Journal articles on the topic 'Work environment – Malawi'

Cassava, a crop widely adapted in the tropics, has the important attribute of withstanding adverse environmental conditions better than do many other staple crops. The performance of an individual genotype, however, is influenced by the environment in which it grows. In Malawi, the heterogeneity of agro-ecologies requires the cumbersome and costly assessment of new cassava genotypes at many sites. This study was conducted, therefore, to test the feasibility of selecting only a few locations for cassava evaluation that would be representative of all the agro-ecologies in which cassava is grown in Malawi. Enormous environmental effects, largely contributed by the interaction between season and location, were manifested. Genotype×environment interaction, due largely to a third level interaction (genotype×season×location), was highly significant for all the traits studied. A principal component analysis scatter plot showed no particular grouping of environments, but a pair-wise comparison showed that some of the locations had limited genotype×environment interaction, indicating that it would be sufficient to use one of these sites for evaluating these traits. The value of the residual was often large, probably as an effect of environmental heterogeneity in the test sites. The authors conclude that cassava genetic improvement will continue to be slow if Malawi is used as a single breeding zone. They recommend a much finer grouping of the locations and the use of smaller plot sizes to allow more clones to be tested at more sites for the same cost. Locations may be selected for intensive cassava breeding work from those that give the best discrimination between genotypes while having insignificant genotype×environment interactions in a relatively large number of environments.

Purpose: To investigate and describe the nature and extent of violence against nurses and the perceived effects thereof on nurses in the southern region of Malawi.Methods: A descriptive, cross-sectional study in which 190 questionnaires were sent out to nurses from five facilities, 112 were returned completed (60% response rate). The five facilities included two central hospitals, one psychiatric hospital and two health care centres.Results: 86% of the respondents agreed that violence against nurses is a problem in Malawi. The prevalence of violence for the five facilities in the preceding 12 months was 71% (CI 61%–79%) and was highest at the psychiatric hospital (100%). The types of violence experienced include verbal abuse (95%), threatening behaviours (73%), physical assaults (22%), sexual harassments (16%) and other (3%). Perpetrators of violence were: patients (71%); patients' relatives (47%); and work colleagues (43%). Nurses reacted to incidents of violence by reporting to managers, telling their friends, crying, retaliating, or ignoring the incident. Most (80%) nurses perceived that violence has psychological effects on them, which consequently affects their work performance and make them lose interest in the nursing profession.Conclusions: Workplace violence against nurses exists in Malawi and it affects nurses psychologically; may result in poor work performance; and may be a causative factor in the attrition of nurses from the nursing profession. The study recommends that health facilities should adopt policies aimed at minimizing violence against nurses to create motivating and safe working environment for nurses.

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

This article chronicles a crisis of alignment regarding Critical Pedagogy due to the top-down power structures of White authority that is pervasive in the theory’s North American academic environment. Contesting the often touted “radical” or “revolutionary” nature of Critical Pedagogy in higher education spaces, the author questions his relationship with Paulo Freire’s work, Pedagogy of the Oppressed, ultimately abandoning the content of writing over the way the theory/philosophy is lived in academia. Through the lived experience of engaging with community in the James Bay Cree territories and Malawi, the question is asked as to who owns Freire’s rebellious call to action.

The accountancy profession subscribes to the values of accountability, integrity, honesty, accuracy among others and that is the reason accountants are required in any field of work to provide an independent report of how the resources are deployed to bring the outcome and assess if indeed the outcome from the use of such resources is as it had been expected by all the stakeholders. This requirement is common to all sectors of the economy, whether in the public or private sector. The paper discusses the changing role of the accountant in the public sector in response to the growing concerns of public resource abuse. Africa, Malawi in particular, has been a victim of gross resource abuse by public officers through among others fraud, corruption, theft and gross mismanagement. Malawi has recently been rated highly in terms of corrupt practices with the public sector taking a leading position leading to gross mismanagement of public resources since the dawn of democracy in 1994. The study takes a look at the changing roles of an accountant in the public sector where the control environment in the financial management system, and the political will of those in charge of the public sector, are not the same as those in the private sector. The accounting weaknesses or challenges as revealed by the reviewed audit reports are scrutinised and the role of the accountant with respect to each challenge is reviewed and recommendations suggested which if implemented, may block the future recurrence of such weaknesses in the financial management systems in the public sector.

Introduction: All surgical procedures have the potential for infection and some of the main sources are contamination from airborne particles, theatre personnel and the theatre environment. There is strong evidence that the use of ultra-clean air flow systems in orthopedic operating theatres reduces the incidence of deep sepsis after surgery. In the developing world however, this is often an unrealistic solution. The aim of this study was to establish baseline levels of contamination in a working orthopedic theatre, at the Queen Elizabeth Central Hospital, Blantyre, Malawi. To feedback results to the theatre team, promote infection prevention discussion and work with the team to implement workable and realistic goals to improve the intra-operative environment. Methodology: Samples were collected from theatre equipment available at the time of surgery, from theatre water and theatre air using passive air sampling techniques. Samples were immediately transferred to the Central Microbiology Laboratory for culture on basic culture media. Results: Bacterial contamination of theatre equipment, intra-operative theatre air and water was detected. Results were discussed with the theatre and infection prevention team who were receptive to feedback with regards to infection prevention strategies and keen to develop simple measures which could be put in place to change practice. Conclusions: In this setting, we suggest that implementing workable and realistic goals such as, establishing baseline rates of bacterial contamination and introduction of strict protocols for asepsis and theatre etiquette, may reduce bacterial contamination rates and subsequent intra-operative infection in the absence of expensive engineering solutions.

Jack Mapanje’s poetry is a true reflection of his society through the use of obscuring devices. These obscuring devices are necessary to ensure that the literary work reaches its intended audience in a totalitarian society. Overall, Jack Mapanje’s poetry exploits creatures from the world of nature—mammals, birds, amphibians, reptiles and insects—for close association with life experiences in various contexts and situations and with people he viewed with contempt and disgust and those he regarded with tenderness and compassion. He utilises them to conceptualize and construct a wide range of ideas that respond to questions of justice, identity and belonging. It all thus becomes part of ecocriticism which is defined by various authors as ‘the study of the relationship between literature and the physical environment’. This eco-critical reading, the use of animal imagery in his poetry makes it stand apart and ahead of other resistance poetry and makes new statements about the relationships between animals, poetry and political resistance in African literature. Mapanje’s poetry is a direct response and a stance of resistance to social injustice, especially the debasement of culture, abuse of power, despotism, oppression and exploitation of the masses by the hegemonic regime of Dr. Hastings in Malawi that leads to his incarceration and final forced flight from his motherland. This paper attempts to showcase the nature of poetic expressions produced in a repressive society.

Purpose The purpose of this paper is to discuss the role of languages and translation in the context of capacity building in NGOs in Kyrgyzstan. It argues that language barriers can impede local capacity building, while translation can help in overcoming some of the issues encountered. Design/methodology/approach The paper reports on what NGO workers have said on the role of languages and translation in their work in 34 semi-structured interviews conducted in Kyrgyzstan in January 2018. The discussion is structured around a theoretical understanding of capacity building at three levels: the organisational level, the individual level and a broader enabling environment. Findings First, the paper demonstrates that knowledge of English plays a key role in accessing international funding and information. Second, it describes the challenges that NGO workers encounter when translating information related to development into Russian and Kyrgyz. Third, it argues that donors do not overtly consider the important role of languages. Together, the findings suggest that ignoring the role of languages and translation can have a negative effect on project outcomes and power relationships. Practical implications Policy recommendations for international NGOs and donors drawn from this case study and from comparative case studies on Peru and Malawi have been published in Crack et al. (2018). Originality/value The paper argues that taking the role of languages and translation into account can result in a more in-depth understanding of aspects that may contribute to better local capacity building.

Doctors are scarce in Malawi and, therefore, a considerable amount of work is carried out by paramedical clinical officers (COs). Although their training is limited, they take care of the majority of patients in the country. The CO project started in the Southern region of Malawi in 2005 in order to improve the number of surgical and gynaecological operations and skills of COs. Nine district hospitals and eight Christian Health Organisation of Malawi (CHAM) hospitals were visited and all surgical registers from 2004 and 2007 were analysed and COs were interviewed. The interviewed COs felt at ease when performing operations; in 2004 they performed 61% and in 2007 87% of the surgical and gynaecological procedures itemised in the questionnaire. In 2004 a total of 18,524 operations were registered in the 17 hospitals in the Southern region of Malawi and there were 19,644 in 2007. Certified COs performed significantly more surgical than gynaecological operations. In 2004, 8.4% of their performed operations consisted of major surgical operations and 17.7% in 2007. A two-year postgraduate training in surgery is being developed for them but, in the meantime, it will be necessary to ensure a continuation of the CO project in the central and northern regions of Malawi.

SummaryThis study investigates current contraceptive use among Malawi couples. The data examined are from the 2001 Malawi Diffusion and Ideational Change Project (MDICP). The aim of the study is to explore whether contraceptive use among married couples is affected by the couple's concerns about HIV/AIDS and couple's age difference. Contraceptive use was found to be associated with the couple's HIV concern and family planning goals. There is no significant association between spousal age difference and contraceptive use. The findings are important for future work on the connection of marital concerns about HIV/AIDS with contraceptive behaviours, especially the use of condoms, and for informing HIV preventive strategies in marriage.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/Principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/Significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.

This paper forms part of the results of the ongoing doctoral thesis with the title Resilience and intellectual disability in residential environments using life stories. From a narrative and inclusive biographical approach, we delve deeper into the life history of four people who have been diagnosed with intellectual disability and who live in a residential environment in the city of Malaga (Spain). The field work was carried out using semi-structured and in-depth biographical interviews. The analysis reveals one of the conceptions that is a priority in this paper: the “social image” of disability, structured in three main areas for the purposes of this article: “the image of disability from social culture and identity”, “the image of disability from close contexts” and, lastly, “subversive experiences to the image of disability from inside”. In conclusion, there is a commitment to continue generating another social image of disability based on a more social and inclusive paradigm.

Lack of social support and sex work stigma may hinder STI/HIV prevention for female sex workers (FSW). We explored the associations between sex work stigma and social support with sexual behaviors in Malawi. In 2017, 150 HIV-negative, venue-based FSW completed a behavioral survey containing sex work stigma items and social support. Linear binomial regression models were used to estimate prevalence differences of inconsistent condom use and substance use before sex by social support and stigma. A majority (93%) reported sex work–related internalized stigma. About 50% reported family or friend isolation. Social support was high (mean index: 86.53). Inconsistent condom use and substance use before sex had little to no association with stigma and social support. Malawian FSW largely internalize stigma and experience isolation from family and friends yet have high levels of social support. Large-scale evaluations should investigate the role of stigma and social support in STI/HIV prevention for FSW.

Hygiene plays a key role in tipping the balance towards reduction of diarrhoeal and other infectious diseases. Yet it has often been overlooked, positioned as a “supporting rider” of water supply and sanitation services, or narrowly understood as handwashing. By focusing on handwashing infrastructure as proposed for the monitoring of Sustainable Development Goal (SDG) 6, development actors might miss the opportunity of capturing hygiene practices that are socially embedded and can act as a catalyst for change and risk reduction. We develop this argument by presenting an in-depth examination of hygiene practices in a low-income neighbourhood of Lilongwe, Malawi. Despite the high poverty levels and the constant water shortages in the area, a number of water-intensive hygiene practices are consistently carried out, proving that hygiene is central to residents’ everyday lives. Development projects should start by identifying these practices and by reflecting on the extent that these already work or can be made to work for reducing health-related risks.

ABSTRACT:We examined the role of the environment in the development of Parkinson's disease (PD). A group of 42 parkinsonians have been compared with a group of 84 matched controls. The epidemiological study (1987-1989) covered the territory of the Community Health Department of Valleyfield, in southern Quebec (Canada). Odds ratio adjusted for age and sex were calculated for seven environmental factors. A decreased risk for PD was associated with residence in rural areas (OR: 0.31; p ≤ 0.05) and residence near industry or mining (OR: 0.15; p ≤ 0.05). An increased risk for PD seems to be associated with occupational exposure to the three metals Mn, Fe and Al (OR: 2.28; p = 0.07) especially when the duration of exposure is longer than 30 years (OR: 13.64; p ≤ 0.05). Other environmental factors not found to be associated with PD were: pesticides manipulation, farm work, industrial work and well water consumption.

Training university students so that they become professionals who will promote an improvement in the relationship between socio-economic activity and the environment is one of the main challenges in higher education. Thus, it is important to evaluate the Environmental Education Programmes offered by public institutions to the university community. The objective of this research is to assess the impact of the ‘Red Andalucia Ecocampus University of Malaga’ Programme in relation to the involvement of the university community in the environmental sustainability of its setting. A mixed methods design was used. Research participants included teachers, students and administrative and service staff at different research and training centres of the University of Malaga (n = 387). The results in this research work reveal that this Programme has an effective methodological design when it comes to acquiring concepts and strengthening environmental values in the university community.
 Keywords: Environmental education, programme evaluation, sustainability, higher education.

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

In Bantul, Yogyakarta Special Region there have been reported 6 elephantiasis cases and ware suspected as filariasis. Elephantiasis is classified into two, namely filarial elephantiasis and nonfilarial elephantiasis. Filarial elephantiasis caused by lymphatic filarial worms infection and nonfilarial elephantiasis can be caused by podoconiosis, leprosy, tuberculosis, or chlamydia infection. The aim of the study was to ascertain whether elephantiasis cases are caused by filariasis. Activities carried out in the work area of the Bantul District Health Office in July 2016 i.e.: (1) patient location survey, (2) interviews with patients, their families, and surrounding communities, (3) examination of patients, and (4) observe the environment around the patient's residence to ensure existence of vector mosquito breeding places. This study found two people with elephantiasis, patients from Depok, Gilangharjo, Pandak, Bantul was suspected elephantiasis due to Brugia malayi infection. Patient from Cawan, Argodadi, Sedayu, Bantul was suspected elephantiasis due to podoconiosis. In Cawan found many breeding sites for the Anopheles vagus mosquito.

Gender mainstreaming in the water sector in Malawi was analyzed using the Mzimba Integrated Rural Water Supply and Sanitation (IRWSS) project as a case in point. Information required for the study was obtained through interviews, administering a set of questionnaires and data collecting from existing documents. The results show that women in decision-making positions at head office of the Ministry responsible for water affairs only constitute about 11.1%. Assessment of the budget allocations has revealed that previously no budgetary allocations were made for gender issues, and that since the 2006/07 fiscal year about US$14,286 was allocated for gender mainstreaming. Women's involvement in local governance institutions and project activities in Mzimba is generally high. Most local water committees have 60% women and 40% men, whereas participation in project activities is highly rated at 97.2%. To improve gender balance, the Ministry responsible for water has to work with stakeholders in the education sector. Besides, great disparities still exist between men's and women's participation in water projects at a local level (97.2% for women) and a person's socioeconomic position greatly affects their inclusion in the local governance structures. Addressing these issues would, therefore, result in better gender integration in the water sector.

Filariasis is a chronic infectious disease caused by filarial worms and transmitted by Mansonia, Anopheles, Culex, Armigeres mosquitoes. Living microfilariae are channeled and lymph nodes and cause inflammation of lymph node channels. This disease is one of the serious public health problems in Indonesia. Almost all regions of Indonesia are filariasis-endemic areas, especially in Eastern Indonesia which has a higher prevalence. The purpose of this study was to determine the factors associated with the incidence of filariasis in Pota District, East Manggarai Regency in 2016. The location of this study was carried out in Pota Subdistrict, East Manggarai Regency, with sampling in 4 villages conducted for approximately 2 months, namely in September to October 2016. This study used a descriptive survey method and finger blood survey to see the description of physical environmental factors and behavior of the head of the family in filariasis disease and type of microfilariae. Independent variables (free), which are included in this variable are environmental factors and behavior of the family head with indications of the physical environment (temperature, humidity, place of breeding of family mosquitoes and mosquito resting places) and the behavior of the head of the family which consists of knowledge and attitudes (knowledge of disease Filariasis: Dependent variable (bound) or variable Y which is expected to experience changes due to the influence of independent variables included in this variable is the incidence of Filariasis Disease. The population in this study were all family heads in Pota District, totaling 4570 populations, with Sampling technique is proportionally 154. Data is processed and analyzed descriptively presented in the form of frequency distribution tables of each independent variable with a 95% confidence level (α = 0.05). The results of this study indicate that the four factors include environment, work, Air humidity, per Night effects significantly have a risk of filariasis transmission (p> 0.05). Of the various species found two types of filariasis species namely Wuchereria Bancrofti and Brugia malayi. The conclusion from the results of this study can be concluded that the incidence of filariasis in Sambi Rampas subdistrict, East Manggarai Regency was caused by environmental factors, occupation, air humidity, human behavior and all blood survey samples found (100%) positive for filariasis Wuchereria Bancrofti and Brugia Malayi.

The urban population, worldwide, is growing exponentially and with it the demand for information on pollution levels, vehicle traffic, or available parking, giving rise to citizens connected to their environment. This article presents an experimental long range (LoRa) and low power consumption network, with a combination of static and mobile wireless sensors (hybrid architecture) to tune and validate concentrator placement, to obtain a large coverage in an urban environment. A mobile node has been used, carrying a gateway and various sensors. The Activation By Personalization (ABP) mode has been used, justified for urban applications requiring multicasting. This allows to compare the coverage of each static gateway, being able to make practical decisions about its location. With this methodology, it has been possible to provide service to the city of Malaga, through a single concentrator node. The information acquired is synchronized in an external database, to monitor the data in real time, being able to geolocate the dataframes through web mapping services. This work presents the development and implementation of a hybrid wireless sensor network of long range and low power, configured and tuned to achieve efficient performance in a mid-size city, and tested in experiments in a real urban environment.

Abstract For fecal sludge from households in low- and middle-income countries to be treated offsite it needs to be removed, which can be greatly affected by the pit latrine floor design. However, it is unclear whether precast pit latrine concrete floors (latrine slabs) can withstand emptiers and their equipment. To investigate this issue, 28 prefabricated latrine slabs were purchased in two cities of Malawi. They were first visually evaluated, and then their compression strength was tested. Additionally, each seller was asked a series of questions to better understand their business, training, and construction practices. Results showed that households should perform due diligence to ensure that they are purchasing a safe precast latrine slab. Commonly reported problems included nonstandard reinforcement material and spacing, in addition to slabs that were not thick enough or were not large enough in diameter. The results of this research illustrate the inherent complexity in ensuring high-quality decentralized sanitation solutions and how one component, the user interface, if implemented poorly, can affect the rest of the value chain. The findings from this work can help inform training and initiatives that engage artisans and suppliers who play a role in the provision of onsite sanitation service delivery.

Ecology is a study that transcends disciplinary boundaries. It has roots in the sciences but enjoys a number of representations in the humanities, specifically through literature. Several African writers have in their imaginative works, portrayed the devastating condition of the environment in a 21st century technological-driven world and also proposed solutions to this malady. In fact, environmental degradation has become a global issue, hence, the pressing need for a lasting panacea. Attempts at literary ecocriticism in Nigerian literature have largely focused on prose fictional works and the poetry collections of older and second generation poets like Tanure Ojaide. Consequently, little research has been carried out on the representation of environmental degradation in the poetry of more contemporary poets like Ibiwari Ikiriko and Albert Otto. This paper therefore, is a critical, close reading of Ikiriko and Otto’s poetry engagement with environmental degradation. The paper adopts the notion of ecopoetry from the ecocritical theory, which accounts for poetry foregrounding questions of ethics in relation to the environment. It acts as a reminder to humans of their responsibility towards the earth and challenges the existing status-quo that has the environment and the common people at the mercy of the ruling class. In this paper, Ikiriko’s Oily Tears of the Delta and Otto’s Letter from the Earth are subjected to literary and critical analysis to examine their preoccupation with the destructive onslaught on nature, and the traumatic experiences of the marginalised. Amidst the environmental depredation, the poets express hope and revolutionary fervour towards the rejuvenation of their society.

<p class="Textoindependiente21">This work presents a mentoring program for first year engineering students in the Telecommunications Engineering College (ETSIT) at the University of Malaga (UMA). Actors involved in the program are professors from staff, veterans mentoring students and, of course, freshmen. All of them has been organized trough the Moodle based Virtual Learning Environment Platform of the UMA. The program has gone through several phases over three years. This paper shows the main objectives of this mentoring program, the initial design to get them where professors played mentor role, and successive changes made to try to improve the results, including the assumption of the mentor role by senior students (peer mentoring). The tools used for program evaluation are shown too. Despite the low participation, it has been a framework for the development of various educational and socializing activities (for mentors and mentees) focused on developing generic competences. Furthermore, it has been a research tool to get a better understanding of problems affecting students newly enrolled.</p>

People pursue scientific study to learn about the riddle of the world we live. Assuming that the ontological vocation of the academic profession is to transform the world for better living, economics as a scientific discipline will have to develop theories and tools to understand social reality and work towards its creative transformation. This article tries to argue that mainstream economics that reduces social life into exchange value calculus or mathematical formalism rules out such a process of building a better society. It has dismissed vital issues like structural inequalities, social injustices and the like as central issues of development economics. This may be seen as an effort to draw attention towards rethinking the domain of the discipline of economics and set its epistemological foundation on a more relevant footing.

Over the past 30 years, information technology has gradually transformed the way health care is provisioned for patients. Chronic Obstructive Pulmonary Disease (COPD) is an incurable malady that threatens the lives of millions around the world. The huge amount of medical information in terms of complex interdependence between progression of health problems and various other factors makes the representation of data more challenging. This study investigated how formal semantic standards could be used for building an ontology knowledge repository to provide ubiquitous healthcare and medical recommendations for COPD patient to reduce preventable harm. The novel contribution of the suggested framework resides in the patient-centered monitoring approach, as we work to create dynamic adaptive protection services according to the current context of patient. This work executes a sequential modular approach consisting of patient, disease, location, devices, activities, environment and services to deliver personalized real-time medical care for COPD patients. The main benefits of this project are: (1) adhering to dynamic safe boundaries for the vital signs, which may vary depending on multiple factors; (2) assessing environmental risk factors; and (3) evaluating the patient’s daily activities through scheduled events to avoid potentially dangerous situations. This solution implements an interrelated set of ontologies with a logical base of Semantic Web Rule Language (SWRL) rules derived from the medical guidelines and expert pneumologists to handle all contextual situations.

A split infinitive construction denotes a type of syntactic tmesis in which a word or a phrase, especially an adverb, occurs between the infinitive marker to and the verb. The early instances of the split infinitive in English date back to the 13th century, when a personal pronoun, an adverb or two or more words could appear in such environments (Visser 1963-1973 II: 1038-1045). This paper investigates the split infinitive in Middle English with the following objectives: a) to trace the origin and development of the construction; b) to analyse the nature of the splitting adverb in terms of its etymology and lexico-grammatical features; and c) to examine the prosodic patterns contributing to the acceptance of particular splitting combinations. The source of evidence comes from the following corpora: Helsinki Corpus of English Texts, Innsbruck Corpus of Middle English Prose, Penn-Parsed Corpora of Historical English, Middle English Medical Texts, Middle English Grammar Corpus, and the Malaga Corpus of Late Middle English Scientific Prose.

Restoring interlocking forest-agricultural landscapes—forest-agricscapes—to sustainably supply ecosystem services for socio-ecological well-being is one of Malawi’s priorities. Engaging local farmers is crucial in implementing restoration schemes. While farmers’ land-use decisions shape land-use/cover and changes (LUCC) and ecological conditions, why and how they decide to embrace restoration activities is poorly understood and neglected in forest-agricscape restoration. We analyze the nature of farmers’ restoration decisions, both individually and collectively, in Central Malawi using a mixed-method analysis. We characterize, qualitatively and quantitatively, the underlying contextual rationales, motives, benefits, and incentives. Identified decision-making rules reflect diverse and nuanced goal frames of relative importance that are featured in various combinations. We categorize the decision-making rules as: problem-solving oriented, resource/material-constrained, benefits-oriented, incentive-based, peers/leaders-influenced, knowledge/skill-dependent, altruistic-oriented, rules/norms-constrained, economic capacity-dependent, awareness-dependent, and risk averse-oriented. We link them with the corresponding vegetation- and non-vegetation-based restoration practices to depict the overall decision-making processes. Findings advance the representation of farmers’ decision rules and behavioral responses in computational agent-based modeling (ABM), through the decomposition of empirical data. The approach used can inform other modeling works attempting to better capture social actors’ decision rules. Such LUCC-ABMs are valuable for exploring spatially explicit outcomes of restoration investments by modeling such decision-making processes and policy scenarios.

This paper addresses the relationship between land use and mobility patterns. Since each particular zone directly feeds the global mobility once acting as origin of trips and others as destination, both roles are simultaneously used for predicting land uses. Specifically this investigation uses mobility data derived from mobile phones, a technology that emerges as a useful, quick data source on people’s daily mobility, collected during two weeks over the urban area of Malaga (Spain). This allows exploring the relevance of integrating weekday-weekend trip information to better determine the category of land use. First, this work classifies patterns on trips originated and terminated in each zone into groups by means of a clustering approach. Based on identifiable relationships between activity and times when travel peaks appear, a preliminary categorization of uses is provided. Then, both grouping results are used as input variables in a K-nearest neighbors (KNN) classification model to determine the exact land use. The KNN method assumes that the category of an object must be similar to the category of the closest neighbors. After training the models, the findings reveal that this approach provides a precise land use categorization, yielding the best accuracy results for the major categories of land uses in the studied area. Moreover, as a result, the weekend data certainly contributes to finding more precise land uses as those obtained by just weekday data. In particular, the percentage of correctly predicted categories using both weekday and weekend is around 80%, while just weekday data reach 67%. The comparison with actual land uses also demonstrates that this approach is able to provide useful information, identifying zones with a specific clear dominant use (residential, industrial, and commercial), as well as multiactivity zones (mixed). This fact is especially useful in the context of urban environments where multiple activities coexist.

Abstract CRIMINOLOGICAL AND PSYCHIATRIC STUDIES IN JAPAN Criminological development in Japan is largely the work of the Japanese Association of Criminology, founded in Tokyo in 1913. The year 1935 saw the debut of the publication Acta criminologia?: et medicinee legalis japonica. After an interruption of several years caused by the second world war, society made great strides, and important research could then be undertaken. There are now three State institutes of criminology in Japan: the General Research Institute of Forensic Medicine at the Tokyo University of Medicine and Dentistry, the Institute of Research, Practical and Clinical Training at the Ministry of Justice, and the Institute of Encephalographie Research of the University of Tokyo. Among the most important criminological and psychiatric research projects are: 1) Study of twins: Led by Yoshimasu, this could be considered as one of the most brilliant contributions of Japanese criminology to science. It is based on the rate of concordance between homozygotic and heterozygotic twins. For a clearer understanding of the phenomenon of concordance between the two partners, Yoshimasu used the following factors: age at first offence, age at the time of research, and number of relapses. The results of his analysis show a lesser rate of agreement than that of foreign studies, nevertheless this rate increased perceptibly after the second world war, which is explained by the influence of environment. 2) Research on recidivism by means of analysis of the life curve: In 1951, Yoshimasu discovered a new method for analyzing the criminal careers of recidivists (this method is defined in English as «the criminal life curve» and in German, die kriminelle Lebenskurve). It comprises three indices: a) age at the time of first offence: before or after 25 years; b) the type of offence: classified in accordance with the kind of crime, the sequence of crime and the kinds of crimes committed during any one episode, i.e. one, the same or different; c) interval between the offences: sequence, remission, intermission, suspension. Later on, various studies were added to this research. 3) Characteristics of various crimes: The studies undertaken dealt with homicidal women, homicidal girls, mass murderers (Massenmo'rder). These studies showed interesting results, because there is an intimate relationship between patricide and the family environment in the traditional Japanese atmosphere. Other researchers were interested in arsonists, sex criminals, persistent embezzlers, recidivists in crimes of violence. 4) Research on juvenile delinquency: In this field, Japan may well be proud of having several pioneers. We stressed the importance of the psychopathic personality, as much as the sheer asymmetry of psychic and physical maturity. 5) Criminality of the mentally disturbed with encephalitis due to anti-rabies vaccination: Studies undertaken after the massacre of 12 employees of the Teikoku Bank of Tokyo revealed that subjects suffering from this malady have a deviated personality of a mythomanie type with Korsakov's syndrome. Other studies show a seat of demyelinized fibres. Treatment could thus be applied to effectively fight this illness. 6) Amphetamine drug addiction and criminality: This problem took on the dimensions of a national crisis after the second world war, when amphetamine drug addiction rose to 200 000. The work undertaken on this problem revealed psychopathic personalities characterized by hyperthymic tendencies, hysterics, explosiveness or instability, as explained by Kurt Schneider. 7) Reactions to penal institutions and disciplinary infractions: With regard to these, a new method called infractiologie was used. It is concerned with the actual relationship which exists between crimes committed in society and infractions committed within the penal institution.

In Africa, the natural history of SCD is often assumed to be same to the African Diaspora in the US, Jamaica, Europe or Latin America. Yet the environment can be different, including different pathogen exposure, such as malaria. To help better understand this, over 2000 references were identified using the names of all current or past names of African continent countries and the truncated word sickl$, followed by secondary nested and cross reference searches. Six cases series describing causes of death were identified, representing 182 children (Ndugwa, 1973, Athale, 1994, Koko, 1998, Diagne, 2000, Rahimy, 2003, Van-Dunem, 2007). Gender was reported in 172, 73 were female (42%). Age was reported in 118, 52 were < 5 years (44%). Four studies described some impediment to care or arrival for care in extremis in1/4 to over ½ of patients that died. In Uganda, 9/12 (75%) patient died at home. In Gabon 6/23 (26%) patients died within 4 hours of reaching the hospital and 11/23 (48%) within 24 hours. In Benin 2/10 (20%) died of splenic sequestration diagnosed at home; 38/64 (53%) of patients in Mozambique that died, lived outside of the capital. Causes of death were identified in 146 individuals. These included: fever/sepsis: n=59 (40%), including meningitis: n=15 (10%) and pyelonephritis: n=2 (1%); acute anemia: n=43 (29%), including spleen sequestration: n=28 (19%) and aplastic anemia: n=8 (5%); pain: n=22 (15%); acute chest syndrome/pneumonia: n=18 (12%); CNS: n=8 (5%), including stroke: n=4 (3%), seizure/ coma: n=5 (3%); liver disease: n=5 (3%) including hepatitis: n=3 (2%); Other: n=19 (13%) including wasting/ malnutrition: n=7 (5%), heart failure/cardiomyopathy: n=4 (3%), diarrhea and vomiting: n=3 (2%), transfusion reaction: n=2 (1%). Infectious pathogens were identified in 26, including malaria: n=10 (38%), S. pneumoniae: n=3 (12%), Salmonella: n=2 (8%), H. influenza, Klebsiella and Citrobacter: n=1 (4%) each; viral agents were reported in n=8 (31%) including HBV: n=5 (19%), HIV: n=3 (12%). Reported general population hemoglobinopathy surveys after birth revealed the following Relative Risk (RR) of observing individuals with hemoglobin SS compared to Hardy Weinberg expected frequencies (some age cohorts overlap; Tanzania '56, Benin '09, Burkina Faso '70, Central African Republic'75, Gabon'65/'80, Gambia'56, Ghana '56/‘57/'00/'10, Kenya '04/'10, Malawi '72/'00/'04, Mozambique '86, Nigeria '56/'70/'79/'81/'84/'05, Senegal '69, Sierra Leone '56). Age 0-1 years, total n=2112 observed n=22 (1.0%), expected n=16.5 (0.8%), RR=1.3 (95% CI=0.7,2.5), p=0.441. Age 0-6 years, total n=4078; observed n=39 (1.0%); expected n=40.6 (1.0%); RR=1.0 (95% CI=0.6,1.5), p=0.925. Age 5-19 years, total n=1880; observed n= 5 (0.3%); expected n= 24.8 (1.3%); RR=0.2 (95% CI=0.1,0.5); p<0.001. Adults, total n=12814; observed n= 20 (0.2%); expected n= 118.9 (0.9%); RR=0.2 (95% CI=0.1,0.3), p<0.001. Pregnant, total n=5815; observed n= 19 (0.3%); expected n= 78.5 (1.3%), RR=0.2 (95% CI=0.1,0.4), p<0.001. Cohorts of children with SCD are indicated in the table. In summary, access to care, as well as acute anemias are a frequent cause of mortality. Along with viral pathogens and transfusion related deaths this indicates the importance of a safe blood supply. By adulthood, the observed frequency of individuals with SCD is only 1/5 of expected. However, reported clinic cohorts suggest similar if not better survival than in the general population, possibly due to lost to follow up, but also malaria/bacterial infection prevention and nutritional support. Careful prospective studies are needed.TableCohorts of children in Africa with Sickle Cell AnemiaCountryAge median years, (range)Death/TotalnFollow up yearsPatient-yearsDeaths/100 patient-yearsU5M/100 child-yrs♦Uganda, 735 -9, (0-20)12/6282--2.7Senegal, ‘008 (0-22)11/323710331.12.2Senegal, 03330/55612--2.2Benin,032.910/2361.5-6.59831.02.4Kenya,096 (0-13)2/1241.21181.72.7♦: Under five year old mortality 2009 (source: Unicef), divided by 5Prophylactic interventions: Uganda: chloroquine; Senegal: chloroquine (wet season), nets, penicillin prophylaxis <5 yrs, folic acid, parasite treatment & iron supplement as needed; Benin: chloroquine, nets, penicillin prophylaxis, antibiotics for fever, folic acid, nutritional support; Kenya; Proguanil, folic acid, nutritional support, parasite treatment & iron supplement as needed. Disclosures: No relevant conflicts of interest to declare.

Education in Oceania continues to reflect the embedded implicit and explicit colonial practices and processes from the past. This paper conceptualises a cultural approach to education and leadership appropriate and relevant to the Republic of the Marshall Islands. As elementary school leaders, we highlight Kanne Lobal, a traditional Marshallese navigation practice based on indigenous language, values and practices. We conceptualise and develop Kanne Lobal in this paper as a framework for understanding the usefulness of our indigenous knowledge in leadership and educational practices within formal education. Through bwebwenato, a method of talk story, our key learnings and reflexivities were captured. We argue that realising the value of Marshallese indigenous knowledge and practices for school leaders requires purposeful training of the ways in which our knowledge can be made useful in our professional educational responsibilities. Drawing from our Marshallese knowledge is an intentional effort to inspire, empower and express what education and leadership partnership means for Marshallese people, as articulated by Marshallese themselves. 
 
 
 
 Introduction
 As noted in the call for papers within the Waikato Journal of Education (WJE) for this special issue, bodies of knowledge and histories in Oceania have long sustained generations across geographic boundaries to ensure cultural survival. For Marshallese people, we cannot really know ourselves “until we know how we came to be where we are today” (Walsh, Heine, Bigler & Stege, 2012). Jitdam Kapeel is a popular Marshallese concept and ideal associated with inquiring into relationships within the family and community. In a similar way, the practice of relating is about connecting the present and future to the past. Education and leadership partnerships are linked and we look back to the past, our history, to make sense and feel inspired to transform practices that will benefit our people. In this paper and in light of our next generation, we reconnect with our navigation stories to inspire and empower education and leadership. Kanne lobal is part of our navigation stories, a conceptual framework centred on cultural practices, values, and concepts that embrace collective partnerships. Our link to this talanoa vā with others in the special issue is to attempt to make sense of connections given the global COVID-19 context by providing a Marshallese approach to address the physical and relational “distance” between education and leadership partnerships in Oceania. 
 
 Like the majority of developing small island nations in Oceania, the Republic of the Marshall Islands (RMI) has had its share of educational challenges through colonial legacies of the past which continues to drive education systems in the region (Heine, 2002). The historical administration and education in the RMI is one of colonisation. Successive administrations by the Spanish, German, Japanese, and now the US, has resulted in education and learning that privileges western knowledge and forms of learning. This paper foregrounds understandings of education and learning as told by the voices of elementary school leaders from the RMI. The move to re-think education and leadership from Marshallese perspectives is an act of shifting the focus of bwebwenato or conversations that centres on Marshallese language and worldviews. 
 
 The concept of jelalokjen was conceptualised as traditional education framed mainly within the community context. In the past, jelalokjen was practiced and transmitted to the younger generation for cultural continuity. During the arrival of colonial administrations into the RMI, jelalokjen was likened to the western notions of education and schooling (Kupferman, 2004). Today, the primary function of jelalokjen, as traditional and formal education, it is for “survival in a hostile [and challenging] environment” (Kupferman, 2004, p. 43).
 
 Because western approaches to learning in the RMI have not always resulted in positive outcomes for those engaged within the education system, as school leaders who value our cultural knowledge and practices, and aspire to maintain our language with the next generation, we turn to Kanne Lobal, a practice embedded in our navigation stories, collective aspirations, and leadership. The significance in the development of Kanne Lobal, as an appropriate framework for education and leadership, resulted in us coming together and working together. Not only were we able to share our leadership concerns, however, the engagement strengthened our connections with each other as school leaders, our communities, and the Public Schooling System (PSS). Prior to that, many of us were in competition for resources.
 
 Educational Leadership: IQBE and GCSL
 Leadership is a valued practice in the RMI. Before the IQBE programme started in 2018, the majority of the school leaders on the main island of Majuro had not engaged in collaborative partnerships with each other before. Our main educational purpose was to achieve accreditation from the Western Association of Schools and Colleges (WASC), an accreditation commission for schools in the United States. The WASC accreditation dictated our work and relationships and many school leaders on Majuro felt the pressure of competition against each other. We, the authors in this paper, share our collective bwebwenato, highlighting our school leadership experiences and how we gained strength from our own ancestral knowledge to empower “us”, to collaborate with each other, our teachers, communities, as well as with PSS; a collaborative partnership we had not realised in the past. The paucity of literature that captures Kajin Majol (Marshallese language) and education in general in the RMI is what we intend to fill by sharing our reflections and experiences. To move our educational practices forward we highlight Kanne Lobal, a cultural approach that focuses on our strengths, collective social responsibilities and wellbeing.
 
 For a long time, there was no formal training in place for elementary school leaders. School principals and vice principals were appointed primarily on their academic merit through having an undergraduate qualification. As part of the first cohort of fifteen school leaders, we engaged in the professional training programme, the Graduate Certificate in School Leadership (GCSL), refitted to our context after its initial development in the Solomon Islands. GCSL was coordinated by the Institute of Education (IOE) at the University of the South Pacific (USP). GCSL was seen as a relevant and appropriate training programme for school leaders in the RMI as part of an Asia Development Bank (ADB) funded programme which aimed at “Improving Quality Basic Education” (IQBE) in parts of the northern Pacific. GCSL was managed on Majuro, RMI’s main island, by the director at the time Dr Irene Taafaki, coordinator Yolanda McKay, and administrators at the University of the South Pacific’s (USP) RMI campus.
 
 Through the provision of GCSL, as school leaders we were encouraged to re-think and draw-from our own cultural repository and connect to our ancestral knowledge that have always provided strength for us. This kind of thinking and practice was encouraged by our educational leaders (Heine, 2002). We argue that a culturally-affirming and culturally-contextual framework that reflects the lived experiences of Marshallese people is much needed and enables the disruption of inherent colonial processes left behind by Western and Eastern administrations which have influenced our education system in the RMI (Heine, 2002). Kanne Lobal, an approach utilising a traditional navigation has warranted its need to provide solutions for today’s educational challenges for us in the RMI.
 Education in the Pacific
 Education in the Pacific cannot be understood without contextualising it in its history and culture. It is the same for us in the RMI (Heine, 2002; Walsh et al., 2012). The RMI is located in the Pacific Ocean and is part of Micronesia. It was named after a British captain, John Marshall in the 1700s. The atolls in the RMI were explored by the Spanish in the 16th century. Germany unsuccessfully attempted to colonize the islands in 1885. Japan took control in 1914, but after several battles during World War II, the US seized the RMI from them. In 1947, the United Nations made the island group, along with the Mariana and Caroline archipelagos, a U.S. trust territory (Walsh et al, 2012). Education in the RMI reflects the colonial administrations of Germany, Japan, and now the US. 
 
 Before the turn of the century, formal education in the Pacific reflected western values, practices, and standards. Prior to that, education was informal and not binded to formal learning institutions (Thaman, 1997) and oral traditions was used as the medium for transmitting learning about customs and practices living with parents, grandparents, great grandparents. As alluded to by Jiba B. Kabua (2004), any “discussion about education is necessarily a discussion of culture, and any policy on education is also a policy of culture” (p. 181). It is impossible to promote one without the other, and it is not logical to understand one without the other. Re-thinking how education should look like, the pedagogical strategies that are relevant in our classrooms, the ways to engage with our parents and communities - such re-thinking sits within our cultural approaches and frameworks. Our collective attempts to provide a cultural framework that is relevant and appropriate for education in our context, sits within the political endeavour to decolonize. This means that what we are providing will not only be useful, but it can be used as a tool to question and identify whether things in place restrict and prevent our culture or whether they promote and foreground cultural ideas and concepts, a significant discussion of culture linked to education (Kabua, 2004). 
 
 Donor funded development aid programmes were provided to support the challenges within education systems. Concerned with the persistent low educational outcomes of Pacific students, despite the prevalence of aid programmes in the region, in 2000 Pacific educators and leaders with support from New Zealand Aid (NZ Aid) decided to intervene (Heine, 2002; Taufe’ulungaki, 2014). In April 2001, a group of Pacific educators and leaders across the region were invited to a colloquium funded by the New Zealand Overseas Development Agency held in Suva Fiji at the University of the South Pacific. The main purpose of the colloquium was to enable “Pacific educators to re-think the values, assumptions and beliefs underlying [formal] schooling in Oceania” (Benson, 2002). 
 
 Leadership, in general, is a valued practice in the RMI (Heine, 2002). Despite education leadership being identified as a significant factor in school improvement (Sanga & Chu, 2009), the limited formal training opportunities of school principals in the region was a persistent concern. As part of an Asia Development Bank (ADB) funded project, the Improve Quality Basic Education (IQBE) intervention was developed and implemented in the RMI in 2017. Mentoring is a process associated with the continuity and sustainability of leadership knowledge and practices (Sanga & Chu, 2009). It is a key aspect of building capacity and capabilities within human resources in education (ibid).
 Indigenous knowledges and education research
 According to Hilda Heine, the relationship between education and leadership is about understanding Marshallese history and culture (cited in Walsh et al., 2012). It is about sharing indigenous knowledge and histories that “details for future generations a story of survival and resilience and the pride we possess as a people” (Heine, cited in Walsh et al., 2012, p. v). This paper is fuelled by postcolonial aspirations yet is grounded in Pacific indigenous research. This means that our intentions are driven by postcolonial pursuits and discourses linked to challenging the colonial systems and schooling in the Pacific region that privileges western knowledge and learning and marginalises the education practices and processes of local people (Thiong’o, 1986). A point of difference and orientation from postcolonialism is a desire to foreground indigenous Pacific language, specifically Majin Majol, through Marshallese concepts. Our collective bwebwenato and conversation honours and values kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness) (Taafaki & Fowler, 2019). 
 
 Pacific leaders developed the Rethinking Pacific Education Initiative for and by Pacific People (RPEIPP) in 2002 to take control of the ways in which education research was conducted by donor funded organisations (Taufe’ulungaki, 2014). Our former president, Dr Hilda Heine was part of the group of leaders who sought to counter the ways in which our educational and leadership stories were controlled and told by non-Marshallese (Heine, 2002). As a former minister of education in the RMI, Hilda Heine continues to inspire and encourage the next generation of educators, school leaders, and researchers to re-think and de-construct the way learning and education is conceptualised for Marshallese people. The conceptualisation of Kanne Lobal acknowledges its origin, grounded in Marshallese navigation knowledge and practice. Our decision to unpack and deconstruct Kanne Lobal within the context of formal education and leadership responds to the need to not only draw from indigenous Marshallese ideas and practice but to consider that the next generation will continue to be educated using western processes and initiatives particularly from the US where we get a lot of our funding from. 
 
 According to indigenous researchers Dawn Bessarab and Bridget Ng’andu (2010), doing research that considers “culturally appropriate processes to engage with indigenous groups and individuals is particularly pertinent in today’s research environment” (p. 37). Pacific indigenous educators and researchers have turned to their own ancestral knowledge and practices for inspiration and empowerment. Within western research contexts, the often stringent ideals and processes are not always encouraging of indigenous methods and practices. However, many were able to ground and articulate their use of indigenous methods as being relevant and appropriate to capturing the realities of their communities (Nabobo-Baba, 2008; Sualii-Sauni & Fulu-Aiolupotea, 2014; Thaman, 1997). At the same time, utilising Pacific indigenous methods and approaches enabled research engagement with their communities that honoured and respected them and their communities. For example, Tongan, Samoan, and Fijian researchers used the talanoa method as a way to capture the stories, lived realities, and worldviews of their communities within education in the diaspora (Fa’avae, Jones, & Manu’atu, 2016; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014; Vaioleti, 2005). Tok stori was used by Solomon Islander educators and school leaders to highlight the unique circles of conversational practice and storytelling that leads to more positive engagement with their community members, capturing rich and meaningful narratives as a result (Sanga & Houma, 2004). 
 
 The Indigenous Aborigine in Australia utilise yarning as a “relaxed discussion through which both the researcher and participant journey together visiting places and topics of interest relevant” (Bessarab & Ng’andu, 2010, p. 38). Despite the diverse forms of discussions and storytelling by indigenous peoples, of significance are the cultural protocols, ethics, and language for conducting and guiding the engagement (Bessarab & Ng’andu, 2010; Nabobo-Baba, 2008; Sualii-Sauni & Aiolupotea, 2014). Through the ethics, values, protocols, and language, these are what makes indigenous methods or frameworks unique compared to western methods like in-depth interviews or semi-structured interviews. This is why it is important for us as Marshallese educators to frame, ground, and articulate how our own methods and frameworks of learning could be realised in western education (Heine, 2002; Jetnil-Kijiner, 2014). In this paper, we utilise bwebwenato as an appropriate method linked to “talk story”, capturing our collective stories and experiences during GCSL and how we sought to build partnerships and collaboration with each other, our communities, and the PSS. 
 Bwebwenato and drawing from Kajin Majel
 
 Legends and stories that reflect Marshallese society and its cultural values have survived through our oral traditions. The practice of weaving also holds knowledge about our “valuable and earliest sources of knowledge” (Taafaki & Fowler, 2019, p. 2). The skilful navigation of Marshallese wayfarers on the walap (large canoes) in the ocean is testament of their leadership and the value they place on ensuring the survival and continuity of Marshallese people (Taafaki & Fowler, 2019; Walsh et al., 2012). During her graduate study in 2014, Kathy Jetnil-Kijiner conceptualised bwebwenato as being the most “well-known form of Marshallese orality” (p. 38). The Marshallese-English dictionary defined bwebwenato as talk, conversation, story, history, article, episode, lore, myth, or tale (cited in Jetnil Kijiner, 2014). Three years later in 2017, bwebwenato was utilised in a doctoral project by Natalie Nimmer as a research method to gather “talk stories” about the experiences of 10 Marshallese experts in knowledge and skills ranging from sewing to linguistics, canoe-making and business. 
 
 Our collective bwebwenato in this paper centres on Marshallese ideas and language. The philosophy of Marshallese knowledge is rooted in our “Kajin Majel”, or Marshallese language and is shared and transmitted through our oral traditions. For instance, through our historical stories and myths. Marshallese philosophy, that is, the knowledge systems inherent in our beliefs, values, customs, and practices are shared. They are inherently relational, meaning that knowledge systems and philosophies within our world are connected, in mind, body, and spirit (Jetnil-Kijiner, 2014; Nimmer, 2017). Although some Marshallese believe that our knowledge is disappearing as more and more elders pass away, it is therefore important work together, and learn from each other about the knowledges shared not only by the living but through their lamentations and stories of those who are no longer with us (Jetnil-Kijiner, 2014).
 
 As a Marshallese practice, weaving has been passed-down from generation to generation. Although the art of weaving is no longer as common as it used to be, the artefacts such as the “jaki-ed” (clothing mats) continue to embody significant Marshallese values and traditions. For our weavers, the jouj (check spelling) is the centre of the mat and it is where the weaving starts. When the jouj is correct and weaved well, the remainder and every other part of the mat will be right. The jouj is symbolic of the “heart” and if the heart is prepared well, trained well, then life or all other parts of the body will be well (Taafaki & Fowler, 2019). In that light, we have applied the same to this paper. Conceptualising and drawing from cultural practices that are close and dear to our hearts embodies a significant ontological attempt to prioritize our own knowledge and language, a sense of endearment to who we are and what we believe education to be like for us and the next generation.
 
 The application of the phrase “Majolizing '' was used by the Ministry of Education when Hilda Heine was minister, to weave cultural ideas and language into the way that teachers understand the curriculum, develop lesson plans and execute them in the classroom. Despite this, there were still concerns with the embedded colonized practices where teachers defaulted to eurocentric methods of doing things, like the strategies provided in the textbooks given to us. In some ways, our education was slow to adjust to the “Majolizing '' intention by our former minister. In this paper, we provide Kanne Lobal as a way to contribute to the “Majolizing intention” and perhaps speed up yet still be collectively responsible to all involved in education. 
 Kajin Wa and Kanne Lobal 
 
 “Wa” is the Marshallese concept for canoe. Kajin wa, as in canoe language, has a lot of symbolic meaning linked to deeply-held Marshallese values and practices. The canoe was the foundational practice that supported the livelihood of harsh atoll island living which reflects the Marshallese social world. The experts of Kajin wa often refer to “wa” as being the vessel of life, a means and source of sustaining life (Kelen, 2009, cited in Miller, 2010). “Jouj” means kindness and is the lower part of the main hull of the canoe. It is often referred to by some canoe builders in the RMI as the heart of the canoe and is linked to love. The jouj is one of the first parts of the canoe that is built and is “used to do all other measurements, and then the rest of the canoe is built on top of it” (Miller, 2010, p. 67). The significance of the jouj is that when the canoe is in the water, the jouj is the part of the hull that is underwater and ensures that all the cargo and passengers are safe. For Marshallese, jouj or kindness is what living is about and is associated with selflessly carrying the responsibility of keeping the family and community safe. 
 
 The parts of the canoe reflect Marshallese culture, legend, family, lineage, and kinship. They embody social responsibilities that guide, direct, and sustain Marshallese families’ wellbeing, from atoll to atoll. For example, the rojak (boom), rojak maan (upper boom), rojak kōrā (lower boom), and they support the edges of the ujelā/ujele (sail) (see figure 1). The literal meaning of rojak maan is male boom and rojak kōrā means female boom which together strengthens the sail and ensures the canoe propels forward in a strong yet safe way. Figuratively, the rojak maan and rojak kōrā symbolise the mother and father relationship which when strong, through the jouj (kindness and love), it can strengthen families and sustain them into the future. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Figure 1. Parts of the canoe
 
 Source: https://www.canoesmarshallislands.com/2014/09/names-of-canoe-parts/ 
 
 From a socio-cultural, communal, and leadership view, the canoe (wa) provides understanding of the relationships required to inspire and sustain Marshallese peoples’ education and learning. We draw from Kajin wa because they provide cultural ideas and practices that enable understanding of education and leadership necessary for sustaining Marshallese people and realities in Oceania. When building a canoe, the women are tasked with the weaving of the ujelā/ujele (sail) and to ensure that it is strong enough to withstand long journeys and the fierce winds and waters of the ocean. The Kanne Lobal relates to the front part of the ujelā/ujele (sail) where the rojak maan and rojak kōrā meet and connect (see the red lines in figure 1). Kanne Lobal is linked to the strategic use of the ujelā/ujele by navigators, when there is no wind north wind to propel them forward, to find ways to capture the winds so that their journey can continue. As a proverbial saying, Kanne Lobal is used to ignite thinking and inspire and transform practice particularly when the journey is rough and tough. In this paper we draw from Kanne Lobal to ignite, inspire, and transform our educational and leadership practices, a move to explore what has always been meaningful to Marshallese people when we are faced with challenges. The Kanne Lobal utilises our language, and cultural practices and values by sourcing from the concepts of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity). 
 
 A key Marshallese proverb, “Enra bwe jen lale rara”, is the cultural practice where families enact compassion through the sharing of food in all occurrences. The term “enra” is a small basket weaved from the coconut leaves, and often used by Marshallese as a plate to share and distribute food amongst each other. Bwe-jen-lale-rara is about noticing and providing for the needs of others, and “enra” the basket will help support and provide for all that are in need. “Enra-bwe-jen-lale-rara” is symbolic of cultural exchange and reciprocity and the cultural values associated with building and maintaining relationships, and constantly honouring each other. As a Marshallese practice, in this article we share our understanding and knowledge about the challenges as well as possible solutions for education concerns in our nation.
 
 In addition, we highlight another proverb, “wa kuk wa jimor”, which relates to having one canoe, and despite its capacity to feed and provide for the individual, but within the canoe all people can benefit from what it can provide. In the same way, we provide in this paper a cultural framework that will enable all educators to benefit from. It is a framework that is far-reaching and relevant to the lived realities of Marshallese people today. Kumit relates to people united to build strength, all co-operating and working together, living in peace, harmony, and good health. 
 
 Kanne Lobal: conceptual framework for education and leadership
 An education framework is a conceptual structure that can be used to capture ideas and thinking related to aspects of learning. Kanne Lobal is conceptualised and framed in this paper as an educational framework. Kanne Lobal highlights the significance of education as a collective partnership whereby leadership is an important aspect. Kanne Lobal draws-from indigenous Marshallese concepts like kautiej (respect), jouj eo mour eo (reciprocity), and jouj (kindness, heart). The role of a leader, including an education leader, is to prioritise collective learning and partnerships that benefits Marshallese people and the continuity and survival of the next generation (Heine, 2002; Thaman, 1995). 
 
 As described by Ejnar Aerōk, an expert canoe builder in the RMI, he stated: “jerbal ippān doon bwe en maron maan wa e” (cited in Miller, 2010, p. 69). His description emphasises the significance of partnerships and working together when navigating and journeying together in order to move the canoe forward. The kubaak, the outrigger of the wa (canoe) is about “partnerships”. For us as elementary school leaders on Majuro, kubaak encourages us to value collaborative partnerships with each other as well as our communities, PSS, and other stakeholders. Partnerships is an important part of the Kanne Lobal education and leadership framework. It requires ongoing bwebwenato – the inspiring as well as confronting and challenging conversations that should be mediated and negotiated if we and our education stakeholders are to journey together to ensure that the educational services we provide benefits our next generation of young people in the RMI. Navigating ahead the partnerships, mediation, and negotiation are the core values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity).
 
 As an organic conceptual framework grounded in indigenous values, inspired through our lived experiences, Kanne Lobal provides ideas and concepts for re-thinking education and leadership practices that are conducive to learning and teaching in the schooling context in the RMI. By no means does it provide the solution to the education ills in our nation. However, we argue that Kanne Lobal is a more relevant approach which is much needed for the negatively stigmatised system as a consequence of the various colonial administrations that have and continue to shape and reframe our ideas about what education should be like for us in the RMI. Moreover, Kannel Lobal is our attempt to decolonize the framing of education and leadership, moving our bwebwenato to re-framing conversations of teaching and learning so that our cultural knowledge and values are foregrounded, appreciated, and realised within our education system.
 
 
 
 
 
 
 
 
 
 Bwebwenato: sharing our stories
 In this section, we use bwebwenato as a method of gathering and capturing our stories as data. Below we capture our stories and ongoing conversations about the richness in Marshallese cultural knowledge in the outer islands and on Majuro and the potentialities in Kanne Lobal.
 
 Danny Jim
 When I was in third grade (9-10 years of age), during my grandfather’s speech in Arno, an atoll near Majuro, during a time when a wa (canoe) was being blessed and ready to put the canoe into the ocean. My grandfather told me the canoe was a blessing for the family. “Without a canoe, a family cannot provide for them”, he said. The canoe allows for travelling between places to gather food and other sources to provide for the family. My grandfather’s stories about people’s roles within the canoe reminded me that everyone within the family has a responsibility to each other. Our women, mothers and daughters too have a significant responsibility in the journey, in fact, they hold us, care for us, and given strength to their husbands, brothers, and sons. The wise man or elder sits in the middle of the canoe, directing the young man who help to steer. The young man, he does all the work, directed by the older man. They take advice and seek the wisdom of the elder. In front of the canoe, a young boy is placed there and because of his strong and youthful vision, he is able to help the elder as well as the young man on the canoe. The story can be linked to the roles that school leaders, teachers, and students have in schooling. Without each person knowing intricately their role and responsibility, the sight and vision ahead for the collective aspirations of the school and the community is difficult to comprehend. For me, the canoe is symbolic of our educational journey within our education system. As the school leader, a central, trusted, and respected figure in the school, they provide support for teachers who are at the helm, pedagogically striving to provide for their students. For without strong direction from the school leaders and teachers at the helm, the students, like the young boy, cannot foresee their futures, or envisage how education can benefit them. This is why Kanne Lobal is a significant framework for us in the Marshall Islands because within the practice we are able to take heed and empower each other so that all benefit from the process. Kanne Lobal is linked to our culture, an essential part of who we are. We must rely on our own local approaches, rather than relying on others that are not relevant to what we know and how we live in today’s society. 
 
 One of the things I can tell is that in Majuro, compared to the outer islands, it’s different. In the outer islands, parents bring children together and tell them legends and stories. The elders tell them about the legends and stories – the bwebwenato. Children from outer islands know a lot more about Marshallese legends compared to children from the Majuro atoll. They usually stay close to their parents, observe how to prepare food and all types of Marshallese skills. 
 
 Loretta Joseph Case
 There is little Western influence in the outer islands. They grow up learning their own culture with their parents, not having tv. They are closely knit, making their own food, learning to weave. They use fire for cooking food. They are more connected because there are few of them, doing their own culture. For example, if they’re building a house, the ladies will come together and make food to take to the males that are building the house, encouraging them to keep on working - “jemjem maal” (sharpening tools i.e. axe, like encouraging workers to empower them). It’s when they bring food and entertainment.
 
 Rubon Rubon
 Togetherness, work together, sharing of food, these are important practices as a school leader. Jemjem maal – the whole village works together, men working and the women encourage them with food and entertainment. All the young children are involved in all of the cultural practices, cultural transmission is consistently part of their everyday life. These are stronger in the outer islands. Kanne Lobal has the potential to provide solutions using our own knowledge and practices. 
 
 Connie Joel
 When new teachers become a teacher, they learn more about their culture in teaching. Teaching raises the question, who are we? A popular saying amongst our people, “Aelon kein ad ej aelon in manit”, means that “Our islands are cultural islands”. Therefore, when we are teaching, and managing the school, we must do this culturally. When we live and breathe, we must do this culturally. There is more socialising with family and extended family. Respect the elderly. When they’re doing things the ladies all get together, in groups and do it. Cut the breadfruit, and preserve the breadfruit and pandanus. They come together and do it. Same as fishing, building houses, building canoes. They use and speak the language often spoken by the older people. There are words that people in the outer islands use and understand language regularly applied by the elderly. Respect elderly and leaders more i.e., chiefs (iroj), commoners (alap), and the workers on the land (ri-jerbal) (social layer under the commoners). All the kids, they gather with their families, and go and visit the chiefs and alap, and take gifts from their land, first produce/food from the plantation (eojōk).
 
 Tommy Almet
 The people are more connected to the culture in the outer islands because they help one another. They don’t have to always buy things by themselves, everyone contributes to the occasion. For instance, for birthdays, boys go fishing, others contribute and all share with everyone. Kanne Lobal is a practice that can bring people together – leaders, teachers, stakeholders. We want our colleagues to keep strong and work together to fix problems like students and teachers’ absenteeism which is a big problem for us in schools. 
 
 Demetria Malachi
 The culture in the outer islands are more accessible and exposed to children. In Majuro, there is a mixedness of cultures and knowledges, influenced by Western thinking and practices. Kanne Lobal is an idea that can enhance quality educational purposes for the RMI. We, the school leaders who did GCSL, we want to merge and use this idea because it will help benefit students’ learning and teachers’ teaching. Kanne Lobal will help students to learn and teachers to teach though traditional skills and knowledge. We want to revitalize our ways of life through teaching because it is slowly fading away. Also, we want to have our own Marshallese learning process because it is in our own language making it easier to use and understand. Essentially, we want to proudly use our own ways of teaching from our ancestors showing the appreciation and blessings given to us. 
 Way Forward
 To think of ways forward is about reflecting on the past and current learnings. Instead of a traditional discussion within a research publication, we have opted to continue our bwebwenato by sharing what we have learnt through the Graduate Certificate in School Leadership (GCSL) programme. Our bwebwenato does not end in this article and this opportunity to collaborate and partner together in this piece of writing has been a meaningful experience to conceptualise and unpack the Kanne Lobal framework. 
 Our collaborative bwebwenato has enabled us to dig deep into our own wise knowledges for guidance through mediating and negotiating the challenges in education and leadership (Sanga & Houma, 2004). For example, bwe-jen-lale-rara reminds us to inquire, pay attention, and focus on supporting the needs of others. Through enra-bwe-jen-lale-rara, it reminds us to value cultural exchange and reciprocity which will strengthen the development and maintaining of relationships based on ways we continue to honour each other (Nimmer, 2017). We not only continue to support each other, but also help mentor the next generation of school leaders within our education system (Heine, 2002). 
 
 Education and leadership are all about collaborative partnerships (Sanga & Chu, 2009; Thaman, 1997). Developing partnerships through the GCSL was useful learning for us. It encouraged us to work together, share knowledge, respect each other, and be kind. The values of jouj (kindness, love), kautiej (respect), and jouj eo mour eo (reciprocity) are meaningful in being and becoming and educational leader in the RMI (Jetnil-Kijiner, 2014; Miller, 2010; Nimmer, 2017). These values are meaningful for us practice particularly given the drive by PSS for schools to become accredited. 
 
 The workshops and meetings delivered during the GCSL in the RMI from 2018 to 2019 about Kanne Lobal has given us strength to share our stories and experiences from the meeting with the stakeholders. But before we met with the stakeholders, we were encouraged to share and speak in our language within our courses: EDP05 (Professional Development and Learning), EDP06 (School Leadership), EDP07 (School Management), EDP08 (Teaching and Learning), and EDP09 (Community Partnerships). In groups, we shared our presentations with our peers, the 15 school leaders in the GCSL programme. We also invited USP RMI staff. They liked the way we presented Kannel Lobal. They provided us with feedback, for example: how the use of the sail on the canoe, the parts and their functions can be conceptualised in education and how they are related to the way that we teach our own young people.
 
 Engaging stakeholders in the conceptualisation and design stages of Kanne Lobal strengthened our understanding of leadership and collaborative partnerships. Based on various meetings with the RMI Pacific Resources for Education and Learning (PREL) team, PSS general assembly, teachers from the outer islands, and the PSS executive committee, we were able to share and receive feedback on the Kanne Lobal framework. The coordinators of the PREL programme in the RMI were excited by the possibilities around using Kanne Lobal, as a way to teach culture in an inspirational way to Marshallese students. Our Marshallese knowledge, particularly through the proverbial meaning of Kanne Lobal provided so much inspiration and insight for the groups during the presentation which gave us hope and confidence to develop the framework. Kanne Lobal is an organic and indigenous approach, grounded in Marshallese ways of doing things (Heine, 2002; Taafaki & Fowler, 2019). Given the persistent presence of colonial processes within the education system and the constant reference to practices and initiatives from the US, Kanne Lobal for us provides a refreshing yet fulfilling experience and makes us feel warm inside because it is something that belongs to all Marshallese people.
 
 
 Conclusion
 Marshallese indigenous knowledge and practices provide meaningful educational and leadership understanding and learnings. They ignite, inspire, and transform thinking and practice. The Kanne Lobal conceptual framework emphasises key concepts and values necessary for collaborative partnerships within education and leadership practices in the RMI. The bwebwenato or talk stories have been insightful and have highlighted the strengths and benefits that our Marshallese ideas and practices possess when looking for appropriate and relevant ways to understand education and leadership.
 
 Acknowledgements
 We want to acknowledge our GCSL cohort of school leaders who have supported us in the development of Kanne Lobal as a conceptual framework. A huge kommol tata to our friends: Joana, Rosana, Loretta, Jellan, Alvin, Ellice, Rolando, Stephen, and Alan.
 
 
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Abstract Background A competent, responsive, and productive health workforce is central to a well-performing health system capable of providing universal access to high-quality care. Ensuring health workers’ psychological wellbeing is critical to sustaining their availability and productivity. This is particularly true in heavily constrained health systems in low- and lower-middle-income countries. Research on the issue, however, is scarce. This study aimed to contribute to filling the gap in knowledge by investigating levels of and factors associated with psychological wellbeing of mid-level health workers in Malawi. Methods The study relied on a cross-sectional sample of 174 health workers from 33 primary- and secondary-level health facilities in four districts of Malawi. Psychological wellbeing was measured using the WHO-5 Wellbeing Index. Data were analyzed using linear and logistic regression models. Results Twenty-five percent of respondents had WHO-5 scores indicative of poor psychological wellbeing. Analyses of factors related to psychological wellbeing showed no association with sex, cadre, having dependents, supervision, perceived coworker support, satisfaction with the physical work environment, satisfaction with remuneration, and motivation; a positive association with respondents’ satisfaction with interpersonal relationships at work; and a negative association with having received professional training recently. Results were inconclusive in regard to personal relationship status, seniority and responsibility at the health facility, clinical knowledge, perceived competence, perceived supervisor support, satisfaction with job demands, health facility level, data collection year, and exposure to performance-based financing. Conclusions The high proportion of health workers with poor wellbeing scores is concerning in light of the general health workforce shortage in Malawi and strong links between wellbeing and work performance. While more research is needed to draw conclusions and provide recommendations as to how to enhance wellbeing, our results underline the importance of considering this as a key concern for human resources for health.

Abstract Background The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives’ experiences and perception of the clinical learning environment in Malawi. Methods A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed. Results A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment. Conclusion Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Abstract Background Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. Methods Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. Results The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. Conclusions We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

Despite repeated emphasis on the links between the natural environment and human well-being and the disproportionate and direct dependence of the rural poor on natural resources, these links have not been well addressed in poverty assessments. Common poverty profiles neither reflect the contribution of nature to well-being nor the multiple values and meanings that people ascribe to nature. Building on a conceptual grounding for including environmental components in well-being measures, our work aimed to determine for which components it is legitimate to do so according to the people whose well-being is measured. We developed a focus group discussion protocol to elicit perceptions of environment-well-being relationships in rural settings in Rwanda and Malawi. The protocol included a well-being free-listing exercise, a matching exercise linking the listed items to predefined well-being dimensions, and a discussion of environment-well-being connections. We found that severe environmental degradation, hazards, and conflicts over access to land and forests in these diverse rural areas are deeply and directly linked to well-being. Environmental changes such as flooding or extended drought led to losses of income, crops, and assets, as well as prolonged periods of psychological stress, constrained freedom of choice, and in extreme cases, death. Our results suggest that some environmental components are constituent to well-being. We emphasise the importance of validating the precise environmental components that are considered relevant to well-being in different contexts. Extending poverty measurement with relevant environmental components can help in targeting action towards reducing poverty in a more legitimate, context-specific way.

AbstractIn the wild, behaviors are often expressed over long time periods in complex and dynamic environments, and many behaviors include direct interaction with the environment itself. However, measuring behavior in naturalistic settings is difficult, and this has limited progress in understanding the mechanisms underlying many naturally evolved behaviors that are critical for survival and reproduction. Here we describe an automated system for measuring long-term bower construction behaviors in Lake Malawi cichlid fishes, in which males use their mouths to sculpt sand into large species-specific structures for courtship and mating. We integrate two orthogonal methods, depth sensing and action recognition, to simultaneously track the developing bower structure and the thousands of individual sand manipulation behaviors performed throughout construction. By registering these two data streams, we show that behaviors can be topographically mapped onto a dynamic 3D sand surface through time. The system runs reliably in multiple species, across many aquariums simultaneously, and for up to weeks at a time. Using this system, we show strong differences in construction behavior and bower form that reflect species differences in nature, and we gain new insights into spatial, temporal, social dimensions of bower construction, feeding, and quivering behaviors. Taken together, our work highlights how low-cost tools can automatically quantify behavior in naturalistic and social environments over long timescales in the lab.

Abstract Background The linear theories of change which ground many interventions do not account for the complex processes and systems in which they are implemented. This reductionist approach prioritises statistical methods which do not accommodate the stochastic, non-linear, dynamic interactions between humans and their environment. The inclusion of practitioners in the process of evidence development and utilisation of complex systems methods mitigates these issues and results in locally relevant, timely evidence for decision-making. Methods The aim of this work was to develop localised evidence for decision-making for schistosomiasis control in Uganda, Malawi, and Tanzania. Workshops were conducted with practitioners from the Ministries of Health at various levels and partner organisations to identify evidence needs for their decision-making processes and perceptions of disease transmission and control activities. Participatory systems mapping was used to identify factors directly and indirectly related to transmission. The maps were synthesised to a master complex systems map, which served as the blueprint for a generalised spatial agent-based model and specific ABMs tailored to the evidence needs of decision-makers. Results There was a gap in available evidence for practitioners to advocate for resources within the MoH and government budgets, as well as intervention efficacy and resource allocation. The adaptable and data-inclusive characteristics of the AMBs made them well-suited to produce localised outputs. Converted to NetLogo with a tailored user interface, these models were appropriate and responsive to the needs of decision-makers from village to national levels and across country contexts. Conclusions Used together, participatory and agent-based modelling resulted in the development of responsive and relevant evidence for practitioner decision-making. This process is generalisable and transferable to other diseases and locations outside of those in this study. Key messages The use of participatory systems mapping to develop agent-based models resulted in relevant and timely evidence for practitioner decision-making. The approach used here is transferable and generalisable outside schistosomiasis control and the contexts in this study.

The purpose of this study is to describe and analyze the effect of the work environment and teacher competence through the school climate on teacher performance. The method used is quantitative with path analysis using a research sample of 90 teachers. Research data were collected using a questionnaire. Then the data obtained from the questionnaire was analyzed through Smart PLS. The results showed that 1) work environment has no effect on teacher performance. 2) Teacher competence has an effect on teacher performance. 3) School climate has no effect on teacher performance. 4) The work environment affects the school climate. 5) Teacher competence affects the school climate. 6) There is no significant effect of work environment on teacher performance through school climate. 7) No significant effect of teacher competence on teacher performance through the school climate.

The filarial nematode Brugia malayi represents a leading cause of disability in the developing world, causing lymphatic filariasis in nearly 40 million people. Currently available drugs are not well-suited to mass drug administration efforts, so new treatments are urgently required. One potential vulnerability is the endosymbiotic bacteria Wolbachia—present in many filariae—which is vital to the worm. Genome scale metabolic networks have been used to study prokaryotes and protists and have proven valuable in identifying therapeutic targets, but have only been applied to multicellular eukaryotic organisms more recently. Here, we present iDC625, the first compartmentalized metabolic model of a parasitic worm. We used this model to show how metabolic pathway usage allows the worm to adapt to different environments, and predict a set of 102 reactions essential to the survival of B. malayi. We validated three of those reactions with drug tests and demonstrated novel antifilarial properties for all three compounds.

Abstract Background Child marriage in Malawi is a significant problem with 42.1% of women 20–24 married by age 18. In 2017 the Malawi government formalized legislation to make marriage under age 18 illegal; violators are subject to fines. While leveraging laws to reduce child marriage is common, the enactment of laws and their enforcement has led to some novel practices. One such practice observed in Malawi is marriage withdrawal, where the community intervenes when a child marriage has taken place to force the girl to return to her natal home. Methods This paper is a qualitative analysis of perceptions regarding marriage withdrawal. We conducted focus group discussions and in-depth interviews with married and unmarried adolescents, parents of adolescents, and key community members in Mangochi and Nkhata Bay. Data were collected as part of an evaluation of the More Than Brides Alliance program aimed at delaying marriage and improving access to sexual and reproductive health services in Malawi. Results The knowledge that violation of marriage laws entails substantial fines is widespread and marriage withdrawals are seen by some respondents as a way of enforcing the spirit of child marriage laws while avoiding fines. Some respondents suggest that enforcement of marriage laws has an unintended effect of driving marriages underground. One important disconnect between the laws and the realities of child marriage practices in these communities is that the law holds parents responsible for the marriage and for preventing it, while parents do not necessarily exercise control, particularly when the marriage is precipitated by pregnancy. While parents and other adults view withdrawals as an acceptable resolution of a problematic child marriage, girls noted many drawbacks for withdrawn girls such as stigma and limited education and livelihood opportunities once withdrawn. Conclusions Our exploration of perceptions about marriage laws suggest that the imposition of fines may have some unintended consequences, both driving the practice underground and encouraging practices to evade fines, and may be associated with unintended consequences for adolescent girls. Programs to address child marriage should include other approaches that address more distal drivers including poverty and lack of alternatives to child marriage. Trial registration This work is part of an RCT registered August 4, 2016 in the AEA RCT registry identified as: AEARCTR-0001463. See: https://www.socialscienceregistry.org/trials/1463

Abstract Background Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. Method We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. Results We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808). Conclusion The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies.

AbstractRetention in antiretroviral therapy (ART) services is critical to achieving positive health outcomes for individuals living with HIV, but accumulating evidence indicates that individuals are likely to miss ART appointments over time. Thus, it is important to understand why individuals miss appointments and how they re-engage in HIV care. We used in-depth interviews with 44 ART clients in Malawi who recently missed an ART appointment (> 14 days) but eventually re-engaged in care (within 60 days) to explore reasons for missed appointments and barriers and facilitators to re-engagement. We found that most individuals missed ART appointments due to unexpected life events such as funerals, work, and illness for both clients and their treatment guardians who were also unable to attend facilities. Several reasons differed by gender—work-related travel was common for men, while caring for sick family members was common for women. Barriers to re-engagement included continued travel, illness, and restricted clinic schedules and/or staff shortages that led to repeat facility visits before being able to re-engage in care. Strong internal motivation combined with social support and reminders from community health workers facilitated re-engagement in HIV care.

PurposeThis paper aims to explore the local conceptualisation of gender and framings of men and masculinities at the local level, which may be applied to improve gender mainstreaming in smallholder farming.Design/methodology/approachQualitative data were collected from a total of 70 key informants and community members knowledgeable about climate change and smallholder agriculture, disaster risks, gender and broader community issues in Malawi and Zambia. The thematic analysis was used to identify the themes emerging from the qualitative data.FindingsPractitioners apply western framings of gender while communities consider their realities and contexts and emphasise that gender means men and women need to work together. Although institutional provisions are in place for gender mainstreaming, practitioners have cautioned against the influence of the global north in gender mainstreaming, which ignores local realities. Applying a masculinities lens at a local level established the existence of subordinate and marginalised men often excluded from interventions and how hierarchical relationships among men limited women's participation.Research limitations/implicationsFuture research, practice and policy initiatives in disaster risk reduction and resilience-building need to engage with positive masculinities in gender mainstreaming. This work stimulates a broader framing of gender that builds on the core values and perspectives of communities.Practical implicationsContemporary gender mainstreaming approaches need to consider local contextualisation of gender, emphasising the critical aspect of cooperation between women and men in overcoming climate-related hazards and risk reduction.Originality/valueThis work contributes to the nascent discourse on local gender perspectives and masculinities in disaster risk reduction and resilience in Southern Africa.

Malaria is a worldwide disease that causes a high number of deaths. It is caused by the bite of the Anopholes mosquito infected by the parasitic protozoan of the genus Plasmodium. The purpose of this article is to show the numbers of confirmed cases of malaria in Brazil, regarding the years of confirmation, the age group and the notification region, between the years 2011 to 2015. Data taken from the SUS IT department, DATASUS and from articles. There was a decline in the number of the period cited, people between the age group of 20 to 39 years, followed by the group between 49 and 59 years, the largest number of cases occurred with male people, the largest number of cases occurred with people of white race followed by browns, the highest number of cases per schooling is unknown where schooling is known, the highest numbers are with people from complete high school, followed by people with complete higher education, most cases occurred in an urban area , the southeastern region has the highest number of confirmed cases of malaria in the period, the highest number of cases occurred in the state of Rondônia. It is concluded that campaigns had an influence on society and collaborated with the reduction of the number of communicable diseases like malaria. Men work in areas with a higher risk of contamination and in places of vector proliferation, so they are more exposed to areas of mosquito proliferation and contagion. In Brazil the majority of the population is recognized as being white and brown, respectively, so the numbers show these ethnicities as the most infected. The mosquito seems to proliferate more easily in places where there have been man-made changes. The urban environment, as it is an extremely modified place, causes a greater number of cases due to the greater availability of breeding sites. It is believed that for this reason the southeastern region has a greater number of cases and because it is also one of the regions of the country that has suffered the most changes by man. The opening of highways and the increase in settlements facilitate contact between mosquitoes and humans. The state of Rondônia has a large number of settlements and deforestation to accommodate progress.

This reflection describes my funded visit to South Africa to assist in primary care research capacity building as Chair, WONCA Working Party on Research (WP-R). The trip included time at the Universities of Walter Sisulu, Limpopo and Stellenbosch to mentor postgraduate students working on master’s and PhD theses. I held one-on-one and group sessions and ran interactive scientific writing workshops. I assisted with the establishment of a Stellenbosch University Family Physician Research Network of faculty academics and family physicians (FP) which will generate research questions from community stakeholders. I also ran a writing workshop at the Joint 5th WONCA Africa and 20th South African National Family Practitioners Conference in Pretoria attended by about 100 conference delegates, ranging from FP registrars to academics with PhDs and peer-reviewed publications. A WP-R panel presentation of international comparisons of primary care systems was also held at this conference, with the countries of Ghana, Malawi, Zimbabwe, Ethiopia and Nigeria presented. During my stay, Ireflected on the differences between family medicine in South Africa and in my home country, New Zealand (NZ). In South Africa, there is high prevalence of HIV and tuberculosis, seldom seen in NZ. Donor-funded vertical programmes cause significant fragmentation of care. Family doctors generally work in district hospitals, providing consultancy support to nurseled clinics. They have a laudable requirement to complete a Master’s in Medicine in conjunction with vocational training. Academic family medicine in South Africa is coming of age. I feel privileged to play a small part in its journey to maturity.

Abstract Background The interconnections between health and the economy are well known and well documented. The funding gap for realizing SDG3 for good health and well-being, however, remains vast. Simultaneously, economic growth, as expressed and measured in SDG8, continues to leave many people behind. In addition, international financial institutions, notably the International Monetary Fund (IMF), continue to influence the economic and social policies that countries adopt in ways that could undermine achievement of the SDGs. We examine the incoherence between the economic growth and health goals of the SDGs with reference to three East African countries, Malawi, Uganda, and Tanzania, where our organization has been working with partner organizations on SDG related policy analysis and advocacy work. Results In all three study countries, some health indicators, notably infant and child mortality, show improvement, but other indicators are lagging behind. Underfunding of the health sector is a major cause for poor health of the population and inequities in access to health care. GDP increases (as a measure of economic growth) do not automatically translate to increases in the countries’ health spending. Health expenditure from domestic public resources remains much lower than the internationally recommended minimum of USD 86 per capita. To achieve this level of health spending from domestic resources only, GDP in these countries would require an unrealistic manifold increase. External aid is proving insufficient to close the funding gap. IMF policy advice and loan conditionality that focus on GDP growth and tight monetary and fiscal targets impair growth in health and social sector spending, while recommended taxation measures are generally regressive. Conclusions The existence of the GDP-focused SDG8 can delay efforts towards the achievement of the SDG3 for health and well-being if governments choose to focus on GDP growth without taking sufficient measures to equally distribute wealth and invest in the social sectors, often under the influence of policies advised or conditions put in place by the IMF. Although the IMF has started to acknowledge the importance of social development, its policy advice still adheres to austerity and pro-cyclical economic development harming a country’s population health. To realize the SDGs everywhere, governments should abandon GDP growth as a policy objective and place more emphasis on SDG17 on global co-operation.