Areas Of Malawi Research Articles

Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study.

Female genital schistosomiasis (FGS), caused by the parasite Schistosoma haematobium (Sh), is prevalent in Sub-Saharan Africa. FGS is associated with sexual dysfunction and reproductive morbidity, and increased prevalence of HIV and cervical precancerous lesions. Lack of approved guidelines for FGS screening and diagnosis hinder accurate disease burden estimation. This study evaluated FGS burden in two Sh-endemic areas in Southern Malawi by visual and molecular diagnostic methods. Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. 'Visual-FGS' was defined as specific genital lesions. 'Molecular-FGS' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). 'Molecular-FGS' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high 'molecular-FGS' prevalence, despite <10% prevalence of urinary Sh among school-age children. Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.

Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi

The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in non-eligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. By April 30, 2021, 652 673 children had received at least one dose of RTS,S and 494 745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26 285 children aged 1-59 months were admitted to sentinel hospitals and 13 198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 0·63 [95% CI 0·22-1·79]; hospital admission with cerebral malaria: IRR 1·03 [95% CI 0·61-1·74]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 1·03 [95% CI 0·88-1·21]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S. Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

A novel record of African wild dogs (Lycaon pictus) in Vwaza Marsh Wildlife Reserve, Malawi.

Most African wild dog (Lycaon pictus) populations are in decline and, due to habitat fragmentation and conflict rates in areas of higher anthropogenic land-use, are primarily restricted to protected areas. As a species that occurs at low densities, with a strict reproductive social structure, wild dogs rely on long-range dispersal to facilitate colonization, reproduction, and pack formation. In Malawi, large carnivores have been subject to widespread population decline and several protected areas have a reduced large carnivore guild, including the loss of resident wild dog populations. Here, during a biodiversity monitoring camera trap survey, we captured a novel record of wild dogs in Vwaza Marsh Wildlife Reserve (Vwaza), Malawi. The 11 photographic captures of potentially three individual wild dogs represent the first documented evidence of the species in Vwaza and the first record since an unconfirmed report in 2011. We hypothesize that this group of wild dogs moved into Vwaza through the Malawi-Zambia Transfrontier Conservation Area (MZTFCA), with the MZTFCA linking protected areas in Malawi with the Luangwa Valley, Zambia. The evidence provided here, and similar documentation in Kasungu National Park, Malawi, show that large carnivores can potentially move through the MZTFCA into protected areas in Malawi. We argue that the MZTFCA provides an important dispersal corridor that could help facilitate the recolonization of wild dogs, and other large carnivores, in Malawian protected areas. However, further research is needed to assess the permeability and status of the MZTFCA corridor into Malawi. We show that camera traps can be useful to document novel records of rare species and can be used to inform conservation management planning.

Groundwater Quality Assessment in Urban Areas of Malawi: A Case of Area 25 in Lilongwe

Groundwater sources provide an important supply of alternative drinking water in most urban areas in Malawi. This study was conducted to assess the quality of groundwater in Area 25, a typical urban residential area in Malawi. Samples were collected from wells and analyzed for physicochemical and bacteriological parameters following standard methods. Results were compared to Malawi Standards (MS) and World Health Organization (WHO) drinking water quality guidelines. The overall water quality index was computed to ascertain the general quality of the water. Levels of pH, phosphate, sulfate, arsenic, lead, and potassium were below the guideline limits while, electrical conductivity, total dissolved solids, chloride, fluoride, nitrate, total hardness, calcium, and magnesium were observed above permissible limits, posing a health risk to the residents. The quality index ranged from 22 (excellent quality) to 64 (Poor quality) with an average of 41 (good quality). Fecal coliforms were present in 70% of the sampled locations with an average of 7.9 cfu/100 ml. The presence of these bacteria presents a serious risk for waterborne disease outbreaks. This study, therefore, recommends the provision of basic treatment techniques to improve the quality of water in the area before consumption, regular monitoring of groundwater resources, and proper design and setting of septic systems.

Combating coronavirus disease (COVID-19) in rural areas of Malawi: Factors affecting the fight.

Owing to their detachment from urban areas, people living in rural areas of Malawi are on the receiving end of health services and socio-economic benefits. The study therefore explored how Malawians living in these areas are adhering to coronavirus disease 2019 (COVID-19) containment measures and the factors that affect the COVID-19 fight amongst this population. The study investigated how the rural population in Malawi adheres to COVID-19 containment measures. The study was conducted in two districts in Northern Malawi. Data were collected from 263 participants. The chi-square (χ2) test was performed to determine the association between demographic variables and COVID-19 prevention practices and factors affecting the COVID-19 fight. Education was significantly associated with wearing of masks (p = 0.01), use of sanitisers (p 0.01) and practising social distancing (p = 0.07). Monthly income was associated with the use of sanitisers (p 0.01). Women were more exposed to fake news about COVID-19 (p = 0.09); older people were more likely to disregard COVID-19 containment measures for cultural reasons (p = 0.07); and monthly income was associated with a lack of resources for following COVID-19 containment measures (p 0.01). Findings show that factors affecting the COVID-19 fight are influenced by various socio-economic factors which should therefore be taken into account in policy planning aiming at controlling the pandemic.Contribution: The study provides health stakeholders with a policy direction that enhances better coordination, implementation and monitoring of COVID-19 response and recovery activities in rural areas in Malawi. The findings have implications on controlling current and future communicable diseases; the proposed strategies might be employed in fighting similar current and future pandemics.

Assessing the safety, impact and effectiveness of RTS,S/AS01E malaria vaccine following its introduction in three sub-Saharan African countries: methodological approaches and study set-up

BackgroundFollowing a 30-year development process, RTS,S/AS01E (GSK, Belgium) is the first malaria vaccine to reach Phase IV assessments. The World Health Organization-commissioned Malaria Vaccine Implementation Programme (MVIP) is coordinating the delivery of RTS,S/AS01E through routine national immunization programmes in areas of 3 countries in sub-Saharan Africa. The first doses were given in the participating MVIP areas in Malawi on 23 April, Ghana on 30 April, and Kenya on 13 September 2019. The countries participating in the MVIP have little or no baseline incidence data on rare diseases, some of which may be associated with immunization, a deficit that could compromise the interpretation of possible adverse events reported following the introduction of a new vaccine in the paediatric population. Further, effects of vaccination on malaria transmission, existing malaria control strategies, and possible vaccine-mediated selective pressure on Plasmodium falciparum variants, could also impact long-term malaria control. To address this data gap and as part of its post-approval commitments, GSK has developed a post-approval plan comprising of 4 complementary Phase IV studies that will evaluate safety, effectiveness and impact of RTS,S/AS01E through active participant follow-up in the context of its real-life implementation.MethodsEPI-MAL-002 (NCT02374450) is a pre-implementation safety surveillance study that is establishing the background incidence rates of protocol-defined adverse events of special interest. EPI-MAL-003 (NCT03855995) is an identically designed post-implementation safety and vaccine impact study. EPI-MAL-005 (NCT02251704) is a cross-sectional pre- and post-implementation study to measure malaria transmission intensity and monitor the use of other malaria control interventions in the study areas, and EPI-MAL-010 (EUPAS42948) will evaluate the P. falciparum genetic diversity in the periods before and after vaccine implementation.ConclusionGSK’s post-approval plan has been designed to address important knowledge gaps in RTS,S/AS01E vaccine safety, effectiveness and impact. The studies are currently being conducted in the MVIP areas. Their implementation has provided opportunities and posed challenges linked to conducting large studies in regions where healthcare infrastructure is limited. The results from these studies will support ongoing evaluation of RTS,S/AS01E’s benefit-risk and inform decision-making for its potential wider implementation across sub-Saharan Africa.Graphic abstract

Spatial and Temporal Change of Land Cover in Protected Areas in Malawi: Implications for Conservation Management

Protected areas (PAs) transform over time due to natural and anthropogenic processes, resulting in the loss of biodiversity and ecosystem services. As current and projected climatic trends are poised to pressurize the sustainability of PAs, analyses of the existing perturbations are crucial for providing valuable insights that will facilitate conservation management. In this study, land cover change, landscape characteristics, and spatiotemporal patterns of the vegetation intensity in the Kasungu National Park (area = 2445.10 km2) in Malawi were assessed using Landsat data (1997, 2008 and 2018) in a Fuzzy K-Means unsupervised classification. The findings reveal that a 21.12% forest cover loss occurred from 1997 to 2018: an average annual loss of 1.09%. Transition analyses of the land cover changes revealed that forest to shrubs conversion was the main form of land cover transition, while conversions from shrubs (3.51%) and bare land (3.48%) to forest over the two decades were comparatively lower, signifying a very low rate of forest regeneration. The remaining forest cover in the park was aggregated in a small land area with dissimilar landscape characteristics. Vegetation intensity and vigor were lower mainly in the eastern part of the park in 2018. The findings have implications for conservation management in the context of climate change and the growing demand for ecosystem services in forest-dependent localities.

Factors Influencing the Use of Solar Energy Technology in a Local Township of Blantyre City, Malawi

Challenges with access to electricity are global but becoming increasingly high in Malawi where more than 96% of the electricity is produced from hydro generation. Energy sources for electricity production can be renewable or non-renewable. Due to many challenges facing hydropower production such as water levels, debris in the inlet ponds, etc., renewable energy sources that produce clean energy such as solar power are becoming common. However, despite such opportunities, access to electricity whether renewable (solar) or non-renewable (hydro production) to many people in urban areas in Malawi is still a challenge. A household survey was carried out involving 100 households aimed to establish factors that influence the use of solar energy technology in Machinjiri, one of the townships in the city of Blantyre, in southern Malawi. Only 32% of the households have access to solar energy. Results indicated that the level of education attained has an influence on the peoples’ choices to use solar technology. In this regard, respondents with basic primary school certificate reported 8% while those with college education reported 32% and those with higher education, Malawi School Certificate of Education (MSCE) reported 52% use of solar energy for lighting. Some of the reasons for not using solar energy include: low production during winter (55%), not durable (23%), no knowledge (18%) and others mention combined reasons (4%). Only a few people use solar energy for lighting. Therefore, there is a need for the government and non-governmental organizations to continue sensitizing people on the importance of using renewable energy such as solar energy. Furthermore, the government should create deliberate conditions to make solar energy equipment affordable to many Malawians with low incomes.

Plasma cytokines quantification among Trypanosoma brucei rhodesiense sleeping sickness cases and controls in Rumphi, Malawi.

Trypanosoma brucei (T.b.) rhodesiense is the cause of the acute form of human African trypanosomiasis (HAT) in eastern and southern African countries, including Malawi. For a long time, untreated HAT infections were believed to be 100% fatal. However, recent studies show that infection by T.b. rhodesiense can result in a wide range of clinical outcomes in its human host. Apart from other factors such as parasite diversity, cytokines have been strongly implicated to play a major role in the outcome of T.b. rhodesiense infections.In this study, we quantify the levels of three cytokines Interleukin-8 (IL-8), Tumor Necrotic Factor alpha (TNF-α) and Interleukin -10 (IL-10) in plasma amongst HAT cases (treated and untreated) and controls recruited during medical survey. Two-hundred and thirty-three plasma samples (HAT cases and controls) from Rumphi, one of the endemic areas in Malawi were used. Blood collected was centrifuged, plasma extracted and stored in cryovials at -80°C until processing. Plasma cytokine concentration was measured using ELISA. Plasma samples for 233 individuals, 76 HAT cases and 157 controls were quantified. Among the cases, nine had their plasma collected before treatment (untreated) and the rest were treated before blood for plasma analysis was collected. Controls had significantly higher mean plasmatic levels of TNF-α (94.5 ±474.12 pg/ml) and IL-8 (2258.6 ±5227.4 pg/ml) than cases TNF-α (29.35±181.58 pg/ml) and IL-8 (1191.3±4236.09 pg/ml). Controls and cases had similar mean levels of IL-10 in plasma. Only IL-8 had statistically significant higher median levels in the untreated than treated HAT cases P=0.006. Our data suggest that cytokines could be considered as biomarkers of HAT infection and treatment. Further studies with a larger cohort of cases and additional cytokines which are known to be associated with HAT infection outcomes will be required to evaluate these cytokines further.

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi.

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

Climatic suitability predictions for the cultivation of macadamia in Malawi using climate change scenarios.

Abstract Global climate change is altering the suitable areas of crop species worldwide, with cascading effects on people and animals reliant upon those crop species as food sources. Macadamia is one of these essential lucrative crop species that grows in Malawi. Here, we used an ensemble model approach to determine the current distribution of macadamia production areas across Malawi in relation to climate. For future distribution of suitable areas, we used the climate outputs of 17 general circulation models based on two climate change scenarios (RCP 4.5 and RCP 8.5). The precipitation of the driest month and isothermality were the climatic variables that strongly influenced macadamia’s suitability in Malawi. We found that these climatic requirements were fulfilled across many areas in Malawi under the current conditions. Future projections indicated that vast parts of Malawi’s macadamia growing regions will remain suitable for macadamia, amounting to 36,910 km2 (39.1%) and 33,511 km2 (35.5%) of land based on RCP 4.5 and RCP 8.5, respectively. Alarmingly, suitable areas for macadamia production are predicted to shrink by −18% (17,015 km2) and −21.6% (20,414 km2) based on RCP 4.5 and RCP 8.5, respectively, with much of the suitability shifting northwards. This means that some currently productive areas will become unproductive in the future, while current unproductive areas will become productive. Notably, suitable areas will increase in Malawi’s central and northern highlands, while the southern region will lose most of its suitable areas. Our study, therefore, shows that there is potential for expanding macadamia production in Malawi. Most, importantly our future projections provide critical evidence on the potential negative impacts of climate change on the suitability of macadamia production in the country. We recommend developing area-specific adaptation strategies to build resilience in the macadamia sector in Malawi under climate change.

Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population

BackgroundAn epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting.MethodsWe conducted a cross-sectional study from January–August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR.ResultsThe mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)].ConclusionsReduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions.

Using scenarios to understand community-based interventions for bushmeat hunting and consumption in African savannas

Community-based interventions are an important strategy to reduce bushmeat hunting, one of the key threats to African wildlife. However, understanding the possible effects of such programs prior to implementation is vital, in order to ensure that scarce funds are correctly directed. Here we used scenario-based interviews to explore the potential effects of seven programs on proxies for bushmeat hunting and consumption, including the provision of alternative protein sources, the provision of alternative incomes, and the harvesting of natural resources from protected areas. We conducted 250 interviews with respondents living around four protected areas in Malawi, and investigated how time budgets, household and village meat availability, and perceptions of fairness would change under each program. Respondents were most likely to substitute their current activities (including illegal hunting) under alternative income projects such as microenterprise and skills-training programs. All programs except increased enforcement were likely to increase the availability of meat in both households and villages. However, the effect of the scenarios on meat availability was perceived to be greater at village level than household level. Projects that provided long-term benefits such as a microenterprise program or skills training, were preferred over, and seen to be fairer than, programs relating to resource use, such as regulated hunting or park-based resource harvesting schemes. These results illustrate that programs that can harness development goals, while linking back to conservation rules, may successfully reduce bushmeat hunting and consumption around protected areas.

Bushmeat hunting and consumption is a pervasive issue in African savannahs: insights from four protected areas in Malawi

The hunting and consumption of wild meat (bushmeat) is recognized as a key threat to the world’s biodiversity and there are indications this threat may extend to much of the African continent. However, this problem is understudied in African savannah systems—particularly in southern Africa. Due to its illicit nature, little research on the drivers behind hunting and consumption exists, especially using methods appropriate to the topic’s sensitivity. We explored the prevalence of hunting and consumption of wild meat in the low-income country of Malawi, by conducting 1562 interviews in communities neighbouring four different protected areas. We identified characteristics of households illegally hunting and consuming wild meat, using the unmatched count technique and socio-demographic variables in linear models. Consumption had a higher prevalence than hunting, reaching up to 39% of the population, while 4–19% of the population engaged in hunting. Consumption was more prevalent in poorer households, while hunting was more prevalent in wealthier households. Increased involvement in community projects initiated by protected areas did not always lead to reduced consumption or hunting, including at protected areas with substantial outside investment, indicating these projects need a clearer link to conservation outcomes. A preference for the taste of wild meat and for added diversity in diet were key drivers of consumption, whereas hunting was primarily motivated by the need for income. Our results highlight the disparity between drivers of hunting and consumption of wild meat and the pervasive nature of this threat, despite considerable investment into community projects and enforcement.

Energy and Water Needs Analysis: Towards Solar Photovoltaic Water Pumping in Rural Areas of Malawi

Water and energy are both major challenges in rural areas of developing countries, including in the sub-Saharan Africa Region. This study assessed water and energy needs, challenges, and costs in order to produce a body of knowledge and further explore ways in which the water-energy synergies could be utilised. A mixed-mode survey method consisting of questionnaires, semi-structured interviews, observations and focus group discussions involving participants in the rural areas of Chiradzulu District in Malawi was employed. The study findings show that water access is generally inadequate, caused by high population, low yield, disparity in the distribution of water sources, and non-functionality. Using the contingent valuation method, logistic regression showed the only predictor of willingness to pay for drinking water was income and the predictors to pay for irrigation water were occupation, age and household size. Sustainable energy access was also found lacking for cooking and basic energy services such as for lighting, mobile charging and for radios. Biomass remains the main source of cooking energy, whereas battery powered torches have replaced paraffin for lighting. Overall, the household survey results imply that there is need for more sustainable water and energy provision. To address both challenges, the study recommends solar PV water pumping systems which can be designed in such a way that they can be simultaneously used for providing basic energy services. Further research is needed to address cooking energy choices.

Ability to understand and correctly follow HIV self-test kit instructions for use: applying the cognitive interview technique in Malawi and Zambia.

IntroductionThe ability to achieve an accurate test result and interpret it correctly is critical to the impact and effectiveness of HIV self‐testing (HIVST). Simple and easy‐to‐use devices, instructions for use (IFU) and other support tools have been shown to be key to good performance in sub‐Saharan Africa and may be highly contextual. The objective of this study was to explore the utility of cognitive interviewing in optimizing the local understanding of manufacturers’ IFUs to achieve an accurate HIVST result.MethodsFunctionally literate and antiretroviral therapy‐naive participants were purposefully selected between May 2016 and June 2017 to represent intended users of HIV self‐tests from urban and rural areas in Malawi and Zambia. Participants were asked to follow IFUs for HIVST. We then conducted cognitive interviews and observed participants while they attempted to complete the HIVST steps using a structured guide, which mirrored the steps in the IFU. Qualitative data were analysed using a thematic approach.ResultsOf a total of 61 participants, many successfully performed most steps in the IFU. Some had difficulties in understanding these and made errors, which could have led to incorrect test results, such as incorrect use of buffer and reading the results prematurely. Participants with lower levels of literacy and inexperience with standard pictorial images were more likely to struggle with IFUs. Difficulties tended to be more pronounced among those in rural settings. Ambiguous terms and translations in the IFU, unfamiliar images and symbols, and unclear order of the steps to be followed were most commonly linked to errors and lower comprehension among participants. Feedback was provided to the manufacturer on the findings, which resulted in further optimization of IFUs.ConclusionsCognitive interviewing identifies local difficulties in conducting HIVST from manufacturer‐translated IFUs. It is a useful and practical methodology to optimize IFUs and make them more understandable.

Big Cats Return to Majete Wildlife Reserve, Malawi: Evaluating Reintroduction Success

Large carnivores are frequently reintroduced into protected areas to compensate for anthropogenic-driven losses. The lack of post-release monitoring has impeded our knowledge on how these carnivores adapt to their new environment, which often results in uncertainty of whether or not reintroductions were successful. Between 2011 and 2012, six leopards (Panthera pardus) and three lions (Panthera leo) were reintroduced into Majete Wildlife Reserve, Malawi, and each animal was fitted with a GPS or VHF collar to monitor their post-release movements and behaviour. All individuals survived longer than two and a half years post-release and successful breeding events were recorded for all females, except one leopard. Released felids showed little initial exploratory behaviour, none homed to their capture location and all individuals displayed at least some degree of release site fidelity. Lions established permanent ranges between five and seven months after release, with a mean home range of 82.1km2 (95%, T-LoCoH). Three leopards established permanent ranges between four and eight months, with a mean home range of 181.6 km2 (95%; T-LoCoH). Two leopards did not establish fixed home ranges, but rather exhibited continuous shifts in range which were likely due to natural disruptive events such as season, prey availability and other competitors. Our findings suggest that reintroduced felids may take longer to establish permanent home ranges than previously thought, highlighting the importance of long-term post-release monitoring. Based on our study, reintroduction appears to be an effective and viable tool to restore large carnivores in protected areas in Malawi.

Bioclimatic assessments for tea cultivation in Western Nghe An

Bioclimatic assessments for tea cultivation in Western Nghe An

World Librarians: A Peer-to-Peer Commons for Closing the Global Digital Divide

INTRODUCTION An estimated 53% of the world’s population do not have Internet access. As a consequence, they lack information capital that could be key to bettering their lives. In this practice article, we introduce a sociotechnical system called “World Librarians.” This system, facilitated by a knowledge commons, provides educators, librarians, students, and medical professionals in remote Internet-poor areas of Malawi with access to digital content that they request. OBJECTIVE We describe the social and technical methods by which a team of educators, librarians, students, and information technology specialists in information-privileged environments share educational content to information-disadvantaged communities. METHODS After briefly discussing key foundational components and partnerships, we explain the mechanics of the sociotechnical system. We follow this with two proof-of-concept cases where offline requesters in remote school and library contexts in rural Malawi are assisted by an online librarian searcher team at the University of Massachusetts Amherst. RESULTS The proof of concept cases demonstrate that the relatively low-cost sociotechnical system accomplishes the goal of sharing open access educational content in remote areas with limited or no access to networked information. Moreover, the cases demonstrate that the content shared can be content global southerners offline want and need, rather than information global northerners think they should have. CONCLUSIONS The World Librarians system is ready to be scaled and replicated at other institutions with ready access to high-speed networked information. The authors welcome contact from readers who might be interested in establishing their library as a new “searcher node” in the growing World Librarians network.

Sex and area differences in the association between adiposity and lipid profile in Sub-Saharan Africa: A comparison with a European population

Introduction Sub-Saharan African (SSA) countries are facing a rising epidemic of non-communicable diseases (NCDs) alongside a persistent burden from undernutrition and infectious diseases. Mendelian randomization (using genetic variants as instrumental variables) and randomised controlled trial (RCT) evidence show that high levels of total (TC) and low-density lipoprotein-cholesterol (LDL-C) and of triglycerides (TG) are key causal risk factors for coronary heart diseases (CHD), that can be effectively modified to prevent CHD. Studies in high-income countries show that higher adiposity results in an adverse lipid profile, but whether this association is similar in SSA populations is unclear. One previous small study from Cameroon suggested higher adiposity increased dyslipidaemia in urban dwelling SSA populations but not in those in rural areas, but to our knowledge previous studies have not sought to replicate this. This study aimed to (i) assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence and (ii) compare the associations with observations from a predominantly white European-origin population cohort from the United Kingdom (UK). Methods Baseline data from the Malawi Epidemiology and Intervention Research Unit Non-Communicable Disease study (MEIRU NCD) were used. The study assessed adults in a rural (Karonga, Northern Malawi; n = 12,153) and an urban (area 25 of Lilongwe, the capital city; n= 12,869) of Malawi. The association of body mass index (BMI) and waist-hip ratio (WHR) with fasting lipids [TC, LDL-C, high density lipoprotein-cholesterol (HDL-C) and TG] was assessed by area and sex. Data from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used for the comparison with a population from a high-income European setting, and included 3286 adolescents (mean age 17.8), 4107 mothers (mean age 47.9), and 1933 fathers (mean age 53.3). Multiple linear regression was used to examine the association of both BMI and WHR with each lipid measure, adjusted initially for age and then for potential confounding by household assets, education, marital status, number of children, smoking, alcohol, physical activity, lipid-lowering medication, and HIV status. As the UK data were taken from largely urban/sub-urban dwelling adolescents and middle-aged females and males, we selected two age groups of participants from the urban group of the Malawi cohort that had similar age distributions to the UK cohorts to compare associations between Malawians and UK residents. Results We observed positive linear associations of BMI and WHR with TC, LDL-C and TG and inverse association with HDL-C. Associations between BMI/WHR and serum lipids were in general similar in females and males, however, differed by area, with the associations between BMI and all serum lipids being stronger in rural than urban females, except for HDL-C, which was stronger in urban females. Associations did not differ consistently between rural and urban male residents. Associations of BMI and WHR with lipids were mostly similar or weaker in Malawi than the UK urban residents in both sexes and age groups. However, in middle-aged males, there was some evidence that associations of BMI and WHR with TC and LDL-C were stronger in Malawians. Conclusions The consistent associations observed of higher adiposity with adverse lipid profiles in females and males living in rural and urban areas of Malawi highlight the emerging adverse cardio-metabolic epidemic in this poor population. The similarity (or even stronger) associations between the Malawian and UK population highlight the importance of early interventions to control the emerging obesity epidemic in SSA populations.