcomes in HIV programming for young people. Apart from identifying factors driving high HIV incidence in the study area, the study informed an intervention to test the efficacy of a risk reduction behavioural model [RRBM] developed and designed with input from adolescent participants. KEY WORDS: ADOLESCENT, HIV AND AIDS, BEHAVIOUR CHANGE, RISK REDUCTION, MALAWI
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Hussein, MK. "Local governance and human resource capacity: the case of district assemblies in Malawi." Africa Insight 33, no. 4 (June 1, 2004). http://dx.doi.org/10.4314/ai.v33i4.22336.

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Piccolo, Olivia, Mai-Lei Woo Kinshella, Sangwani Salimu, Marianne Vidler, Mwai Banda, Queen Dube, Kondwani Kawaza, David M. Goldfarb, and Alinane Linda Nyondo-Mipando. "Healthcare worker perspectives on mother’s insufficient milk supply in Malawi." International Breastfeeding Journal 17, no. 1 (February 23, 2022). http://dx.doi.org/10.1186/s13006-022-00460-1.

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Abstract Background Human milk insufficiency is a significant barrier to implementing breastfeeding, and it is identified as a prevalent concern in 60–90% of mothers in low-and-middle-income countries. Breastmilk insufficiency can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants. Studies investigating the impact of breastfeeding interventions to improve milk production highlight inconsistencies between healthcare workers and mothers perceived support, as well as gaps in practical knowledge and training. The aim of this study was to determine perceptions surrounding human milk insufficiency from Malawian healthcare workers. Methods This study is a secondary analysis of 39 interviews with healthcare workers from one tertiary and three district hospitals in Malawi employing content analysis. Interviewed healthcare workers included nurses, clinical officers, midwives, and medical doctors. An inclusive coding framework was developed to identify themes related to human milk insufficiency, which were analyzed using an iterative process with NVivo12 software. Researchers focused on themes emerging from perceptions and reasons given by healthcare workers for human milk insufficiency. Results Inability to produce adequate breastmilk was identified as a prevalent obstacle mothers face in the early postpartum period in both district and tertiary facilities in Malawi. The main reasons given by participants for human milk insufficiency were mothers’ perceived normalcy of milk insufficiency, maternal stress, maternal malnutrition, and traditional beliefs around food and eating. Three focused solutions were offered by participants to improve mother’s milk production – improving education for mothers and training for healthcare providers on interventions to improve mother’s milk production, increasing breastfeeding frequency, and ensuring adequate maternal nutrition pre- and post-partum. Conclusion Health care workers perspectives shed light on the complexity of causes and solutions for human milk insufficiency in Malawi. This research highlights that a respectful professional relationship between health care workers and mothers is an essential bridge to improving communication, detecting human milk insufficiency early, and implementing appropriate interventions. The results of this study may help to inform research, clinical practice, and education in Malawi to improve human milk production.
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Clarke, Morgane, Chiara Pittalis, Eric Borgstein, Leon Bijlmakers, Mweene Cheelo, Martilord Ifeanyichi, Gerald Mwapasa, et al. "Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study." BMJ Quality & Safety, March 16, 2021, bmjqs—2020–012751. http://dx.doi.org/10.1136/bmjqs-2020-012751.

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BackgroundIn low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.AimTo assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.MethodsA mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.Results53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.ConclusionsSurgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.
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Kayuni, Sekeleghe A., Mohammad H. Alharbi, Peter Makaula, Fanuel Lampiao, Lazarus Juziwelo, E. James LaCourse, and J. Russell Stothard. "Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi." Frontiers in Public Health 9 (May 21, 2021). http://dx.doi.org/10.3389/fpubh.2021.590695.

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Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men. Despite the first formal description of MGS in 1911 by Madden, its epidemiology, diagnostic testing and case management of today are not well-described. However, since several interactions between MGS and the Human Immunodeficiency Virus (HIV) are known, there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi, to document its prevalence and assess mens' knowledge, attitudes and practices (KAP). After providing informed written consent, fishermen (n = 376) aged 18+ years (median age: 30 years, range: 18–70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP, with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0 eggs per ml, range: 0.1–30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 eggs per 10 ml, range: 0.1–186.0) and 3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infection. Just under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = −0.25, n = 100, p = 0.01). In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions. This will improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi.
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Mbewe, Rex B., John B. Keven, Themba Mzilahowa, Don Mathanga, Mark Wilson, Lauren Cohee, Miriam K. Laufer, and Edward D. Walker. "Blood-feeding patterns of Anopheles vectors of human malaria in Malawi: implications for malaria transmission and effectiveness of LLIN interventions." Malaria Journal 21, no. 1 (March 3, 2022). http://dx.doi.org/10.1186/s12936-022-04089-7.

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Abstract Background Access to human hosts by Anopheles mosquitoes is a key determinant of vectorial capacity for malaria, but it can be limited by use of long-lasting insecticidal nets (LLINs). In Malawi, pyrethroid-treated LLINs with and without the synergist piperonyl butoxide (PBO) were distributed to control malaria. This study investigated the blood-feeding patterns of malaria vectors and whether LLINs containing pyrethroid and PBO led to a reduction of human blood feeding than those containing only pyrethroids. Methods Mosquitoes were sampled inside houses from May 2019 through April 2020 by aspiration, pyrethrum spray catch, and light trap methods in two sites. One site (Namanolo, Balaka district) had LLINs containing only pyrethroids whereas the other (Ntaja, Machinga district) had LLINs with both pyrethroids and PBO. Anopheles species, their blood-meal host, and infection with Plasmodium falciparum were determined using PCR methods. Results A total of 6585 female Anopheles were sampled in 203 houses. Of these, 633 (9.6%) were blood-fed mosquitoes comprising of 279 (44.1%) Anopheles arabiensis, 103 (16.3%) Anopheles gambiae 212 (33.5), Anopheles funestus, 2 (0.3%), Anopheles parensis and 37 (5.8%) were unidentified Anopheles spp. Blood meal hosts were successfully identified for 85.5% (n = 541) of the blood-fed mosquitoes, of which 436 (81.0%) were human blood meals, 28 (5.2%) were goats, 11 (2.0%) were dogs, 60 (11.1%) were mixed goat-human blood meals, 5 (0.9%) were dog–human, and 1 was a mixed dog-goat. Human blood index (fraction of blood meals that were humans) was significantly higher in Namanolo (0.96) than Ntaja (0.89). Even though human blood index was high, goats were over-selected than humans after accounting for relative abundance of both hosts. The number of infectious Anopheles bites per person-year was 44 in Namanolo and 22 in Ntaja. Conclusion Although LLINs with PBO PBO may have reduced human blood feeding, access to humans was extremely high despite high LLIN ownership and usage rates in both sites. This finding could explain persistently high rates of malaria infections in Malawi. However, this study had one village for each net type, thus the observed differences may have been a result of other factors present in each village.
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Adeyanju, Gbadebo Collins, Cornelia Betsch, Abdu A. Adamu, Khadijah Sanusi Gumbi, Michael G. Head, Aristide Aplogan, Haoua Tall, and Tene-Alima Essoh. "Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi." Global Health Research and Policy 7, no. 1 (August 18, 2022). http://dx.doi.org/10.1186/s41256-022-00261-3.

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Abstract Background The contribution of vaccination to global public health and community wellbeing has been described as one of the greatest success stories of modern medicine. However, 13.5 million children still miss at least one of their routine vaccinations, and this contributes to about 1.5 million deaths from vaccine-preventable diseases. One of the contributing factors has been associated with vaccine hesitancy. Vaccine hesitancy is the delay or refusal of vaccines despite their availability. The study explored factors from multiple perspectives that influence hesitancy among caregivers of children and adolescent girls eligible for childhood routine immunisation and the Human Papillomavirus vaccine in Malawi. Methods The methodology used was qualitative such as key informant interviews and focus-group discussion. Information was obtained from caregivers, community and religious leaders, leaders of civil society groups, teachers in schools where Human Papillomavirus vaccine were piloted, healthcare workers, national and district-level officials of the expanded program on immunisation. There were 25 key informant interviews and two focus-group discussions, with 13 participants. The study was conducted between April to May 2020. The Interviews and discussions were audio-recorded, transcribed, and analysed using a thematic content approach. Results Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine. The drivers included inadequate awareness of the vaccination schedule, rumours and conspiracy theories exacerbated by religious beliefs, low literacy levels of caregivers, distance and transport to the vaccination clinic, gender role and a disconnect between community healthcare workers and community leaders. Conclusions The study demonstrated that a network of factors determines vaccine hesitancy for childhood Routine Immunisation and Human Papillomavirus, and some of them are interrelated with one another. This has implications both for current levels of vaccine acceptance and the introduction of any new vaccine, such as those against Malaria, HIV/AIDS, HPV or COVID-19 (coronavirus disease 2019). Therefore, strategies developed to address vaccine hesitancy must be multi-component and wide-ranging.
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Mkandawire, Jacob C., Mavuto Tembo, Muthi Nhlema, Joel Luhanga, and Rochelle H. Holm. "Do rope and washer pumps provide safe water and satisfied users? A case study piloting new rural water supply technology in Rumphi District, Malawi." Water SA 45, no. 3 July (July 31, 2019). http://dx.doi.org/10.17159/wsa/2019.v45.i3.6742.

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Innovation is needed to develop rural water supply to support sub-Saharan Africa communities that are hard to reach. The purpose of this study was to critically review rope and washer pumps that have been installed on manually drilled boreholes in 48 communities as part of a pilot project in Rumphi District, Malawi, and which serve as a sustainable source of drinking water from both technical (water quality and functionality) and social (user satisfaction) perspectives. At each water source, an infrastructure checklist was used (n = 48); 10 users were interviewed (n = 472); and, if the pump had water, water quality samples were collected (n = 24). The results show that use of a professional driller does not guarantee a functioning rope and washer pump that produces safe water. Where the pumps were functional, most provided safe drinking water. However, only 8% (4/48) of pumps had good water quality, a flow rate of >20 L/min and a full consensus of positive satisfaction among users. Pumps are not necessarily working better or worse in more remote areas. A process of introducing and creating evaluative guidelines for new (approved) technologies for rural water supply has not been established in Malawi. Sub-Saharan African governments need to be open to innovative solutions while making sure that standards, including those for functionality, water quality, user satisfaction, private operators, and human capacity for local government regulators, are being followed to ensure safe water for rural communities.
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44

Chilanga, Emmanuel, Delphine Collin-Vezina, Mohammad Nuruzzaman Khan, and Liam Riley. "Prevalence and determinants of intimate partner violence against mothers of children under-five years in Central Malawi." BMC Public Health 20, no. 1 (December 2020). http://dx.doi.org/10.1186/s12889-020-09910-z.

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Abstract Background Intimate partner violence (IPV) against women is a global human rights violation and a public health problem. The phenomenon is linked to adverse health effects for women and children. Mothers of young children in Malawi can be particularly at risk because of gender-based power imbalances. The objectives of this study were to examine the prevalence and the risk factors of IPV against mothers of children under-five years of age in rural Malawi. Methods A multistage, cross-sectional study design was used. A sample of 538 mothers of young children was randomly selected from postnatal clinics in Dowa district. The WHO’s Violence against women screening instrument was used to collect data. Logistic regressions were used to determine risk factors that were associated with IPV against mothers. Results Overall prevalence of all four forms of IPV against mothers of under-five children was 60.2%. The prevalence of IPV controlling behavior, psychological, physical, and sexual violence were 74.7, 49.4, 43.7 and 73.2% respectively. In multivariate analyses, mothers whose partners had extra marital affairs were more likely to experience controlling behavior (AOR: 4.97, 95% CI: 2.59–8.55, P = 0.001), psychological (AOR: 2.14, 95% CI: 1.486–3.472, P = 0.001) and physical (AOR: 2.29, 95% CI: 1.48–3.94, P = 0.001) violence than mothers whose partners did not have extra marital affairs. Mothers whose partners consume alcohol were more likely to experience sexual violence (AOR: 2.00, 95% CI: 1.17–3.41, P = 0.001) than mothers whose partners did not drink. Finally, mothers who spent more than 30 min drawing water were at greater risk of experiencing IPV than mothers who spent less than 30 min. Conclusion This study found a significantly higher prevalence of IPV against mothers of under-five children in rural Malawi compared to women in the general population. Micro and macro-level programs aimed at mitigating the partners’ potential risk behaviors identified in this study are suggested. Public health programs that support increased household access to safe water are also recommended to help undermine IPV against mothers.
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45

Berman, Leslie, Margaret L. Prust, Agnes Maungena Mononga, Patrick Boko, Macfarlane Magombo, Mihereteab Teshome, Levison Nkhoma, Grace Namaganda, Duff Msukwa, and Andrews Gunda. "Using modeling and scenario analysis to support evidence-based health workforce strategic planning in Malawi." Human Resources for Health 20, no. 1 (April 18, 2022). http://dx.doi.org/10.1186/s12960-022-00730-3.

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Abstract Background A well-trained and equitably distributed workforce is critical to a functioning health system. As workforce interventions are costly and time-intensive, investing appropriately in strengthening the health workforce requires an evidence-based approach to target efforts to increase the number of health workers, deploy health workers where they are most needed, and optimize the use of existing health workers. This paper describes the Malawi Ministry of Health (MoH) and collaborators’ data-driven approach to designing strategies in the Human Resources for Health Strategic Plan (HRH SP) 2018–2022. Methods Three modelling exercises were completed using available data in Malawi. Staff data from districts, central hospitals, and headquarters, and enrollment data from all health training institutions were collected between October 2017 and February 2018. A vacancy analysis was conducted to compare current staffing levels against established posts (the targeted number of positions to be filled, by cadre and work location). A training pipeline model was developed to project the future available workforce, and a demand-based Workforce Optimization Model was used to estimate optimal staffing to meet current levels of service utilization. Results As of 2017, 55% of established posts were filled, with an average of 1.49 health professional staff per 1000 population, and with substantial variation in the number of staff per population by district. With current levels of health worker training, Malawi is projected to meet its establishment targets in 2030 but will not meet the WHO standard of 4.45 health workers per 1000 population by 2040. A combined intervention reducing attrition, increasing absorption, and doubling training enrollments would allow the establishment to be met by 2023 and the WHO target to be met by 2036. The Workforce Optimization Model shows a gap of 7374 health workers to optimally deliver services at current utilization rates, with the largest gaps among nursing and midwifery officers and pharmacists. Conclusions Given the time and significant financial investment required to train and deploy health workers, evidence needs to be carefully considered in designing a national HRH SP. The results of these analyses directly informed Malawi’s HRH SP 2018–2022 and have subsequently been used in numerous planning processes and investment cases in Malawi. This paper provides a practical methodology for evidence-based HRH strategic planning and highlights the importance of strengthening HRH data systems for improved workforce decision-making.
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McBain, Ryan K., Owen Mwale, Todd Ruderman, Waste Kayira, Emilia Connolly, Mark Chalamanda, Chiyembekezo Kachimanga, et al. "Stepped care for depression at integrated chronic care centers (IC3) in Malawi: study protocol for a stepped-wedge cluster randomized controlled trial." Trials 22, no. 1 (September 16, 2021). http://dx.doi.org/10.1186/s13063-021-05601-1.

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Abstract Background Malawi is a low-income country in sub-Saharan Africa that has limited resources to address a significant burden of disease—including HIV/AIDS. Additionally, depression is a leading cause of disability in the country but largely remains undiagnosed and untreated. The lack of cost-effective, scalable solutions is a fundamental barrier to expanding depression treatment. Against this backdrop, one major success has been the scale-up of a network of more than 700 HIV clinics, with over half a million patients enrolled in antiretroviral therapy (ART). As a chronic care system with dedicated human resources and infrastructure, this presents a strategic platform for integrating depression care and responds to a robust evidence base outlining the bi-directionality of depression and HIV outcomes. Methods We will evaluate a stepped model of depression care that combines group-based Problem Management Plus (group PM+) with antidepressant therapy (ADT) for 420 adults with moderate/severe depression in Neno District, Malawi, as measured by the Patient Health Questionnaire-9 (PHQ-9) and Mini-International Neuropsychiatric Interview (MINI). Roll-out will follow a stepped-wedge cluster randomized design in which 14 health facilities are randomized to implement the model in five steps over a 15-month period. Primary outcomes (depression symptoms, functional impairment, and overall health) and secondary outcomes (e.g., HIV: viral load, ART adherence; diabetes: A1C levels, treatment adherence; hypertension: systolic blood pressure, treatment adherence) will be measured every 3 months through 12-month follow-up. We will also evaluate the model’s cost-effectiveness, quantified as an incremental cost-effectiveness ratio (ICER) compared to baseline chronic care services in the absence of the intervention model. Discussion This study will conduct a stepped-wedge cluster randomized trial to compare the effects of an evidence-based depression care model versus usual care on depression symptom remediation as well as physical health outcomes for chronic care conditions. If determined to be cost-effective, this study will provide a model for integrating depression care into HIV clinics in additional districts of Malawi and other low-resource settings with high HIV prevalence. Trial registration ClinicalTrials.govNCT04777006. Registered on 1 March, 2021
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47

Henriksson, Rebecka, Katharine Vincent, and Kivana Naidoo. "Exploring the Adaptive Capacity of Sugarcane Contract Farming Schemes in the Face of Extreme Events." Frontiers in Climate 3 (March 18, 2021). http://dx.doi.org/10.3389/fclim.2021.578544.

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Adaptive capacity determines the extent to which exposure to natural hazards and extreme events translates into impacts. This study traces the effectiveness of adaptive capacity of two different sugarcane contract farming schemes (so-called outgrower schemes)—Phata and Kasinthula—in Chikwawa district in southern Malawi which, due to their proximity, are similarly exposed to extreme events, but have shown different impacts in terms of sugarcane production. We develop a framework to explore and compare the adaptive capacity at scheme management level, and relate the findings to the historical changes in yield, the occurrence of extreme events in the district and the lived experiences of the scheme management over the last ten years (2010–2019) using qualitative data from interviews with scheme managers. The total level and components of adaptive capacity differ in several aspects. Phata had much better prerequisites to mitigate the impacts of the extreme events (i.e., maintain production), particularly related to the Asset base, Knowledge and information, Innovation, and Forward-looking decision-making. Kasinthula on the other hand, was impacted by compound events whilst having low financial capacity, weak governance and reduced human capacity. Kasinthula had limited capacity to recover from the severe 2015 floods, the adaptive capacity thus drawn upon and were not restored when next event occurred (drought). This novel, comparative approach to assessing adaptive capacity, linking to past events, has been shown useful in order to determine the components that are missing and need to be built in order to reduce risk from extreme events and climate change. These findings are important to ensure future adaptation of sugarcane outgrowers, and relevant also to other contract farming arrangements or similar kinds of agricultural organizations.
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48

Roll, Amy, Malvika Saxena, Elizabeth Orlan, Angelin Titus, Sanjay Kamlakar Juvekar, Marie-Claire Gwayi-Chore, Euripide Avokpaho, et al. "Policy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths." Global Health Research and Policy 7, no. 1 (December 2, 2022). http://dx.doi.org/10.1186/s41256-022-00281-z.

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Abstract Background Recent evidence suggests that soil-transmitted helminth (STH) transmission interruption may be feasible through community-wide mass drug administration (cMDA) that deworms community members of all ages. A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries. We conducted formative qualitative research in Benin, India, and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective. Methods We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national, state/district, and sub-district levels. Participants included World Health Organization country office staff, implementing partners, and national and sub-national government officials. We used the Consolidated Framework for Implementation Research to guide data collection, coding, and analysis. Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder. Results Key facilitators to launching a cMDA program included availability of high-quality, tailored sensitization materials, and human and material resources that could be leveraged from previous MDA campaigns. Key barriers included the potential to overburden existing health workers, uncertainty of external funding to sustain a cMDA program, and concerns about weak intragovernmental coordination to implement cMDA. Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA, and implementation evidence to effectively operationalize cMDA. Importantly, if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term. Conclusions Overall, policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available. Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement. However, launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers. Trial registration This study was registered in the U.S. National Library of Medicine Clinical Trials registry (NCT03014167).
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49

Phiri, Mphatso Dennis, Robert S. McCann, Alinune Nathanael Kabaghe, Henk van den Berg, Tumaini Malenga, Steven Gowelo, Tinashe Tizifa, et al. "Cost of community-led larval source management and house improvement for malaria control: a cost analysis within a cluster-randomized trial in a rural district in Malawi." Malaria Journal 20, no. 1 (June 13, 2021). http://dx.doi.org/10.1186/s12936-021-03800-4.

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Abstract Background House improvement (HI) to prevent mosquito house entry, and larval source management (LSM) targeting aquatic mosquito stages to prevent development into adult forms, are promising complementary interventions to current malaria vector control strategies. Lack of evidence on costs and cost-effectiveness of community-led implementation of HI and LSM has hindered wide-scale adoption. This study presents an incremental cost analysis of community-led implementation of HI and LSM, in a cluster-randomized, factorial design trial, in addition to standard national malaria control interventions in a rural area (25,000 people), in southern Malawi. Methods In the trial, LSM comprised draining, filling, and Bacillus thuringiensis israelensis-based larviciding, while house improvement (henceforth HI) involved closing of eaves and gaps on walls, screening windows/ventilation spaces with wire mesh, and doorway modifications. Communities implemented all interventions. Costs were estimated retrospectively using the ‘ingredients approach’, combining ‘bottom-up’ and ‘top-down approaches’, from the societal perspective. To estimate the cost of independently implementing each intervention arm, resources shared between trial arms (e.g. overheads) were allocated to each consuming arm using proxies developed based on share of resource input quantities consumed. Incremental implementation costs (in 2017 US$) are presented for HI-only, LSM-only and HI + LSM arms. In sensitivity analyses, the effect of varying costs of important inputs on estimated costs was explored. Results The total economic programme costs of community-led HI and LSM implementation was $626,152. Incremental economic implementation costs of HI, LSM and HI + LSM were estimated as $27.04, $25.06 and $33.44, per person per year, respectively. Project staff, transport and labour costs, but not larvicide or screening material, were the major cost drivers across all interventions. Costs were sensitive to changes in staff costs and population covered. Conclusions In the trial, the incremental economic costs of community-led HI and LSM implementation were high compared to previous house improvement and LSM studies. Several factors, including intervention design, year-round LSM implementation and low human population density could explain the high costs. The factorial trial design necessitated use of proxies to allocate costs shared between trial arms, which limits generalizability where different designs are used. Nevertheless, costs may inform planners of similar intervention packages where cost-effectiveness is known. Trial registration Not applicable. The original trial was registered with The Pan African Clinical Trials Registry on 3 March 2016, trial number PACTR201604001501493
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Kinshella, Mai-Lei Woo, Sangwani Salimu, Brandina Chiwaya, Felix Chikoti, Lusungu Chirambo, Ephrida Mwaungulu, Mwai Banda, et al. "Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals." BMC Pediatrics 22, no. 1 (June 27, 2022). http://dx.doi.org/10.1186/s12887-022-03430-y.

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Abstract Background Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of this study is to evaluate barriers and facilitators for phototherapy to treat neonatal jaundice at Malawian hospitals. Methods We conducted a convergent mixed-method study comprised of a facility assessment and qualitative interviews with healthcare workers and caregivers in southern Malawi. The facility assessment was conducted at three secondary-level hospitals in rural districts. In-depth interviews following a semi-structured topic guide were conducted at a district hospital and a tertiary-level hospital. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Results The facility assessment found critical gaps in initiating and monitoring phototherapy in all facilities. Based on a total of 31 interviews, participants identified key challenges in diagnosing neonatal jaundice, counselling caregivers, and availability of infrastructure. Participants emphasized the need for transcutaneous bilirubinometers to guide treatment decisions. Caregivers were sometimes fearful of potential harmful effects of phototherapy, which required adequate explanation to mothers and family members in non-medical language. Task shifting and engaging peer support for caregivers with concerns about phototherapy was recommended. Conclusion Implementation of a therapeutic intervention is limited if accurate diagnostic tests are unavailable. The scale up of therapeutic interventions, such as phototherapy for neonatal jaundice, requires careful holistic attention to infrastructural needs, supportive services such as laboratory integration as well as trained human resources.
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