Dissertations / Theses on the topic 'Malawian'

There is an increased incidence of young people with stroke (age ≤45years) in Human immunodeficiency virus (HIV) endemic countries; this has been largely attributed to hypertension. However, hospital based surveys in countries like Malawi and South Africa have shown that the prevalence of hypertension in these young people is lower than expected, but HIV infection is substantially higher, implicating HIV as a risk factor. For many years a link between HIV and stroke has been postulated, but the relationship is uncertain. Whilst HIV may be a risk factor for stroke directly through mechanisms linked with HIV-associated vasculopathy, or indirectly through opportunistic infections, the drugs that treat HIV infection may also increase the risk of stroke because of their metabolic effects. Many studies, almost all retrospective, have failed to separate the direct effect of HIV infection from the indirect effects, including combined antiretroviral therapy, on cerebrovascular risk. HIV infection increases the risk of stroke mimics such as intracranial toxoplasma infection. The Recognition of Stroke in the Emergency Room (ROSIER) score is commonly used to screen for a stroke and triage patients for computer tomography (CT) of the brain. However, the accuracy of the ROSIER score and CT brain to reliably differentiate a stroke diagnosis from those with a stroke mimic in people with HIV infection is uncertain. I found that the ROSIER score and CT brain imaging had poor diagnostic accuracy in an HIV positive population. Therefore, in my thesis, every patient with an acute neurological symptom was fully assessed for a stroke as part of the screening process and confirmation was by magnetic resonance brain imaging. I subsequently investigated the risk factors and aetiology of stroke through a prospective case-control study in an HIV endemic country. Through this work, I showed that HIV infection is associated with cerebrovascular disease. Although hypertension was the leading risk factor in the population overall, HIV infection and its treatment was the second most important, and the most important in younger patients. Unexpectedly, I found that starting combined antiretroviral therapy in a subgroup of people living with HIV infection independently increased the risk of stroke. In this cohort, ischaemic stroke was the predominant stroke type and opportunistic infections only accounted for less than a third of these cases. The heterogeneity of HIV stroke with respect to risk factors for stroke, the degree of immunosuppression and HIV activity, and prior or current opportunistic infection has made it difficult to generalise epidemiological findings in some studies to populations at large. My study, to some extent unravels some of this ambiguity. I speculate that HIV related strokes evolves through the introduction of cART and then transitions into an aging population, accelerating atherosclerotic stroke and potentially contributing to an anticipated stroke epidemic in countries like Malawi.

Background: Concerns have been well documented about women either dying or developing severe morbidities from prolonged and obstructed labour. These concerns have noted that maternity care during labour has not been of a sufficient standard to improve the outcome for women giving birth in Malawi. This ‘failure to save’ women remains, despite assertions that obstructed and prolonged labour can be prevented through appropriate decision making during the progress and management of labour. Midwives in Malawi form the majority of maternity healthcare workers and an important aspect of their decision-making role is to assess the progress of labour when caring for women in labour. To date, there has been limited exploration of either midwifery decision making during labour or the contextual factors that influence midwives’ decision making. The aim of this study was to explore how Malawian midwives make decisions during the first stage of labour in a hospital setting and to identify the contextual factors that influence their decision making. Design and Method: Using a qualitative ethnographic research approach, 27 participant observations, 26 follow-up interviews and document reviews comprised the data collection. Nine Malawian nurse-midwives who worked at a tertiary (n=5) and a secondary referral hospital (n=4), with a mixture of qualifications and experiences, participated. Each nurse midwife was observed three times with subsequent follow-up interviews. Interviews were conducted in a vernacular language, audio-taped, transcribed, translated into English and back translated into vernacular language. Qualitative data analysis software, NVivo 10, was used to assist with data management for the analysis. All data was analysed using the principle of theme and category formation. Findings: Three major themes were identified - contextual factors influencing midwifery decision making - the role of cue acquisition - the role of the partograph during care of women in the first stage of labour. Integration of the themes has led to the development of a proposed conceptual model of ‘supporting normality’ during the first stage of labour, which suggests that the midwives strived to make decisions during the care of women in labour with the aim of supporting the normal physiological processes of labour. The first theme illustrates that for Malawian midwives, decision making is a complex and contextually dependent undertaking. In everyday practice, decision making was influenced by multiple and competing factors but the midwives developed strategies to manage and control the context of their practice and facilitate decision making. The role of cue acquisition comprised a six-stage subprocess illustrating the ways in which midwives utilise assessment data to reason and make decisions during the care of women in labour. These processes involved the midwives building a case for each woman’s labour progression by piecing together segments of information they obtained. This process was striking when there was uncertainty in a woman’s progress of labour as they used deductive thinking by cross-checking data obtained across the labour progression span. There was a constant forward and backward moving of thought processes supported by actions that uncovered real case-building evidence for informing decisions about whether to intervene or not. The model further indicates the role of the partograph, which alerted midwives to the presence of progress or non-progress of labour. Although the partograph acted as an adjunct to the midwives’ decision making that could indicate opportunities for early intervention in labour if labour appeared not to be progressing, the midwives were sometimes cautious about its interpretation. This thesis has expanded on current theoretical knowledge of decision making by elaborating on the processes midwives employ to make decisions as they care for women in labour. It also illuminates the impact of contextual factors on decision making, and elucidates various strategies midwives use to advance their professional role. The emerging conceptual model provides implications for future midwifery practice, education and policy both in Malawi and worldwide.

Malawi lost a significant proportion of its most experienced and qualified nurses to international migration between 2000 and 2005. The lure of overseas life and poor conditions of service at home caused an unprecedented wave of migration. This thesis is about the experiences and motivations of nurses who left Malawi, and of those who stayed behind. Using a qualitative biographical method to examine their experiences along a timeline of key life events, I develop a comprehensive picture of nurse migration. The findings show that nurses’ decisions and experiences have been shaped by demographic and political shifts and by a strong culture of family. Population growth has increased competition for higher education and caused a palpable shift in motives for becoming a nurse. Prospective students now see nurse training as a means to a guaranteed career, or to a marketable qualification which can lead to alternative employment. Working conditions have not improved despite numerous government initiatives, and nurses are still leaving for greener pastures. Many now move to Malawian Non-Governmental Organisations, but before 2005 nurses were able to take advantage of the United Kingdom’s (UK) active recruitment strategy. Most were motivated by the prospect of educational opportunities and the financial survival of their families, who often encouraged them because of the status accorded to migration. Whilst nurses in the UK were pleased with their lifestyle improvements, they found it challenging to integrate into society and the workplace. Many also found it difficult to achieve their educational and financial goals, and the stigma of returning to Malawi empty-handed led them to extend their stay. The enduring high status of migration and its unparalleled benefits mean that the desire to migrate is still strong amongst nurses, and many believe that the recent decline in migration is attributable only to tighter UK immigration restrictions.

Multi-drug resistant (MDR) Streptococcus pneumoniae are a major public health concern worldwide. In Malawi a resource poor country, even the simplest antimicrobials remain a precious commodity. Given the limited number of antimicrobials available for the management of MDR invasive pneumococcal disease (IPD) measures need to be implemented to limit the spread of resistance. In order to design such measures it is essential that we gain a better understanding of the evolution of antimicrobial resistance in this setting. The purpose of this thesis was to assess the molecular basis and mode of dissemination of antimicrobial resistance in S. pneumoniae with the aim of identifying a biomarker of antimicrobial resistance that could be used to design a diagnostic PCR to assist epidemiological surveillance of antimicrobial resistance and inform treatment policy. Malawi introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in 2011. To provide baseline data to assess the impact of PCV13 all invasive pneumococci isolated from children admitted to Queen Elizabeth Central Hospital, Malawi 2004-2006 were serotyped and subjected to antimicrobial susceptibility testing. The data suggested PCV13 will not provide protection against 61% of penicillin resistant pneumococci and if serotype replacement occurs following the introduction of PCV13, the incidence of penicillin resistant IPD could therefore increase Over 130 resistant and susceptible pneumococcal isolates from carriage and invasive disease were subjected to whole genome sequencing. The employment of an in vitro and in silco analytical approach established that S. pneumoniae employs a diverse array of antimicrobial resistance mechanisms, the dissemination of which is likely to be driven by high antimicrobial consumption. A relatively high incidence of antimicrobial resistant was observed in serotype 1 pneumococci, the most common cause of IPD in Malawi. This serotype is not usually associated with resistance in other geographic locations, the short duration of serotype 1 carriage is assumed to limit the chance it has to acquire resistance mechanisms via recombination. Interestingly the resistance mechanisms employed by serotype 1 had been acquired through multiple recombination events. Recombination was evidenced to contribute to >90% of the variation in the serotype 1 genomes. To allow the identification of resistance biomarkers free from any preconceptions about which genes are involved in resistance, multiple antimicrobial resistant lineages were generated in vitro. Isolates were sequenced at several time points as resistance developed. Comparison of the resistant isolates to the wild type isolates identified single nucleotide polymorphisms in 46 genes, 40 of these genes have not previously been implicated in antimicrobial resistance. The role of these genes in resistance warrants further investigation. The analysis suggests that rather than a single biomarker future research needs to identify multiple biomarkers; the dynamic nature of this organism means that it can adopt one of many routes to antimicrobial resistance.

Proponents of socially and culturally oriented mathematics education have argued that teaching approaches which value and connect with the learner's prior knowledge and everyday experience are more likely to promote active, meaningful, relevant and liberatory learning than approaches which rely on transmission and abstract presentation of mathematical content. In Malawi, proposals to reform the outdated secondary mathematics curriculum have been made with the aim of aligning mathematics instruction with the social and political changes in the current Malawian society. Using a case study approach, this study investigated the extent to which everyday experiences could be used as a vehicle for changing the learning and teaching of secondary mathematics in Malawi. The study was collaborative, taking place over a period of five months in severely overcrowded and poorly resourced classes in two schools. It involved three mathematics teachers in a cycle of planning and teaching mathematics lessons based on the use of everyday experiences, and observation of and reflection on these lessons, in order to document the effects of using everyday experiences on student learning and teachers' teaching practices. The data was collected through student questionnaires; classroom observations and fieldnotes; interviews and reflective meetings with teachers; and informal meetings with key education officials in Malawi. Mathematics examination results from students involved in this study and a corresponding group from the previous year were collected. A reflective and critical approach was adopted in the interpretation and discussion of the data. Teachers' participation in this study resulted in heightened awareness of their teaching roles and the value of linking school mathematics with everyday experience. The study also shows that students found mathematics interesting and important to learn despite their lack of success in it. In addition, the study documented a number of constraints to change in mathematics instruction such as teachers' focus on mathematics content and examination requirements, and students' resistance to inquiry learning. It also recorded possibilities and barriers to collaboration both between teachers and researchers, and teachers themselves. The findings of this study are timely since they could serve to inform the reform of the Malawian secondary mathematics curriculum currently being undertaken, which began without a critical examination of the classroom conditions necessary to accommodate a socio-politically relevant mathematics education.

The aim and purpose of this report is to describe how the domestic tobacco industry is affectingsustainable development in Malawi. This is done by describing the environmental and socio-economic effects ofthe cultivation and selling of tobacco leaves. Together with an outlook on the future developments of the industry,this information is used to describe how the Malawian tobacco industry corresponds to sustainable developmentand how it can be changed to improve sustainability in the country. The report is based on a literature study andtwo interviews. Theories on sustainable development and developmental concepts form the theoreticalbackground for the report. The conclusion of the report is that the situation regarding the Malawian tobaccoindustry is a complex one, where direct economic benefits are the main motive, but various socio-economic andenvironmental effects combine to make the situation unsustainable in a number of aspects. The suggestion of thisreport is to turn away from the current high dependence on tobacco to a more diversified agriculture, wheredifferent types of food crops substitute tobacco as the main source of income, while at the same time providingmore food in a country where poverty and malnutrition are problematic issues.

This project explores the dialectic between the identities which social essayist literacy traditions encourage and novice writers' view of such identities (Lillis, 2001) as novices transition to university education in a Malawian university. To do this, the study adopts the view of academic writing as social semiosis with identity implications (Ivanič, 1998). This position is predicated on the view that saying something is a performative act which hails a social being (Gee, 1996). Therefore, in asking novice writers to write in a certain way, the academy implicitly asks them to take on new discoursal identities. The study examines the dialectic that ensues from this. Such dialectic is largely examined from an Ubuntu perspective which stipulates that selfhood is brought about in interaction with and because of the "other" (cf., Swanson, 2007, 2009). To achieve this, the study adopts "ethnography as method" (Lillis, 2008) or "talk around text". Novice academic texts were analysed to isolate the identity positions which they performatively enacted. Then, in a discourse based interview set up (Hyland, 2012a), participants were given an opportunity to explicate why as well as how they created the positions identified. The emerging data from these talks were then analysed using Bamberg's (1997) model of interactive positioning to explore further how these novices perceive themselves in light of the emerging positions in their written texts. The findings of this study point to academic writing as a "stage managed form of interaction" (Thompson, 2001) in which what goes into the essay is hardly determined by the individual writer. The study's findings highlight that the contents of most novice essays are determined by "the reader/assessor" (Ivanič, 1998) and the impressions novices want to create for this authoritative "other". Novice writers' attempts to performatively take up authoritative positions in their writing are however hampered by both a lack of knowledge of academic writing conventions as well as a reverence for secondary discourse. This makes their writing to be either "voiceless" or mildly assertive. They thus struggle to dialogically assert themselves as authoritative since authoritativeness in academic writing is contingent on the "other". This is something novice academic writers in Malawi struggle to negotiate.

Mortality from cardiovascular disease (CVD) is predicted to surpass that of infectious disease in sub-Saharan Africa (SSA) by 2030. HIV doubles the risk of CVD in high resource settings, but the contribution of HIV and immune activation to the risk of CVD in SSA is unknown. HIV-1-infected adults with CD4 < 100 cells/ul were recruited 2 weeks following initiation of anti-retroviral therapy (ART) within the REALITY trial (NCT01825031), along with healthy HIV-uninfected adults and followed for 44-weeks. Acute infections (malaria, TB, cryptococcal meningitis, pneumonia, gastroenteritis) were recorded. Pulse wave velocity (PWV) was assessed using the Vicorder system. Flow cytometry identified T-cell activation (HLA-DR/CD38+), exhaustion(PD1+) and senescence(CD57+) in all participants and circulating microparticles(CMPs) in 72 participants. Independent predictors of PWV were identified using linear regression. Backwards elimination was performed with an exit of p > 0.1 Variables with univariable p < 0.2 were included (spearman-rho or Wilcoxon ranksum). 279 HIV-infected adults had similar median(IQR) age [36(31-43) vs 35(3-41) years, p=0.4], but lower systolic BP [120(108-128) vs 128(114-134) mmHg, p < 0.01], BMI [20(18-21) vs 22(20-25) kg/m2, p < 0.01] and proportion of women [122(44%) vs 66(60%), p < 0.01] than 110 HIV uninfected adults. Following adjustment for confounders, HIV infection was associated with a 12%-increase in PWV (p < 0.01) at baseline, which remained at week 10 (14%-increase, p=0.02) but resolved by week 24. %CD4-PD1 and %CD8-PD1 were independently associated with PWV at baseline (fold change 2% and 3% per 10%increase, p=0.06 and 0.05 respectively). A decrease in %CD4-PD1 was associated with improvement in PWV by week 44 (rho 0.20, p=0.02). At baseline, median (IQR) CMPs were increased in HIV infection [5.1(2.0-18.0) x 10⁶ versus 0.4(0.2-6.0) x 10⁶, p < 0.00001)] and in high versus low immune activation [4.0(2.3-5.6) x 10⁶ versus 0.3(0.1-0.5) x 10⁶, p < 0.0001)]; and were strongly related to PWV (rho 0.42, p < 0.001). An acute infection during the study carried a 51% adjusted increase in %CD8 activated T cells at week 44 (p=0.02) and an increase in PWV at week 44 of 0.80m/s [versus -0.10m/s (p=0.01)] for HIV uninfected participants. These results strongly implicate HIV and immune activation in increased endothelial damage during the first 12 weeks of ART therapy. Improvement in PWV on ART and cotrimoxazole is associated with decreases in immune activation. HIV and co-infections may present modifiable CVD risk factors in low resource SSA setting.

There is some controversy in terms of the basement geology of Malawi which ultimately stems from the overall lack of metamorphic studies conducted in the area. The geological complexity of Malawi comes from that fact that it sits at the intersection of three major orogenic belts: The Palaeoproterozoic Ubendian Belt, Mesoproterozoic Kibaran/Irumide Belt, and Pan African Mozambique Belt. Its complexity makes it difficult to unravel, especially in terms of identifying features of older orogenic events which have already experienced multiple metamorphic overprinting from subsequent events. This thesis provides a more detailed pre-rift evolution of the Malawian basement rocks by reporting ages and P-T conditions from four localities surrounding Lake Malawi, namely Chilumba, Mlowe, Maganga, and Mangochi. Results reveal that at 1985-1974 Ma, garnet-cordierite granulites were equilibrated under conditions of 760°C at 4.5-5 kbar possibly as a result of subduction-related magmatism. Subsequently, at 1100 Ma, charnockites were emplaced and metamorphosed under peak conditions of 770-780°C at 4.3-6 kbar due to Kibaran-age magmatic underplating. Remnants of the Irumide/Kibaran Orogeny is relatively scarce throughout Malawi and although the Mangochi charnockites were emplaced during Kibaran-age tectonism, it also experienced at least two different metamorphic events thereafter. The first occurred either during early stages of the East African orogen or Rodinia break-up at 900-800 Ma while the second occurred during the late stages of the East African orogen at 650-600 Ma. Possible remnants of the Kuunga Orogeny are recorded in Chilumba and Maganga as an amphibolite facies metamorphic event which took place around 570 Ma under peak conditions of roughly 660-670°C at 6-8 kbar. Findings of this study have not only provided a more detailed metamorphic history of Malawi but also paved way for future studies in the area to further explore why similar rocks found in such close proximity to each other preserve vastly different tectonic environments.

This thesis is the result of ethnographic fieldwork conducted in Phalombe District in Malawi, Southern Africa, where I studied agricultural development projects in the village of Kachala. The focus of this investigation is on people's perceptions and ideas of development co-operation and the meanings of development and poverty in general. Perceptions of development and poverty among villagers in Kachala are compared to those of development agents working for development organizations in the area. These perceptions are also compared to the definitions of development and poverty found throughout development literature. This research demonstrates - through examples from Phalombe District and elsewhere - how notions of development are relative, diverse and context-specific, and therefore not static and universally applicable. Finally, participatory development ideals and the structurally unequal donor-recipient relationships, at the core of the current development system, are discussed. This thesis illustrates how the common portrayal of development as an oppressive, disempowering industry, characterized by top-down interventions, does not always apply.

This thesis presents an institutional analysis of academic talent management (TM) in Malawian universities. Through this analysis, the thesis adds to our understanding of why organisations adopt (or fail to adopt) TM practices. In particular, the thesis stretches the boundaries of the use of institutional theory in TM studies. It does this by incorporating the role of institutional logics because isomorphic pressures alone do not adequately explain an organisation’s actions and decisions on TM. Using the unique context of Malawi’s higher education (HE) sector which comprises public, religious and private universities, the study has found that institutional logics combine with isomorphic pressures to explain why organisations within the same context may adopt different TM approaches. In addition to the above the thesis addresses the dearth of empirical studies on academic TM in Africa since TM discourse and practices are shaped by USA and European perspectives. A qualitative method is adopted for data collection. Data processing and organisation is done in NVivo while template analysis is employed to make sense of the data. The findings are based on three case studies: public, religious and private universities. Evidence from the cases supports the contextual nature of TM by linking adoption of a particular talent strategy to specific institutional logics and specific pressures faced by differently owned universities. Although it is clear from the cases that TM is not fully developed and entrenched in Malawi’s universities, the level of development and application of practices is influenced by each university’s unique circumstances. It is therefore possible for organisations within the same sector to respond differently and reject the need to appear homogeneous. Specifically, organisations can display diversity in approach, following institutional logics, to the application of TM practices despite the taken-for-granted notion that organisations that share the same context tend to look more similar and adopt similar practices. While TM studies have been dominated by USA and European ideas particularly those in business organisations, the contribution of this research is that it fills a specific literature gap and adds its voice to the debate on the contextual nature of TM practices as well as the extent to which isomorphic pressures explain adoption of TM practices. It contends that isomorphic pressures alone do not adequately explain an organisation’s decisions and actions regarding TM practices.

Can a hospital be more than a center for treatment? Can it initiate a sense of healing in the individual as well as the community? The hospital in its early form was a facility meant to house the sick in ancient Egyptian temples. Prayers, sacrifices and dream interpretations were used in the healing process as well as quintessential medical procedures such as opium for pain and stitching of wounds. Monasteries were later established to accommodate travelers, the indigent and the sick. Hospitals were constructed next to Religious institutions but also utilized house calls for the wealthy class. Monasteries were also organized in cloisters which were places of retreats from the mundane. The idea of hospitals today is to diagnose, treat and heal patients which has proven to be effective with most diseases being prevented and eradicated entirely from our day to day lives. However, these conditions aren't as similar in Malawi. The origin of the word hospital is derived from the Latin word "hospitalia" meaning a place of refuge for guests and strangers. The need for effectively functioning hospital in Malawi is apparent, but the need to create a hospital that heals and creates a sense of community and tranquility for both the guest and wondering traveler is paramount.
Master of Architecture

Background: Cerebral malaria is a major cause of mortality and morbidity in African children. Pathology is related to interactions between malaria-infected red blood cells (iRBC) and the endothelium but the aetiology of the neurological compromise remains unclear. Methods: This thesis involved direct and downstream investigation of the endothelium in Malawian children with cerebral malaria and controls in post-mortem samples, plasma and through developing a novel ex vivo method to examine endothelium in subcutaneous tissue. Results: In post-mortem samples of brain in fatal cerebral malaria, there was thrombosis and loss of endothelial protein C receptor (EPCR) associated with iRBC sequestration. iRBC associated loss of EPCR and thrombomodulin was also demonstrated in post- mortem samples of gut and subcutaneous tissue but this was less marked than in the brain and rarely associated with thrombosis. Subcutaneous biopsies taken on admission with cerebral malaria demonstrated reduced EPCR and thrombomodulin ex vivo, showing that loss of these receptors is present at the time of presentation and are not just agonal events. Examination of coagulation in blood demonstrated activation of coagulation, as indicated by raised thrombin-anti-thrombin complexes and reduced protein C and antithrombin levels. However this was compensated as there was normal prothrombin fragment (F1+2)-to-activated protein C ratios and only mildly altered clotting times. Examination of markers of endothelial activation (soluble Intracellular Adhesion 2 Molecule-1 [sICAM-1] and Angiopoetin-2 [Ang-2]) and inflammation (C-reactive protein [CRP]) revealed endothelial activation and inflammation at presentation and during recovery and demonstrated that in cerebral malaria and in uncomplicated malaria there is persistent endothelial activation after parasites are cleared, up to a month after presentation. Complexes of very low density lipoprotein (VLDL) and CRP were also raised in cerebral and uncomplicated malaria. Conclusions: In cerebral malaria in Malawian children there is localised microvascular loss of endothelial anticoagulant receptors at sites of iRBC sequestration. In the brain, where constitutive expression of EPCR and thrombomodulin is low, this is accompanied by thrombosis; outside the brain, where constitutive EPCR and thrombomodulin expression is high, coagulation is compensated. This activation of coagulation and of the endothelium in response to acute infection leaves a residual imprint as detected by markers of endothelial activation and inflammation even in uncomplicated malaria several weeks after parasites are cleared. Since children in sub-Saharan African frequently suffer repeated infections these endothelial alterations may have important consequences both for subsequent infections and for long-term health. These mechanisms highlight potential targets for therapy.

This study explores the processes undertaken to make an intercultural production of Shakespeare’s 'Romeo and Juliet' meaningful for a contemporary Malawian audience. I consider the notions of global, universal, intercultural and postcolonial Shakespeare, and through the examination of 'Rei Lear' (Cape Verde, 2003), 'Ìtàn Ògìnìntìn' (Nigeria, 2012) and 'Toufann' (Mauritius, 1999) I demonstrate how the influences of colonialism, language politics and education created a complex matrix of factors that have affected the development of drama and Shakespeare in production in various African nations. This analysis created a framework for how a translation and production of 'Romeo and Juliet' could be researched and realised through theatrical practice. Examination of the genesis and development of Shakespeare in production in Malawi, using surveys, interviews, scholarly articles and archival research, situated where my production fitted within the country’s contemporary theatre landscape. Practical workshops aided my investigations as to how the translated script could be meaningfully realised by Malawian performers and how the play could be relocated to Malawi. I engaged in a three-week rehearsal period where students from Mzuzu University produced a full production of the play. 'Romio ndi Julieti' was performed in three public venues: Luwinga Secondary School, Mzuzu University and Chingalire village. DVDs of workshop/rehearsal excerpts and the final production of Romio ndi Julieti at Chingalire village (9 April 2016) form part of this practice-led research thesis. Among the findings of this study I have shown that translating 'Romeo and Juliet' into a vernacular language and using contemporary Malawian performance styles meant that the production had a greater impact on both the performers and the audience than if it had been performed in English. Working in Chichewa freed the actors, some performing in the language for the first time, to showcase Malawian performance forms, including physical comedy and dance, within the parameters of an ‘elitist’ production. My observations and survey and interview feedback showed that this intercultural theatre encounter had a positive impact on both performers and audience.

This thesis examines the experience of Malawian soldiers serving in Britain's colonial army between 1891 and 1964. Until recently, the experience of East African colonial soldiers in particular has been largely overlooked, and African soldiers in general have been perceived either as collaborators in the machinery of colonial oppression or, conversely, as victims at the hands of the military authorities. However, little attempt has been made to unify these two views of military service. Using Malawi as a case study, this thesis investigates social relations within the colonial army and examines perceptions of their often-violent role within wider colonial society. Developing and expanding upon previous scholarship, this thesis provides the first sustained and unified study of the colonial army in Malawi. The project is based principally upon archival sources in Britain and Malawi, but also draws upon interviews with British and Malawian veterans. Chapter one provides an overview of the institutional history of the Malawian forces. Chapter two outlines the development of recruitment policy, with special reference to the concept of 'martial races', and examines the motivations behind Malawian enlistment. Chapters three and four investigate the reactions of African soldiers to the formal military environment and to barrack life. Chapter five examines perceptions of soldiers' roles in warfare and internal security, and contrasts this with the place of soldiers in their own communities. The thesis highlights the extent to which Malawian soldiers were successfully co-opted by the military authorities, but also stresses the capacity of soldiers to influence the conditions under which they served. This, combined with the unusually long association which many Malawians had with the army, fed into a growing perception of the colonial army as a Malawian institution.

Very little has been done to define the process of clinical learning in Malawi and yet anecdotal observations reveal that it is more challenging than classroom teaching and learning. This set the impetus for this hermeneutic phenomenological study, the aim being to gain an understanding of the nature of the clinical learning experience for undergraduate students in Malawi and to examine their clinical experiences against some experiential learning models (Kolb 1984; Jarvis et al 1998). The study setting was Kamuzu College of Nursing (KCN) and the sample was selected purposively and consisted of 30 undergraduate students who were recruited through volunteering. Conversational interviews were conducted to obtain students’ accounts of their clinical learning experience and an eclectic framework guided the phenomenological analysis. The study raises issues which relate to nursing education and nursing practice in Malawi. From an experiential learning perspective, the study reveals that clinical learning for KCN students is largely non-reflective. The study primarily reveals that the clinical learning experience is enormously challenging and stressful due to structural problems prevalent in the clinical learning environment (CLE). In some clinical settings the CLE appears hostile and oppressive due to negative attitudes which some of the clinical staff display towards KCN students. Consequently, students’ accounts depict emotionally charged situations which confront them and this illustrates that clinical learning for KCN students is an experience suffused with emotions. In literature issues on emotions are commonly discussed under emotional labour (Hochschild 1983) and I used the concept as a basis for my pre-understandings and interpreted the students’ accounts of their clinical learning experience against such a conceptual framework. What resonated from their narratives was the depth of the emotion work they engage in. This enabled me to arrive at a new and unique conceptualisation of clinical learning redefined in terms of emotional labour within the perspective of nurse learning in Africa. The findings are a unique contribution to the literature on emotions and provide essential feedback which forms the basis for improving clinical learning in Malawi.

Thesis (DTh)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: This dissertation develops a theory for doing Malawian urban ministry called "Holistic hermeneutical practical theology." The effects of urbanization: secularization, disorientation, poverty and pollution in Malawi's urban centers make it difficult for the CCAP to implement successful ministry that deals with the shantytowns' circumstances. Chapter one: The first chapter describes the Malawian urban context. It defines the five components of the researcher's topic of study: "Urban poverty as a challenge for ministry within the Malawian (African) context" and the three components of the methodology: "Holistic hermeneutical practical theology." Four relational hypotheses are formulated to guide the study. Different research methods applied to gathering information for chapters of this dissertation are documented at the end of this chapter. Chapter two: The second chapter examines the CCAP's existing ministry practice and addresses the first hypothesis: "Its rural background and theory of ministry prevent the CCAP from developing an effective urban ministry that adequately addresses the problems of the poor." The missionaries introduced a comprehensive ministry approach to the early leaders of the CCAP Nkhoma Synod. In the process of blending the missionary approach to ministry in the local Chewa context, a philosophy of ministry that emphasizes spiritual salvation (neglecting the physical needs) was developed in the CCAP Nkhoma Synod. This approach poses a problem for the Church to adequately address the physical needs and realities of Malawians in the cities. Chapter three: The third chapter discusses the poverty situations of Malawian and South African shantytowns and slums and is the result of research conducted in order to examine the validity of the four hypotheses. The responses of the groups interviewed were helpful for an understanding of the current congregational challenges and ministry opportunities in urban areas. This chapter addresses issues of this thesis positively: research objectives, the population growth data of urban inter-censal, a brief historical description of Malawian cities, the government efforts to address urban challenges and problems, the CCAP ministry approach to urban ministry, and a brief description of two South African poverty scenarios. The research reveals that the church and the government work independently of each other. In this way the validity of the third hypothesis: "A holistic approach to urban ministry with joint forums for development is needed to address urban poverty problems," is confirmed. Chapter four: This chapter describes the extent of poverty in Malawi, which is most disturbing. The recent studies on Malawian poverty indicate that the poverty scenario is a pervasive problem affecting approximately 60% of the population; urban poverty, in particular, is 65%. Furthermore, chapter four discusses a number of issues, some of which are: a description and Christian views of the poor, an overview definition of urban poverty, the causes of poverty and the vocation of the urban church. The cities' informal economies can make a huge difference in the lives of the poor. All of the four hypotheses form the background to this chapter. Chapter five: Chapter five examines four different approaches of the urban ministry in poverty areas. The purpose of this chapter is to understand the approaches of current work in poverty areas. Various approaches are discussed: community organization, effective congregationally based advocacy ministries, a liberation model, and a church in solidarity with the poor and oppressed. This chapter repeatedly confirms the first and the fourth hypotheses. Chapter six: In this chapter the theory of a holistic, hermeneutical practical theology is applied to a number of activities called pillars, juxtapositioning it with the four hypotheses. This is presented as a model for doing urban ministry in Malawian (African) cities. In the process of describing or developing the model, the four hypotheses - that have already been thoroughly proved and discussed - now serve as orientation markers pointing the CCAP towards its future role in urban ministry. The model emphasizes a hermeneutic-communicative praxis, which makes it constantly concerned with understanding the Christian meaning produced in the past, and relating it to interaction with the present-day faith community. Thus, the church in urban Malawi will address the challenges presented by the effects of urbanization and industrialization. The model's ten pillars are discussed: i) ministry in a new era and context, ii) urban ministry among the poor requires community participation, iii) proclaiming the Gospel in word and deed, iv) Christian faith development, v) urban evangelism, vi) effective pastoral care, vii) the need to build faith communities, viii) the need to equip the urban mission, ix) moving towards ecumenical alliances in African cities, and x) the importance of congregational studies. Chapter seven is a summary and conclusion of the dissertation. It discusses issues of this thesis positively: orientation of the study hypotheses, congregational study methods used in each chapter, the study's path and results, the contribution the study has made to the existing knowledge, and the conclusion of the whole dissertation. Urbanization is Africa's new missionary challenge for this century. The Christian task in Africa is the mission of the continent, which is in the process of rapid urbanization. If the church delays its adaptation to the urban context (the theories of which are changing constantly) it will forsake her strategic mission of being a foreign body in the world, where the old and new overlap in her, rendering her too early for heaven and too late for the earth.
AFRIKAANSE OPSOMMING: Hierdie proefskrif ontwikkel 'n teorie vir die Malawiese stadsbediening wat beskryf word as 'n "Holistiese hermeneutiese praktiese teologie." Die invloed van verstedeliking, sekularisasie, disorientasie, armoede en besoedeling in Malawi se stedelike sentra maak dit moeilik vir die CCAP om suksesvolle bediening, onder plakkersdorp-omstandighede, te implementeer. Hoofstuk een: Die eerste hoofstuk beskryf die Malawiese stedelike konteks. Dit omskryf die vyf komponente van die navorser se studie-onderwerp, "Stedelike armoede as 'n uitdaging vir die bediening binne die Malawiese (Afrika) konteks" en die drie komponente van die metodologie, "Holistiese hermeneutiese praktiese teologie." Vier verwante hipoteses is geformuleer om as riglyn vir die studie te dien. Verskillende navorsingsmetodes, toegepas vir die inwin van inligting vir hierdie tesis se hoofstukke, word aan die einde van hierdie hoofstuk beskryf. Hoofstuk twee: Die tweede hoofstuk ondersoek die CCAP se huidige bedieningspraktyk en is gerig tot die eerste hipotese: "Die CCAP se landelike agtergrond en teorie van bediening verhinder die kerk om 'n doeltreffende stedelike bediening te ontwikkel wat die armes se probleme toereikend kan aanspreek." Die sendelinge het 'n omvattende bedieningsbenadering vir die vroee leiers van die CCAP Nkhoma Sinode ingestel. In die proses om die sendingbenadering tot die bediening in die plaaslike Chewa konteks in te voer, is 'n filosofie van bediening wat die geestelike verlossing beklemtoon (terwyl fisieke behoeftes verwaarloos word) in die CCAP Nkhoma Sinode ontwikkel. Hierdie benadering veroorsaak 'n probleem vir die Kerk om die fisieke behoeftes en realiteite van stedelike Malawiers toereikend aan te spreek. Hoofstuk drie: Die derde hoofstuk bespreek die Malawiese en Suid-Afrikaanse plakkersdorpe en agterbuurtes se toestande van armoede. Die hoofstuk is die produk van navorsing wat die geldigheid van die vier hipoteses ondersoek het. Die reaksies van die groepe met wie onderhoude gevoer is, het bygedra tot 'n begrip van die huidige gemeentelike uitdagings en bedieningsgeleenthede in stedelike gebiede. Die proefskrif spreek die volgende kwessies in hierdie hoofstuk aan: navorsingsdoelstellings, die tussentydse data van die bevolkingsgroei van stedelike gebiede, 'n kort historiese beskrywing van Malawiese stede, die regering se pogings om stedelike uitdagings en probleme aan te spreek, die benadering van die CCAP tot stedelike bediening en 'n kort beskrywing van twee Suid-Afrikaanse armoede-tonele. Die navorsing toon dat die kerk en die regering onafhanklik van mekaar werk. Dus, die geldigheid van die derde hipotesis: "'n Holistiese benadering tot die stedelike bediening met gemeenskaplike forums vir ontwikkeling is nodig om stedelike armoedeprobleme aan te spreek" is hiermee bevestig. Hoofstuk vier: Hierdie hoofstuk beskryf die ontstellende impak van armoede in Malawi. Die onlangse studies, met betrekking tot Malawiese armoede, toon dat die armoede-toneel 'n deurdringende probleem is wat ongeveer 60% van die bevolking raak; stedelike armoede, in die besonder, is 65%. Hoofstuk vier bespreek 'n aantal kwessies, sommige hiervan is: 'n beskrywing en Christelike perspektief op armoede, 'n oorsigtelike definisie van stedelike armoede, die oorsake van armoede en die roeping van die stedelike kerk. Die stede se informele ekonomiee kan 'n baie groot verskil in die lewens van die armes maak. Al vier hipoteses vorm die agtergrond van hierdie hoofstuk. Hoofstuk vyf: Hierdie hoofstuk ondersoek vier verskillende benaderinge tot stedelike bediening in areas van armoede. Die doel van hierdie hoofstuk is om die benaderinge in arm dele te verstaan. Verskeie benaderinge word bespreek: gemeenskapsorganisasie, doeltreffende gemeentelik-gebaseerde voorspraakbedienings, 'n bevrydingsmodel en 'n kerk in solidariteit met die armes en verdruktes. Hierdie hoofstuk bevestig herhaaldelik die eerste en die vierde hipoteses. Hoofstuk ses: In hierdie hoofstuk word die teorie van 'n holisties-hermeneutiese praktiese teologie toegepas op 'n aantal aktiwiteite, wat pillare genoem word, en stel dit naas die vier hipoteses. Dit word voorgestel as 'n model vir stedelike bediening in Malawiese (Afrika) stede. In die proses om die model te beskryf of ontwikkel, dien die vier hipoteses (wat reeds deeglik bewys en bespreek is) nou as orientasie merkers wat die pad vir die CCAP vir sy toekomstige rol in die stedelike bediening aanwys. Die model beklemtoon 'n hermeneuties-kommunikatiewe praktyk, wat gedurig in verband gebring word met die verstaan van die Christelike betekenis wat in die verlede teweeggebring is en wat dit, deur interaksie met die huidige geloofsgemeenskap, in verband bring. Dus, die kerk in stedelike Malawi sal die uitdagings wat deur die uitwerking van verstedeliking en industrialisasie gebied word, aanspreek. Die model se tien pilare word bespreek: i) bediening in 'n nuwe era en konteks, ii) stedelike bediening onder die armes benodig gemeenskapsdeelname, iii) die verkondiging van die Evangelie in woord en daad, iv) Christelike geloofsontwikkeling, v) stedelike evangelisasie, vi) doeltreffende pastorale sorg, vii) die behoefte vir die opbou van geloofsgemeenskappe, viii) die behoefte om die stedelike sending toe te rus, ix) die vorm van ekurneniese alliansies in die stede van Afrika, en x) die belangrikheid van gemeentelike studies. Hoofstuk sewe is 'n opsomming en afsluiting van die proefskrif. Dit bespreek hierdie proefskrif se hoofpunte: die orientasie en die hipoteses van die studie, die navorsingsmetodes geimplementeer in elke hoofstuk, die studie se ontwikkeling en resultate, die bydrae van die studie tot die bestaande kennis, en die afsluiting van die werk. Afrika se stede is die nuwe sendinguitdaging. Die Christelike taak in Afrika is die evangelisasie van die vasteland wat tans in die proses van snelle verstedeliking is. Indien die kerk in gebreke bly om in die stedelike konteks aan te pas, sal die kerk sy strategiese missie versaak om lig in die wereld te wees.

Background Community-acquired pneumonia (CAP) is one of the commonest causes of adult hospitalisation in sub-Saharan Africa, but recent data describing its epidemiology, microbial aetiology and outcome are limited. Focusing particularly on Malawi, the overall aim of this thesis was to describe the aetiology and outcome of CAP in sub-Saharan African to determine the key predictors of mortality. Methods Firstly, a systematic review of studies of CAP in adults in sub-Saharan Africa was performed to describe CAP aetiology, estimate the mortality rate and identify risk factors associated with death. Secondly, a prospective observational study of adults hospitalised with clinically diagnosed CAP to Queen Elizabeth Central Hospital, Blantyre, Malawi was completed to describe microbial aetiology using modern diagnostic modalities, determine outcome and identify prognostics factors. Thirdly, having identified in preliminary analyses of the prospective cohort that hypoxaemia was an independent risk factor for mortality, a study of the effectiveness of supplemental oxygen delivery by oxygen concentrator to correct hypoxaemia in adults with suspected CAP was performed. Results In both the systematic review and the prospective cohort the predominant burden of hospitalised CAP was in young (average age 38 and 35, respectively) and HIV-positive (52% and 78%) patients with limited chronic cardiovascular and pulmonary comorbidity. Streptococcus pneumoniae (27% and 21%) and Mycobacterium tuberculosis (19% and 23%) were the most commonly identified causes. The overall mortality rate for hospitalised patients in the systematic review was 9.5%, but data describing prognostic factors were limited. In the prospective cohort (n=459), death by day 30 occurred in 14.6% and was associated with: male sex (aOR 2.57); pre-presentation symptom duration (aOR 1.11 per day increase); inability to stand (aOR 4.28); heart rate (aOR 1.02 per beat/minute rise); oxygen saturations (aOR 0.95 per % rise); white cell count (aOR 0.91 per 109/L rise); haemoglobin (aOR 0.90 per g/dL rise). A newly derived four parameter mortality risk prediction tool based on male sex, oxygen saturations < 90%, inability to stand and heart rate ≥125 /min predicted 30-day mortality with reasonable accuracy (area under the receiver-operating curve (AUROC) 0.79) whilst existing tools performed poorly (CURB65: AUROC 0.60; SMRT-CO: AUROC 0.66). Hypoxaemia was corrected in 86.4% (n=59) of adults with suspected CAP with supplemental oxygen at standard flow-rate of 5 litres/minute. Failure to attain normoxaemia was associated with a more than four-fold increase in the risk of death (RR 4.25). Conclusions The major burden of hospitalised CAP in low-resource, sub-Saharan African settings is seen in young and HIV-positive adults, many of whom have TB. Extrapolating CAP assessment and treatment algorithms from well-resourced settings where the epidemiology and aetiology of disease is very different is flawed. If validated, locally derived severity assessment tools may provide a rational basis on which to stratify CAP management. Strategies to increase early detection and treatment of TB and to improve supportive care, in particular the correction of hypoxaemia, hold considerable promise for improving CAP outcomes and should be evaluated in clinical trials.

This study explored the problem of poor performance in science among students who are provided secondary school places on merit in Malawi. Existing studies of the problem are inconsistent suggesting that these studies may have shed light on some parts of a complex problem. Questionnaires, interviews and analysis of documents were used to obtain information concerning students&rsquo
conceptions of science, science learning and events that eventuated into the problem in the past. The population for this study was 89 government and governmentassisted secondary schools. From that population eighteen schools were randomly selected from each of the six education divisions in the country. One thousand five hundred secondary class 3 students drawn from randomly selected schools participated. The participating students completed a 31item learning beliefs and practices 
questionnaire with items drawn from the science education literature and adapted to the local situation and a selfefficacy and attribution of failure questionnaire. Forty students were interviewed about their concepts of science and science learning. Relevant documents found in the Malawi National Archives were analyzed to determine the origin of the problem.

Thesis (MEd)--University of Stellenbosch, 2007.
ENGLISH ABSTRACT: Through policy document analyses and in-depth semi-structured interviews, this thesis examines the potential of higher education policy frameworks to engender quality university education in Malawian universities. Pertinent to the fast-growing higher education sector in Malawi is the connection between higher education policy frameworks and quality delivery of university education. Education policy frameworks in Malawi are mainly a response to the government’s broad policy of poverty alleviation. Thus this thesis argues that quality university education ought to contribute to poverty alleviation especially by assisting the country to achieve its Millennium Development Goals (MDGs) and to implement the initiatives of the New Economic Partnership for Africa’s Development (NEPAD). To engender quality university education that could help to alleviate poverty in Malawi, this thesis through Habermasian critical inquiry proposes that quality ought to be the corollary of defensible higher education policy frameworks, policy documents need to delineate quality parameters, access to university education needs to be increased and, inevitably, discursive or deliberative higher education policy making ought to be given primacy.
AFRIKAANSE OPSOMMING: Aan die hand van beleidsdokumentontleding en diepgaande, semigestruktureerde onderhoude, ondersoek hierdie tesis die potensiaal van hoëronderwysbeleidsraamwerke om gehalte universiteitsonderrig in Malawiese universiteite teweeg te bring. Van besondere belang vir die snelgroeiende hoëronderwyssektor in Malawi is die verband tussen hoëronderwysbeleidsraamwerke en die lewering van gehalte universiteitsonderrig. Malawiese onderwysbeleidsraamwerke is hoofsaaklik 'n reaksie op die regering se omvattende armoedeverligtingsbeleid. Daarom voer hierdie tesis aan dat gehalte universiteitsonderrig tot armoedeverligting behoort by te dra, veral deur die land te help om sy millenniumontwikkelingsdoelwitte (MOD’s) te bereik en die inisiatiewe van die Nuwe Vennootskap vir Afrika-ontwikkeling (NEPAD) in werking te stel. Ten einde gehalte universiteitsonderrig teweeg te bring wat armoede in Malawi kan help verlig, doen hierdie tesis deur Habermasiese kritiese ondersoek aan die hand dat gehalte die uitvloeisel van verdedigbare hoëronderwysbeleidsraamwerke moet wees, dat beleidsdokumente gehaltegrense moet neerlê, dat toegang tot universiteitsonderrig verbeter moet word, en dat beredeneerde of oorwoë hoëronderwysbeleidbepaling onafwendbaar voorrang behoort te geniet.

Climate change is one of the greatest threats to humanity with millions of people already suffering from its consequences in the last two decades. Social media, as a communication channel, has an important role to play in provoking a response to climate change. Social networking sites are known to be more interactive and potentially provide a great platform for the masses to make their voices heard, shape policy objectives, and even influence intransigent negotiations. This research explored how African youth are using the social media in climate change discussions and advocacy. The literature for this study is drawn from various studies focusing on climate change key issues, climate change communication and application of strategic communication to social media climate change initiatives and campaigns. A mixed method research approach was used to collect data for the study. Findings revealed that Facebook is the common social media platform for climate change discussions among Malawian youth as 62.50% of the participants use it to talk about the issue.

Includes abstract.
Includes bibliographical references.
Problem-based learning (PBL) is a teaching and learning approach that is known to facilitate life-long learning, problem solving, self-directed learning, critical thinking skills and student motivation (Hung, Jonassen & Liu 2006:486; Ehrenberg & Haggblom 2007:67). It is also renowned for the promotion and integration of knowledge. PBL was introduced in Malawian nursing education six years ago; however, its implementation apparently has been very slow throughout the country. The primary purpose of this study was to explore, analyse and describe characteristics that facilitated implementation of PBL in the identified college as a case study. The secondary purpose was to utilise the data gathered from the identified college as a case study to identify a set of critical factors that could guide implementation of PBL in nursing education in Malawi. This was an exploratory and descriptive qualitative case study using an ethnographic approach and guided by the theoretical framework of sociotechnical systems. Purposive sampling technique was employed to select the college, nine participants and documents for review. Three data sources were utilised: semi-structured interviews, participant observation and document reviews. Ethnographic data analysis was done following the four steps of data analysis as described by Spradley (1979), and trustworthiness was ensured utilising the criteria proposed by Lincoln and Guba. Four themes emerged as characteristics that enhanced implementation of PBL: having a goal to achieve, resources for the organisation, influence on the organisation, and critical success factors. These four themes had the following subthemes and categories: (i) having a goal - subthemes were; producing life-long learners, review of the curriculum, gradual introduction of PBL and embracing the PBL. (ii) Resources for the organisation – subthemes were; committed management and leadership, skills development of staff, having staff with the same values, additional staff, having technological and material resources, and staff knowledge of the curriculum. (iii) Influences on the organisation – subthemes were; social influence, economic influence and political influence. (iv) Critical success factors – subthemes were; staff involvement in planning and communication, motivation and commitment of staff, collaboration with other colleges and organisations, and recognition of the need for change.

This thesis examines the inclusion of climate change in Malawian social policy, and the discourse and government documents surrounding it. In Malawi, social protection predates climate change policies – in both policy in practice – however, they have risen up the Governments agenda at the same time. This is unsurprising given the severity and frequency with which the country is impacted by climatic shocks. Moreover, vulnerability and instability in the country leave Malawian disproportionately susceptible to the impact of natural disasters and environmental irregularities. In the wake of a natural disaster, most commonly drought and flooding, there is a significant spike in mentions of both climate change and social protection in Parliamentary discourse. Similarly, Government documents exhibit a wellestablished connection between these two – mention of disaster risk reduction is frequently coupled with a call for social protection to minimize the effects of natural disasters. In many ways, the most recent and current social protection policy is the logical evolution of this. In 2018, the Government of Malawi released the Malawi National Social Support Programme II (MNSSP II) which focused significantly on shock-sensitive social protection to address and minimize the impact of climate change in the country. Previous social protection initiatives in the country have garnered very little political support, and the Government has exhibited a hesitation to provide financial and technical support to these programs.

Childbirth education provided to women is an Integral aspect of the childbirth experience. In Malawi, midwives face a major challenge because one of their major roles is to provide childbirth information to women. However, there are no existing Childbirth Education Programs to facilitate this process. The purpose of this study was, therefore, threefold. First, it explored childbirth Information needs of Malawian mothers from the perspectives of both mothers and midwives, as well as strategies that would be appropriate to disseminate this childbirth information to Malawian women. Second, it developed a Childbirth Educational Program (CEP) to meet the specific needs of Malawian women as previously identified. Third, the CEP was implemented and evaluated for it’s effectiveness in increasing Malawian women’s knowledge of childbirth. The study was conducted in three phases. In Phase One, childbirth information needs of Malawian women were determined using findings from previous studies, focus groups and individual interviews of Malawian midwives. In Phase Two, data obtained from Phase One was used to develop a CEP as well as pretest/posttest questionnaire. In Phase Three, a quasi-experimental study using sequential sampling was conducted to implement and evaluate the CEP. Participants Included pregnant women who attended antenatal clinics at the Ndirande and Limbe Health Centres in Blantyre (Malawi). Following informed consent, 125 women from the Ndirande Health Centre were Invited to participate in the study and recruited to a control group. Another 125 women were also recruited to an intervention group at Limbe Health centre. A pretest was administered to both groups of women to determine their childbirth knowledge prior to implementation of the study. Women In the control group were exposed to routine antenatal education from both hospital and traditional non-hospital sources. Therefore, an increase in childbirth knowledge was anticipated. Additionally, women in the intervention group were exposed to both routine antenatal education as well as a systematic and comprehensive CEP. It was anticipated the degree to which knowledge increased in this group would be higher than in the control group, thus demonstrating the effectiveness of the CEP.

Introduction: Untreated and poorly treated septic arthritis in children is a major cause of orthopaedic pathology in Malawi and the rest of sub Saharan Africa, yet little has been published on its early treatment, or its incidence, clinical features and bacteriology. This is the first prospective study to compare simple aspiration with surgical arthrotomy and lavage. Questions about septic arthritis the thesis will consider: 1. What is the incidence? 2. What are the clinical features? 3. What is the bacteriology? 4. Is there a difference in outcome between treatment by aspiration and arthrotomy with lavage? Methodology: Two studies were performed. The first was an incidence study in a relatively closed population area. The second was a prospective study of 204 patients under the age of 16 with septic arthritis, randomised to treatment by aspiration (group 1) or arthrotomy and lavage (group 2), then followed up clinically, radiologics I ly and haematologically for one year.

The setting for this research is a rural community in the central region of Malawi. As a qualitative case-study it explores attitudes towards development as well as the processes school-based community development might go through to achieve a permanent increase in adaptability (Taylor, 2005). This adaptability is the ability of local communities to finance and maintain interventions and then adapt to changes in the social and economic environment. This thesis explores opportunities the community may develop to avoid dependence on outside control as they become increasingly self-sustaining. The research questions explore these processes and unpack shifts in community power relations while exploring the impact that faith-based organisations bring to the development process. The research positions the researcher within the lived experience of those researched and uses research instruments developed from qualitative research typologies consistent with Berkowitz, and Srivastava & Hopwood underpinned with a philosophical framework drawn from the ideas of Freire, Chambers and Wells. This research considers seven non-governmental organisations (NGOs), six schools and various authority structures within the research locality to explore their roles and the tensions each brings to the other. Drawing on a constructivist epistemology it explores current thinking and practice regarding school-based community development. Additionally, the thesis looks at teacher professionalism and identity, arguing that for teachers to develop a professional identity a degree of autonomy is needed where self-regulation and opportunity to contribute to training is necessary. This exploration is achieved by gathering data using research instruments that include semi-structured interviews, focus groups discussions and reflexive consideration from journaling and regular reviews with assistant researchers. Reflecting on the empirical data gathered to allow theory to emerge it triangulates research methods to increase reliability. I explore the processes, obstacles and hindrances to establish how self-reliance within school-based community development is approached by NGOs, and use the data to support the argument that NGO activity may be contributing to the erosion of traditional authority structures such as the community chief. It is suggested that the creation of space in which to explore common ground between developmental actors is a first step towards the creation of an empowered community whose ownership of the processes is central to a permanently adaptive development.

Thesis (MTh)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Motivated by the observation that child labour is harmful to children, this research aims to determine whether child labour could be described as a violation of human dignity. The research further attempts to develop a theological framework which the Church of Central Africa Presbyterian (C.C.A.P) Synod of Livingstonia in Malawi could adopt in restoring the human dignity that might have been trodden on in child labour practices. In order to achieve the objectives of this study, eight ministers from two presbyteries were interviewed, using a structured questionnaire as the main tool for data collection. The data was analyzed using a thematic data analysis method. The findings indicated that child labour is any work done by children that is detrimental to their welfare. Such work was predominantly on tobacco farms both at commercial and at family levels, and was carried out under hazardous conditions. As a result children experience the following effects; physical abuse; psychological torture, sexual abuse; and these children may end up in perpetual poverty experiences, to mention just a few effects. The critical literature analysis done with reference to theological concept of human dignity, characterized the effects as a violation of human dignity. The main causes of child labour identified during this study were poverty, ignorance of short and long terms impact of child labour effects on children, and the cultural perceptions that children are equipped for the future if they are trained (socialized) to work hard at a tender age. By implication, as long as these causes exist, child labour may remain a problem and children may continue to suffer since these children do not enter labour by choice, but forced by the socio-economic and socio-cultural structures. Although these children experience this human degradation there is no way they can stop working on their own, because they do not have a voice, they are under the control of parents and employers. In this context this study would like to classify working children as among the marginalized, oppressed, weak and vulnerable groups in need of people and institution that can speak and act on their behalf. Therefore it is argued that there is a need for the church to advocate for the marginalized children in this context. The literature consulted further indicated that the church of Jesus Christ is responsible for providing spiritual and physical salvation to people, taking into account how long it may take to deal with some of the main causes of child labour. The church may consider its advocacy role of protecting the dignity of human beings created in the image of God with compassionate love. This research suggests recommendations that are in line with theological understanding of who the church is and the human dignity of people and specifically of children, to address the challenges of child labour practices. The recommendations attempt to involve different stakeholders of the community to work in a consortium.
AFRIKAANSE OPSOMMING: Die navorsing is gemotiveer deur die waarneming dat die gevolge van kinder-arbeid skadelik vir kinders kan wees, en stel dit ten doel om vas te stel of die effek van kinder-arbeid as ʼn skending van menswaardigheid beskryf kan word. Die navorsing streef ook om ʼn teologiese raamwerk te ontwikkel wat die Church of Central Africa Presbyterian (C.C.A.P) Livingstonia Sinode in Malawi kan gebruik om die menswaardigheid wat moontlik deur kinder-arbeid- gebruike vertrap is,te herstel. Ten einde die doelstellings van die studie te bereik, is onderhoude gevoer met agt predikante van twee ringe, Jombo en Rumphi, in Livingstonia Sinode. Tydens die individuele onderhoude is ʼn gestruktureerde vraelys hoofsaaklik gebruik vir die versameling van data. Die versamelde data is ontleed met ʼn tematiese data-ontleding metode. Volgens die bevindings is kinder-arbeid enige arbeid wat kinders verrig wat nadelig vir hul welsyn is. Die meeste werk wat deur kinders verrig word, is op kommersiële tabakplase of in familieverband op kleinboere se tabakplase. Die werk is meestal onder gevaarlike omstandighede. As gevolg van die gevaarlike werk, ervaar kinders fisiese mishandeling, sielkundige teistering, seksuele mishandeling en ook soms gedurige armoede, om net ʼn paar te nadelige effekte te noem. Die kritiese literatuur-analise oor hierdie effekte met verwysing na ʼn teologiese konsep van menswaardigheid, toon dat die gevolge gekenmerk kan word as skending van menseregte. Die volgende primêre oorsake van kinder-arbeid is in die studie geïdentifiseer: armoede, onkunde oor die kort- en langtermyn impak van kinder-arbeid op kinders, en kulturele persepsies dat kinders vir die toekoms toegerus word as hulle op ʼn jong ouderdom geleer word (sosialisasie) om hard te werk. Die implikasie is dat solank hierdie oorsake voortbestaan, sal kinder-arbeid ʼn probleem bly en sal kinders steeds so ly, aansien hierdie kinders nie kies om kinder-arbeid te verrig nie, maar deur sosio-ekonomiese en sosio- kulturele strukture daartoe gedwing word. Al word hierdie kinders onmenswaardig behandel, kan hulle nie ophou werk nie, want hulle het nie ʼn stem nie, hulle word beheer deur hul ouers en werkgewers. In hierdie konteks stel hierdie studie werkende kinders gelyk aan die klassifikasie van die gemarginaliseerde, onderdrukte, swak en weerlose groep namens wie mense en organisasies moet praat en optree. Daar word dus betoog dat daar ʼn behoefte is dat die kerk namens gemarginaliseerde kinders in hierdie konteks intree. Die literatuur dui verder aan dat die aard en missie van die kerk van Jesus Christus maak ons verantwoordelik om spirituele en fisiese verlossing vir mense te bied. In die lig van die uitdagings van kinderswat werk, en met inagneming van hoe lank dit mag neem om sommige van die oorsake van kinder-arbeid aan te spreek, kan die kerk sy rol in terme van die beskerming van die menswaardigheid van mense geskape in die beeld van God met deernisvolle liefde oorweeg. Die navorsing maak voorstelle wat belyn is met die teologiese verstaan van wie die kerk is en die menswaardigheid van mense en spesifiek van kinders, om die uitdagings van kinder- arbeid aan te spreek. Die aanbevelings streef om verskillende aandeelhouers in die gemeenskap te mobiliseer om as ʼn konsortium saam te werk om kinder-arbeid en die onmenswaardige behandeling van kinders te bestry.

Nymphaea petersiana Klotzsch (Nyika) is an important wild tuber eaten in some districts of Malawi. The tubers were processed by boiling/freeze-drying(BFD) and sun-drying(USD). The tuber's nutrient and antinutrient composition was determined to produce a preliminary nutrient data base for use in sub-Saharan Africa. There was no significant difference (P > 0.05) in protein content of BFDand USD samples. Sun-dried samples were significantly (P < .05) higher in ash than boiled samples while boiled samples were significantly higher (P < .05) in crude fat and total carbohydrate. The protein content of the tubers (8.0 and 8.1 %) was higher than that of the staple maize (7.9%), African millets (unspecified) (7.5%), and polished rice (7.0%), but lower than sorghum (10.7%). Protein content was higher than tubers like cassava (1.3%), potato (2%), sweet potato (1.6%), yams (1.5%) and N. lotus (5.2). Nyika tubers have a well balanced amino acid content, limiting only in lysine. There were no significant (P > 0.05) differences in the mineral content of BFD and USD samples, except for iron, which was lower in the boiled samples. Nyika tubers have a higher calcium (1376 and 946 ug/g) and phosphorus (2250 and 2883 ug/g ) content than wild and domesticated cassava, potatoes, sweet potatoes and wild and domesticated yams. Sun-dried tubers have a higher iron content (88ug/g) than maize (20ug/g). The zinc content of tuber was higher (21and 25ug/g) than that of boiled maize flour, boiled sorghum flour, rice, cassava, and sweet potato. The predominant fatty acids in the tubers were oleic (47%), linoleic (32%), palmitic (21%) and linolenic (7%) acids. Ascorbic acid content was very low, only 0.1 and 0.003 mg/100g. Tannin content was lower (1 and 1.7 %) in the tubers than in Vulgare Pers. sorghum, DeKalb sorghum from U.S. and Kabale sorghum from Uganda. There was a significantly (P < 0.05) lower content of phytate in boiled (3.9ug/g) than in sun-dried tubers (6.0 ug/g). Phytate content of the tubers was lower than that of cooked maize flour, unrefined maize flour, cassava and sweet potato. Trypsin inhibitor activity in the tubers was reduced from 463 to 55 TIU/g tuber and chymotrypsin inhibitor activity was reduced to 50 from 267 CIU/g tuber by cooking. Nyika is a good source of iron and quality protein limiting only in lysine. Protein is comparable to staple maize and higher than root crops consumed in Malawi. It is not a good source of fat and ascorbic acid. Tannin, phytate, trypsin, and chymotrypsin inhibitor content lower than most food crops consumed in Malawi.
Ph. D.

The adoption of Information and Communication Technologies (ICTs) in Least Developed Countries (LDCs) has often been motivated by ideas of bridging the digital divide and promoting socio-economic progress within these countries. For example, many LDCs within sub-Saharan Africa and development practitioners alike are enthusiastic about the prospects of socio-economic progress through the adoption and use of ICTs. In Malawi, this belief in ICT potential is widespread and it is presumed that the adoption of ICTs will provide a sufficient condition for socio-economic progress and will offer Malawi the opportunity to leapfrog stages of development and accelerate her progress in socio-economic spheres. In particular, the adoption of computer based ICTs for educational purposes in Malawian secondary schools is being widely promoted. However, in many LDCs particularly those within sub-Saharan Africa, the realisation of such over-hyped technological gains has always remained elusive and literature suggests that the use of computer based ICTs in LDCs is constrained by a cross section of critical challenges (Mansell and Wehn, 1998; Kawooya, 2002; Heeks, 2002). Wade (2004) further explains that ICT initiatives in LDCs are "... biased towards the supply side and give scant attention to demand" (Wade, 2004, pl9l) and that the alleged stories of ICT adoptions within the region are generalised with "little attention to scaling up problems" (p. 186). This suggests that ICT adoption processes can not be understood and explained by simply focusing on the perceived potential of ICTs and disregarding complex socio-technical influences which shape and are shaped by those adoption processes in LDC contexts. This research focussed on the development of a socio-technical conceptualisation of ICT adoption processes in Malawian secondary schools based on empirical evidence. Methodologically, it uses both qualitative and quantitative approaches and focuses on three main notions of ICT choice, ICT use and ICT value in order to investigate ICT adoption processes. Socio-Technical Interaction Networks (STINs) technique is used in order to analyse research data. In particular, analytical affordances provided by the Social Actor Model (Lamb, 2006) are used to gain rich insights into ICT adoption processes in Malawian secondary schools and to generate an evidence based theoretical conceptualisation which appreciates the inextricable interrelationship between ICTs and the context within which they are embedded. The developed framework illustrates the significance of a context specific socio-technical approach when implementing ICT initiatives in Malawian secondary schools and the researcher argues that it deepens our theoretical understanding of the socio-technical nature of technologies and can facilitate the implementation of ICT solutions that are aligned and valuable to the adopting context in LDCs like Malawi.

The construction industry in Malawi plays a vital role in developing the infrastructure of the country that is in need of improvement. Thus, in order to improve the quality of infrastructure in Malawi, the construction industry has to perform better than the status quo. The construction industry is characterised by a complex value chain that comprises of clients, consultants, contractors, and material manufacturers, suppliers, financing institutions, knowledge organisations and regulatory authority. This research looks at the relationship between construction value and project success in the Malawian construction industry. A qualitative research method was used for compiling the primary data for the study. Twenty-nine (29) participants were interviewed. These participants represented clients, consultants, contractors and material suppliers. The findings reveal that value creation in Malawi is characterised by lack of harmonised standards and specifications, inconsistent project management practices, existence of non-value adding activities, corrupt practices, lack of a skilled labour force, and lack of commitment to best practices in H&S as well as environmental management. Further, logistical problems affect the supply of construction materials to the country; while an unfavourable economic environment makes pricing of materials a challenge in the country too. Poor communication and limited use of information technology (IT) is very common in the industry and project implementation is also affected by a poor road network, an intermittent power supply, and a lack of cooperation from other service providers. In terms of supply chain structures in use, the research revealed that the traditional procurement method that is based on the lowest bidder / price is the most dominant method in use and very few members of the construction industry are conversant with other procurement methods. The method is also the preferred procurement method used by public sector clients. The performance of the traditional procurement method largely depends on the competence of the project design and supervision team, the adequacy of the documentation, and the capacity of the contractor. However, in most cases the system has failed to perform due to the poor contract management skills of the supervising consultant and the lack of timely guidance from the public sector clients. The findings also revealed that most of the suppliers or subcontractors are engaged on project based relationships, and members of the industry are unwilling to engage in long terms relationships due to mistrust and greed among members of the industry, and also largely due to lack of proper frameworks that can support such relationships. It is therefore recommended that other procurement methods should be explored and the engagement of the lowest price bidders should be discontinued on small and medium scale projects. The criteria for upgrading contractors to higher categories should equally be revisited to eliminate incompetent contractors. The NCIC should take a leading role in harmonising the various standards and specifications in use in the country. Promotion of the usage IT services should be encouraged to facilitate faster information dissemination. Usage of risk management in construction and evaluation and monitoring of projects should be encouraged and benchmark best practices. Finally, the members of the industry should take up the responsibility to take leading entities in the industry to task, if fundamental changes are to take place in the industry.

The construction industry in Malawi plays a vital role in developing the infrastructure of the country that is in need of improvement. Thus, in order to improve the quality of infrastructure in Malawi, the construction industry has to perform better than the status quo. The construction industry is characterised by a complex value chain that comprises of clients, consultants, contractors, and material manufacturers, suppliers, financing institutions, knowledge organisations and regulatory authority. This research looks at the relationship between construction value and project success in the Malawian construction industry. A qualitative research method was used for compiling the primary data for the study. Twenty-nine (29) participants were interviewed. These participants represented clients, consultants, contractors and material suppliers. The findings reveal that value creation in Malawi is characterised by lack of harmonised standards and specifications, inconsistent project management practices, existence of non-value adding activities, corrupt practices, lack of a skilled labour force, and lack of commitment to best practices in H&S as well as environmental management. Further, logistical problems affect the supply of construction materials to the country; while an unfavourable economic environment makes pricing of materials a challenge in the country too. Poor communication and limited use of information technology (IT) is very common in the industry and project implementation is also affected by a poor road network, an intermittent power supply, and a lack of cooperation from other service providers. In terms of supply chain structures in use, the research revealed that the traditional procurement method that is based on the lowest bidder / price is the most dominant method in use and very few members of the construction industry are conversant with other procurement methods. The method is also the preferred procurement method used by public sector clients. The performance of the traditional procurement method largely depends on the competence of the project design and supervision team, the adequacy of the documentation, and the capacity of the contractor. However, in most cases the system has failed to perform due to the poor contract management skills of the supervising consultant and the lack of timely guidance from the public sector clients. The findings also revealed that most of the suppliers or subcontractors are engaged on project based relationships, and members of the industry are unwilling to engage in long terms relationships due to mistrust and greed among members of the industry, and also largely due to lack of proper frameworks that can support such relationships. It is therefore recommended that other procurement methods should be explored and the engagement of the lowest price bidders should be discontinued on small and medium scale projects. The criteria for upgrading contractors to higher categories should equally be revisited to eliminate incompetent contractors. The NCIC should take a leading role in harmonising the various standards and specifications in use in the country. Promotion of the usage IT services should be encouraged to facilitate faster information dissemination. Usage of risk management in construction and evaluation and monitoring of projects should be encouraged and benchmark best practices. Finally, the members of the industry should take up the responsibility to take leading entities in the industry to task, if fundamental changes are to take place in the industry.

Even though agriculture is the backbone of Malawi‟s economy, food insecurity has remained a continuous threat among the poor. Until the 1980s, Malawi had been achieving national food security through an extensive system of agricultural inputs and marketing subsidies. However, these subsidies were removed and at the same time, the agricultural credit system collapsed. Consequently, agricultural productivity in Malawi remained low, poverty remained pervasive and food insecurity remains a main constraint to national and household food security. Therefore, the success of the agricultural sector in Malawi is very critical for raising the living standards and for food self-sufficiency. In this vein, the study hypothesized that Malawi can only achieve sustainable agricultural development if its agricultural policies are focused towards intensifying agricultural productivity through active participation of smallholder farmers. The major aim of the study was to contribute towards an improved understanding of how the issues of sustainable agricultural development have been addressed in Malawi and how they have influenced the lives of smallholder farmers. The analysis of the results revealed that even though what was implemented in the 1970s to early 1980s was financially unsustainable, but it provided some solutions to the fundamental challenges of smallholder development in Malawi. However, the liberalisations eroded whatever economic benefits achieved then. Never the less, the re-introduction of the agricultural input subsidies restored back the means of production leading to significant transformation of the country from a net importer to a net food exporter. On the other hand, although the agricultural input subsidy programme is being commended for having helped in achieving food security, the study revealed that the programme requires complementary services of credit, extension, research and market to support it. This will provide an exit strategy, which can enable the producers to sell their produce at higher prices sufficient enough for them to afford agricultural inputs without subsidies.

Thesis (PhD)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Notwithstanding that many prominent, influential and highly effective Christian leaders over this past century are making a difference throughout Africa, a serious leadership crisis still looms. There is no doubt that Christianity has spread throughout Africa, reaching many remote areas within the continent. Still the depth to that Christianity remains elusive. Practical theologians have discovered various patterns of leadership abuse, immorality, and heresy throughout Africa. As alarming as these patterns may be, in a positive way they are encouraging many Africans to seek alternative models of leadership. Thus, Africa has now become a place ready to implement effective or authentic leadership models. The purpose of this dissertation is to determine, in a practical theological way, whether African Bible College in Malawi is producing graduates that can be described as authentic Christian leaders. As a way of determining this, the researcher will be 1) investigating the growing (Christian) leadership crisis within sub-Saharan Africa, 2) analyzing various Christian leadership models within the field, 3) conducting empirical research on the African Bible College (ABC) and ABC graduates, 4) exploring normative perceptions of Christian leadership and 5) developing a revised praxis for ABC to help it become an even more effective institution for producing authentic Christian leaders. Authentic leadership in particular emphasizes the “genuineness,” “realness,” and “transparency” of people in leadership positions. It requires a leader to be open, honest, and accountable to others. They must earn the respect and trust of their followers. People today are becoming more skeptical of their leaders. They have grown weary and impatient with typical overbearing, power-hungry, and dishonest leadership personalities. They want to see their leaders actually practicing what they are preaching, living lives of integrity, and truly living out their Christian faith in a God honoring and practical manner. This is why authentic leadership theory has become prominent and widely accepted within the past decade. The theory will be useful for analyzing the leadership of ABC graduates.
AFRIKAANSE OPSOMMING: Nieteenstaande die feit dat baie prominente, gesaghebbende en hoogs effektiewe Christenleiers (gedurende die afgelope eeu) ʼn ware verskil deur die hele Afrika gemaak het (en dit steeds doen), dreig ʼn baie wesenlike en ernstige leierskapkrisis steeds. Daar is geen twyfel nie dat Christenskap soos ’n veldbrand deur die hele Afrika versprei het, en baie afgeleë gebiede op die kontinent bereik het, maar die diepte van daardie Christenskap bly steeds bedrieglik. Praktiese teoloë het verskeie voorbeelde van misbruik van leierskap, immoraliteit en dwaalleer oral in Afrika aangetref. En, so ontstellend soos hierdie voorbeelde ook al is, op ʼn positiewe wyse motiveer en bemoedig hulle baie Afrikane om alternatiewe modelle van leierskap na te jaag. Afrika is dus op die oomblik ʼn baie geskikte plek vir die implementering van effektiewe (of outentieke) leierskapsmodelle. Die doel van hierdie verhandeling is dus om op ʼn prakties-teologiese wyse te bepaal, of die African Bible College (ABC) in Malawi gegradueerdes lewer, wat as outentieke Christenleiers beskryf kan word. In ʼn poging om dit te bepaal, het die navorser 1) die toenemende (Christen-) leierskapskrisis in Afrika suid van die Sahara ondersoek, 2) verskeie Christenleierskap-modelle op die gebied ondersoek, 3) empiriese navorsing oor die ABC en ABC-gegradueerdes gedoen, 4) normatiewe persepsies van Christenleierskap verken en 5) ʼn hersiene praktyk vir ABC ontwikkel wat daartoe sal bydra dat hulle ʼn selfs meer effektiewe instelling vir die lewering van outentieke Christenleiers kan word. Outentieke leierskap beklemtoon in die besonder die “opregtheid”, “egtheid” en “deursigtigheid” van mense in leierskapsposisies. Dit vereis van ʼn leier om oop, eerlik en aanspreeklik teenoor ander te wees. Dit bring mee dat ʼn leier die respek en vertroue van sy of haar volgelinge moet verdien. Mense raak deesdae al hoe meer skepties oor hulle leiers. Hulle het moeg en ongeduldig geraak vir die alomteenwoordige dominerende, magshonger en oneerlike leierskapspersoonlikhede. Hulle wil sien dat hulle leiers se woorde en dade werklik ooreenstem, dat hulle onkreukbare lewens leef en waarlik hulle Christengeloof prakties uitleef op ʼn wyse wat aan God eer bewys. Dit is hoekom outentieke leierskapsteorie die afgelope dekade een van die toonaangewendste en algemeen aanvaarde leierskapsteorieë geword het, en nuttig sal wees vir ontleding van die leierskap van ABC-gegradeerdes.

Introduction: The process of sequestration involving specific cytoadhesion between parasite ligands expressed on the surface of the parasitised red blood cells (pRBC) and host vascular endothelium contributes to pathogenesis of severe falciparum malaria. A major polymorphic surface antigen implicated in cytoadhesion is the Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1). PfEMP1 is encoded by the var multigene family that is sub-divided into three main groups: A, B and C, according to sequence similarities in coding and non-coding sequences. PfEMP1 has variant adhesive phenotypes, some of which interact with ABO blood groups to form rosettes and some involved in apparent formation of platelet-mediated clumps of infected erythrocytes that are thought to contribute to disease severity. With heavy HIV burden concentrating in areas with high malaria rates, co-infections are common. Both HIV and malaria interact with the host immune system, resulting in a complex activation of immune cells and subsequent dysregulated production of cytokines and antibodies. However, there is limited information on the molecular mechanisms of interaction between the two infections. Methods: Real time PCR was used to: 1) compare abundance of the three main var groups and measure the level of cytokine production and receptor expression utilising the resources of a clinicopathological study of 20 Malawian fatal paediatric malaria patients divided into three diagnostic groups: circulating and sequestered parasites (CM1); circulating and sequestered parasites plus perivascular pathology (CM2) and parasitaemic control (PC) groups; and 2) determine the effect of host ABO blood group on expression of var/PfEMP1 subtypes mediating platelet-mediating clumping in 65 Malawian paediatric patients with uncomplicated malaria (UM). Results: While there were no significant associations between ABO blood antigen groups with the clumping phenotype in UM patients, an abundance of var upsA and C transcripts were expressed in CM2 and the PC (p ≤ 0.001) groups. However, a very different expression pattern was observed in the CM1 group, which were mostly HIV positive (80%), with var gene group upsB being more abundant than in the other two diagnostic groups ( p ≤ 0.001). This result was supported by different cytokine/receptor upregulation between HIV positive and HIV negative children, with significant upregulation of TNF in HIV negative children (p ≤ 0.05). Conclusions: This data suggests that perivascular pathogenesis in naturally infected children is associated with differential var gene expression in the body. HIV disruption of cytokine release affects receptor regulation and influences parasite antigen expression.

This thesis re-examines the relationship between finance and growth. Most previous studies that have dealt with different aspects of this relationship show that a well-developed financial system is important for economic growth. However, instead of concentrating on the aggregated perspectives of this relationship, this research investigates whether financial development influences the level of competition in the real sector, as one possible mechanism through which finance may influence growth. The study focuses on the changes in industrial structure and performance following a regime change in the financial system: from financial repression to financial liberalization. It has been suggested that financial liberalization may be a key policy to promote industrialisation as it removes the credit access constraints on firms, especially small and medium ones. Competition among financial institutions, which accompanies financial liberalization, leads to greater availability of finance and a reduction in the cost for firms of raising capital for investment. In turn, this encourages creation and entry of new firms and promotes industrial growth, particularly of those firms and sectors that are external finance dependent. The implications of financial liberalization on the real sector are investigated using industry-level panel data from Malawian manufacturing, a variety of econometric methods, and standard measures of industry structure and performance, as well as financial development indicators. The analysis aims to ascertain whether financial liberalization in Malawi has had any impact on the availability of credit for manufacturing firms and whether its effects, which are hypothesised to influence industry structure and performance, differ depending on characteristics such as the degree of external finance dependence of firms or firm size. The main empirical findings show that financial liberalization, even if it results in greater supply of credit and a larger number of lending institutions compared with the pre-reform period, does not remove financing constraints on firms, especially the small and medium ones. Instead, it is the large existing firms that benefit from a more liberal financial regime. Indeed the evidence is that financial reforms have mostly facilitated the expansion of existing establishments rather than the creation of new establishments, and have resulted in greater industry concentration. Further, profitability and output growth are disproportionately higher in large firms than in small ones. The implementation of financial liberalization in Malawi has been judged a success; nevertheless the evidence is that these reforms have been detrimental to competition in industry. What are the policy implications of these findings? This study shows that financial liberalization is not the key for the promotion of industrialisation. In the presence of pervasive market failures in financial resource allocation, as have been experienced in Malawi, the withdrawal of the state from credit allocation decisions is unlikely to result in industrial development.

The introduction of Information and Communication Technology (ICT) in education has greatly transformed and improved the quality of teaching and learning all over the world. In Malawi, efforts are continuously being directed towards having ICT resources in all primary schools through different ICT interventions. However,though the interventions are likely to be widespread, there is no empirical evidence if the interventions are fully adopted and purposively used by the schools and teachers respectively. While there is considerable evidence to show that the integration of ICT intervention in classrooms is influenced by the entire education system, research on ICT in education is generally limited to the study of teacher level factors. This research examines how ICT interventions in Malawi primary school education system are planned, introduced and guided, and how these processes configure and influence adoption and use of the interventions by schools and teachers,respectively. Based on research questions about how the ICT interventions are conceptualized, implemented and integrated, the main aim of this study is to analyse the activities and processes taking place in the contexts that the ICT interventions are implemented by linking teachers’ ICT practices in classrooms to particular mediating processes and contexts. The study used a qualitative research approach. It firstly investigated the roles,processes and collaborations between government institutions and ICT providers in the conceptualisation of the ICT interventions through interviews and analysis of documents. The baseline data generated from this phase was used to identify case study schools that were used to investigate how the interventions are adopted and used, through interviews with school heads and teachers, classroom observations and analysis of documents. An Activity System Analysis was used to draw relationships between and within how the interventions are conceptualised at national level, how they are implemented in the schools and integrated in the classrooms. The findings reveal gaps in the national education plans and policies as formal guidelines that regulate investments in the primary school education system. The efforts by the various ICT interventions providers are unguided and unregulated,and the process of conceptualising and implementing the ICT interventions in primary education is still in a form of experimentation, being led by the interventions providers rather than the Ministry of Education. This presents tensions as the schools and the teachers try to accommodate requirements for implementing and integrating different ICT interventions without any policy frameworks, curriculum guidelines, ICT training and technical support. The implications from this study reveal the need for policy makers, planners and education practitioners to generate rationale, goals, and vision on how the Malawi primary school education system can incorporate the ICT interventions; guide specific roles for relevant stakeholders in the design and development of specific ICT interventions; produce specific plans and curricula for teacher training and development; and guide the development of school-based ICT plans that can facilitate successful adoption and integration of the ICT interventions.

My thesis examines the effectiveness of a range of participatory theatre-based methodologies as tools for enabling young men to examine and interrogate dangerous formulations of masculinity. My hypothesis was that current applications of Theatre for Development in Malawi are woefully inadequate for the purpose of meaningfully engaging with young men in order to help them stay sexually safe and to examine their understandings of Malawian masculinities. Therefore, my study primarily set out to investigate what theatre forms can be impactful for engaging with young men to explore these masculinities that increase their, and their partners, HIV risk and to enable them to define themselves as male in alternative ways that mitigate high-risk sexual behaviours and violence against women. In chapter one, I discuss the history of popular theatre in Malawi. Chapter two analyses the existing problems with the teaching of TfD at Chancellor College and NGO TfD methodologies in contemporary Malawi. In chapter three, I discuss my practical theatre-based experiments on masculinity and HIV with groups of male students from two secondary schools (Mulunguzi and Dzenza) and one university campus (Chancellor), before concluding with the findings of my research. I argue that in Malawi young men are under social pressure to perform masculinities that increase their HIV risk, and that of their partners, in order to affirm themselves as men. They do this by taking on high-risk sexual practices such as not using condoms, having multiple sex partners and being violent towards women. It is my contention that unless young men are engaged to challenge and change these ‘deadly’ constructions of masculine gender identity the disease will continue to spread. My findings show that the methodology I experimented with impacted some participants; however, in order for meaningful change to occur this work needs to be further developed and boys and girls have to be engaged using creative and critical thinking to discuss sexuality, gender and HIV.