Bay District Research Articles

EngAGE – Local Integrated Multidisciplinary Teams for Older People.

Introduction: Older people in Hawkes Bay have increasingly complex health and social needs. Many remain in their own homes, receiving support from multiple agencies. engAGE was designed to better meet growing demand. Targeted population: Community-dwellers (i.e. not resident in Age Related Residential Care) over 65 years or ‘like in age and need’ i.e. 55 years and over Maori and Pacifica. Stakeholders: Primary Care, community services involved in the care of older people, the Hawkes Bay District Health Board Older Peoples’ Health Service. Practice change implemented: engAGE community multidisciplinary teams (MDT’s) are based geographically around General Practice groupings, consist of staff from primary care, Hospital Older Persons’ Health Services and community providers and meet weekly in a General Practice setting. Referrals come from primary care, acute hospital and community agencies. Comprehensive interprofessional assessment takes place in the client’s home and creative solutions are developed through team discussion to maximise independence. Input continues until goals are met or no further improvement is possible. engAGE Intermediate Care Bed (ICB) services provide an alternative to an inpatient stay in an ARRC facility for clients not well enough to be at home but not requiring hospital care. Admissions come from community (step-up) or acute hospital (step-down). Clients receive MDT input in partnership with their primary care team for up to 6 weeks. Aim: engAGE MDTs provide faster and more appropriate care and support, aiming to impact waiting times for allied health input and care support packages. Staff knowledge of systems, older peoples’ health issues and satisfaction will improve. Comprehensive MDT input and ICB services aim to improve health outcomes and increase independence, reducing emergency department presentations, inpatient bed occupancy and readmission rates for older people and improving satisfaction of clients and caregivers. Older people will remain at home for longer as measured by time from engAGE input to entry into ARRC. Improved service efficiency, hospital inpatient and ARRC resident costs avoided will contribute to financial sustainability services. Timeline: Cross sector Steering Group and Working Group 2011. Pilot MDT with ICB services in a single locality 2012, second MDT 2014. Four further MDTs November 2015. ICB services April 2016. Highlights: engAGE has been well received by clients and staff in primary care, community providers, and hospital. Closer relationships, face to face communication and information sharing have improved system efficiency. Growing group expertise has allowed interprofessional working. Waiting times for allied health input have reduced. ICB’s are well utilised and well received by clients. KPI reporting is in progress. Sustainability: Ongoing support by primary care is critical to sustainability. High workload impacts on primary care attending meetings. The primary care business model is a challenge to integration and a request by primary care for appropriate remuneration for time spent with engAGE requires resolution. Transferability: engAGE is highly transferable to other locations and populations e.g. community mental health, services for youth, children living in poverty. Conclusions: engAGE, in its early stages, is providing responsive, comprehensive input to older people in the Hawkes Bay community.

Analysis of HIV disease burden by calculating the percentages of patients with CD4 counts

South Africa (SA)'s Comprehensive HIV and AIDS Care, Management and Treatment (CCMT) programme has reduced new HIV infections and HIV-related deaths. In spite of progress made, 11.2% of South Africans (4.02 million) were living with HIV in 2015. The National Health Laboratory Service (NHLS) in SA performs CD4 testing in support of the CCMT programme and collates data through the NHLS Corporate Data Warehouse. The objective of this study was to assess the distribution of CD4 counts <100 cells/µL (defining severely immunosuppressed HIV-positive patients) and >500 cells/µL (as an HIV-positive 'wellness' indicator). CD4 data were extracted for the financial years 2010/11 and 2014/15, according to the district where the test was ordered, for predefined CD4 ranges. National and provincial averages of CD4 counts <100 and >500 cells/µL were calculated. Data were analysed using Stata 12 and mapping was done with ArcGIS software, reporting percentages of CD4 counts <100 and >500 cells/µL by district. The national average percentage of patients with CD4 counts <100 cells/µL showed a marked decrease (by 22%) over the 5-year study period, with a concurrent increase in CD4 counts >500 cells/µL (by 57%). District-by-district analysis showed that in 2010/11, 44/52 districts had >10% of CD4 samples with counts <100 cells/µL, decreasing to only 17/52 districts by 2014/15. Overall, districts in the Western Cape and KwaZulu-Natal had the lowest percentages of CD4 counts <100 cells/µL, as well as the highest percentages of counts >500 cells/µL. In contrast, in 2014/15, the highest percentages of CD4 counts <100 cells/µL were noted in the West Rand (Gauteng), Vhembe (Limpopo) and Nelson Mandela Bay (Eastern Cape) districts, where the lowest percentages of counts >500 cells/µL were also noted. The percentages of CD4 counts <100 cells/µL highlighted here reveal districts with positive change suggestive of programmatic improvements, and also highlight districts requiring local interventions to achieve the UNAIDS/SA National Department of Health 90-90-90 HIV treatment goals. The study further underscores the value of using NHLS laboratory data, an underutilised national resource, to leverage laboratory test data to enable a more comprehensive understanding of programme-specific health indicators.

Preserving the Contract: The Experience of Indentured Labourers in the Wide Bay and Burnett Districts in the Nineteenth Century

On the cusp of the pastoral boom of the late 1840s, squatters in the Northern Districts of New South Wales dreamed of the reliable shepherd who could be bought for ten pounds per annum. In the remote Burnett and Wide Bay districts, this aim was realised by the importation of so-called Asiatic labourers, first from Bengal and then from China. In the 1860s, thousands of South Sea Islanders joined these coolie ranks, labouring mostly on the coastal sugar plantations, but also as shepherds on the pastoral runs in the hinterland. Each of these experiments with indentured coloured labourers was deemed a failure by the white employers. In strictly economic terms, this judgement was patently false. On the other hand, as this paper discusses, the assertiveness of the immigrant workers for contractual rights defied their masters' expectations of a cheap and docile labour force.

The Changing Epidemiology of Invasive Pneumococcal Disease Among the Indigenous and Non-indigenous Population of Northwestern Ontario, Canada, from 2006 Through 2015 and Emergence of Non-vaccine Serotypes

BackgroundRates of invasive pneumococcal disease (IPD) among indigenous populations remain substantially higher than their non-indigenous counterparts. The goal of this study was to analyze the epidemiology and demographic features of IPD in northwestern Ontario (NWO) among the indigenous and non-indigenous population in the context of recent changes in the provincial pneumococcal vaccination programs.MethodsTwo databases were used to identify cases of IPD in NWO: Thunder Bay Regional Health Sciences Centre and the Thunder Bay District Health Unit. Adult patients with a diagnosis of IPD at the TBRHSC from January 1, 2006 to December 31, 2015 had their medical charts retrospectively reviewed; TBDHU data contained only serotype, age, and gender data.ResultsTable 1.Number of IPD cases and case fatality rate by indigenous status at the TBRHSC, 2006–2015# of cases# of deathsyearindigenousnon-indigenoustotalindigenousnon-indigenoustotal2006371000020070880112008511160112009820282022010517220222011622281122012381101120131012221342014101121000201531316022total531291824111553 of 182 (29.0%) of patients were indigenous. 35 of 53 (66.0%) of indigenous patients were immunocompromised, whereas 38 of 129 (29.5%) of non-indigenous patients were immunocompromised and the difference was statistically significant (P < 0.001, by chi square test). 35 of 73 (48.0%) of immunocompromised patients were indigenous.Table 2.Serotype distribution of Streptococcus pneumoniae causing IPD in northwestern Ontario, Canada, 2006–2015 (includes both TBRHSC + TBDHU data).yearPCV7PCV13PCV23non-vaccine serotypesunknown serotypestotal200600002626200710211216200822541427200931293164320100784123120112101249372012021184252013032128342014129382320151076923total10388435118285The proportion of non-vaccine serotypes has increased, on average, by 16% per year (P = 0.024, 95% CI: 1.02, 1.32).ConclusionHigh rates of IPD were found to occur among immunocompromised indigenous adults in NWO. Our findings identify a vulnerable cohort of the population that would benefit from pneumococcal vaccination coverage. The proportion of non-vaccine serotypes causing IPD has increased during the 10-year observation period.Disclosures M. Ulanova, Pfizer: Grant Investigator, Grant recipient

High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada.

BackgroundWorldwide, indigenous populations appear to be at increased risk for invasive group A streptococcal (iGAS) infections. Although there is empirical evidence that the burden of iGAS disease is significant among remote First Nations communities in Northwestern Ontario, Canada, the epidemiology of iGAS infections in the area remains poorly characterized.MethodsIndividuals that met case definition for iGAS disease and whose laboratory specimens were processed by Meno Ya Win Health Centre in Sioux Lookout, Canada or who were reported to Thunder Bay District Health Unit, Canada were identified for the period 2009 to 2014. Case demographics, clinical severity, comorbidities, and risk factors were collected through chart review. Strain typing and antibiotic susceptibility were determined when possible. Basic descriptive statistics were calculated.ResultsSixty-five cases of iGAS disease were identified, for an annualized incidence of 56.2 per 100 000. Primary bacteremia was present in 26.2% of cases, and cellulitis was identified in 55.4% of cases. The most common comorbidities identified were diabetes (38.5%) and skin conditions (38.5%). Prevalent risk factors included alcohol dependence (25%). Fourteen different emm types were identified among 42 isolates, with the most common being emm114 (17.4%), emm11 (15.2%), and emm118 (13.0%). Resistance to erythromycin and clindamycin was found in 24.6% of isolates.ConclusionsRural and remote First Nations communities in Northwestern Ontario experience iGAS infections at a rate 10 times the provincial and national average. Compared with other North American series, a lower proportion of isolates causing infection were of emm types included in candidate GAS vaccines.

Urban effects of the transnational circulation of branded buildings: Comparing two skyscrapers and their context in Barcelona and Doha

The use of brand architecture today is widespread since it is supposed to have broad positive effects such as improving the urban environment, skyline and media visibility. This article examines some of these assumptions by comparing two case studies: Agbar Tower in Poblenou, Barcelona and Doha Tower in the West Bay District in Doha, Qatar. Ateliers Jean Nouvel designed both buildings for hosting similar office functions and for distinguishing the image of the respective cities. The two cities have quite different historic development and urban environment, urban planning and design institutions, which we analyze. Drawing from this evidence, the article criticizes the simplistic assumptions that circulate internationally, calling for a deeper understanding of urban design, planning and policy factors. In particular, if urban actors expect to improve material and immaterial features of a city, they should strengthen relevant urban design and planning procedures, rather than simply investing in brand architecture.

Fighting resource scarcity – sustainability in the education system of Malawi – case study of Karonga, Mzimba and Nkhata Bay district

Malawi and specifically the Northern Region remains a mostly agricultural and very rural country. Hence, many households rely on agricultural activities, either as smallholder farmers or employees on bigger farms. Furthermore, the Malawian population growth of three per cent per annum is very high, which is why the demand for food and other resources like water or energy increases drastically. As ‘Agriculture’ is a subject within the Malawian curriculum this article focuses on its role and content. The research focuses on the teaching methods and content of the subject. A main focus was put on the way the concept of sustainability is being taught and the areas of sustainability that are being covered. A qualitative methodological approach, combining document analysis, ethnographical research and fourteen semi-structured interviews with teachers at public secondary schools in the Northern Region provided an in-depth insight into how the concept of sustainability is being grasped and taught. The importance and chances of teaching ‘Agriculture’ as a subject became visible, while at the same time many general and subject-specific obstacles remain and partly diminish the positive effects of the subject. Teachers are aware of the concept of sustainability, without necessarily being familiar with the terminology ‘sustainability’.

Chan Zuckerberg plans Bay Area biohub

The Chan Zuckerberg Initiative, created by Facebook founder Mark Zuckerberg and his wife Priscilla Chan, have pledged $600 million to create a new California bioscience hub. Involving Stanford University and the University of California campuses in San Francisco and Berkeley, the Biohub will have locations in San Francisco’s Mission Bay district and at Stanford. Funds for the Biohub will come out of $3 billion the initiative is pledging over 10 years to fight disease. It has a goal of curing, preventing, or managing all diseases by the end of the century.

Assessing the Impacts of Chinese Sustainable Ground Transportation on the Dynamics of Urban Growth: A Case Study of the Hangzhou Bay Bridge

Although China has promoted the construction of Chinese Sustainable Ground Transportation (CSGT) to guide sustainable development, it may create substantial challenges, such as rapid urban growth and land limitations. This research assessed the effects of the Hangzhou Bay Bridge on impervious surface growth in Cixi County, Ningbo, Zhejiang Province, China. Changes in impervious surfaces were mapped based on Landsat images from 1995, 2002, and 2009 using a combination of multiple endmember spectral mixture analysis (MESMA) and landscape metrics. The results indicated that the area and density of impervious surfaces increased significantly during construction of the Hangzhou Bay Bridge (2002–2009). Additionally, the bridge and connected road networks promoted urban development along major roads, resulting in compact growth patterns of impervious surfaces in urbanized regions. Moreover, the Hangzhou Bay Bridge promoted the expansion and densification of impervious surfaces in Hangzhou Bay District, which surrounds the bridge. The bridge also accelerated socioeconomic growth in the area, promoting rapid urban growth in Cixi County between 2002 and 2009. Overall, the Hangzhou Bay Bridge is an important driver of urban growth in Cixi County, and policy suggestions for sustainable urban growth should be adopted in the future.

Global occurrence, geology and characteristics of tubular halloysite deposits

AbstractHalloysite with tubular morphology is formed in a wide range of geological environments from the alteration of various rock types. Intrusive acidic coarse-grained rocks, such as granites, pegmatites and anorthosite, with large potash and sodic feldspars contents, are subsequently altered to kaolinite, halloysite and other clay minerals by weathering or shallow hydrothermal fluid activity. Processing to separate the halloysite-kaolinite fraction from the altered host rock provides a product which can be used as a paper filler and in ceramics and fibreglass, among other uses, with various deposits in Brazil, China, Thailand and elsewhere. In the Kerikeri-Matauri Bay district of Northland, North Island, New Zealand, volcanic alkali rhyolite was extruded as domes and cooled rapidly with fine-grained feldspar subsequently altered to halloysite. The IMERYS plant in Matauri Bay separates the clay from the quartz-cristobalite matrix with an ∼20% yield of halloysite. The principal market is for high-quality porcelain and bone china that require low levels of Fe2O3 and TiO2. Deposits with high levels of halloysite occur in China, Turkey and the USA. The Dragon mine in Utah, USAwas recently reopened by Applied Minerals Inc. and now produces halloysite from zones of up to 100% white halloysite. Smaller occurrences of tubular halloysite are mined in China, Turkey and elsewhere from masses of comparatively pure clay that appear to have crystallized directly from solutions in which Al and Si were soluble.

Proliferation of the biocontrol agent Fusarium oxysporum f. sp. strigae and its impact on indigenous rhizosphere fungal communities in maize under different agro-ecologies

Our objectives were to (1) monitor the proliferation of the biocontrol agent (BCA) Fusarium oxysporum f. sp. strigae strain “Foxy-2”, an effective soil-borne BCA against the parasitic weed Striga hermonthica, in the rhizosphere of maize under different agro-ecologies, and (2) investigate its impact on indigenous rhizosphere fungal community abundance and composition. Field experiments were conducted in Busia and Homa Bay districts in western Kenya during two cropping seasons to account for effects of soil type, climate, growth stage and seasonality. Maize seeds were coated with or without “Foxy-2” and soils were artificially infested with S. hermonthica seeds. One treatment with nitrogen rich organic residues (Tithonia diversifolia) was established to compensate hypothesized resource competition between “Foxy-2” and the indigenous fungal community. Rhizosphere soil samples collected at three growth stages (i.e., EC30, EC60, EC90) of maize were subjected to abundance measurement of “Foxy-2” and total indigenous fungi using quantitative polymerase chain reaction (qPCR) analysis. Terminal restriction fragment length polymorphism (TRFLP) analysis was used to assess potential alterations in the fungal community composition in response to “Foxy-2” presence. “Foxy-2” proliferated stronger in the soils with a sandy clay texture (Busia) than in those with a loamy sand texture (Homa Bay) and revealed slightly higher abundance in the second season. “Foxy-2” had, however, only a transient suppressive effect on total indigenous fungal abundance which ceased in the second season and was further markedly compensated after addition of T. diversifolia residues. Likewise, community structure of the indigenous fungal community was mainly altered by maize growth stages, but not by “Foxy-2”. In conclusion, no adverse effects of “Foxy-2” inoculation on indigenous fungal rhizosphere communities were observed corroborating the safety of this BCA under the given agro-ecologies.

The Investigation of Groundwater Potential by Vertical Electrical Sounding (VES) Approach in Arguni Bay Region, Kaimana Regency, West Papua

This research was conducted within some villages in the surrounding area that administratively including Arguni Bay District, Kaimana Regency, West Papua. The main objective of this study is to vertically measure resistivity value of aquifer with the intention of recognizing deep groundwater potency as a source of native’s domestic needs. In addition, VES method by Schlumberger electrode array was applied within 18 locations, which expectantly represent the whole area of research. The resistivity data is then interpreted by IP2Win 2.1 Geoelectric Software to entirely describe the aquifer system as well as the occurrence of groundwater. The result indicates that vertically, the aquifer system is dominated by interbedded of claystone and sandstone (argillite group) as a past marine environment mineral. In addition, geomorphological and resistivity sounding interpretation gives a viewpoint that the landforms of the research area may be typified as Structural Mountain with the slope direction is towards the island beaches. Also, structurally, the main groundwater system is fractured aquifer with very limited productivity of groundwater resources. As consequences, this aquifer is more to be an aquitard, rather than an aquifer.

Resilience of family farming 1984–2014: Case studies from two sheep/beef hill country districts of New Zealand

AbstractIn this analysis, the resilience of family farmers is investigated in two hill country districts of New Zealand (Central Hawkes Bay and Waitomo District) by following the experiences of a sample of 119 sheep/beef producers through two snapshots of their circumstances taken three decades apart. The famers and their spouses were first interviewed in 1984 prior to the removal of state subsidies and other assistance. In 2012–2013, 94 of the farmers (or their successors) were interviewed again. During the period under investigation, they had coped with economic shocks, natural disasters (particularly major droughts) and for some, personal tragedies. The focus of the study is on the economic viability of the family farms in the face of a range of hazardous and adverse events, and how their owners (and families) are adapting and responding to global and local economic and social changes, and the natural disasters which are a normal backdrop to farming.

High Incidence of Invasive Group A Streptococcus Disease Caused by Strains of Uncommon emm Types in Thunder Bay, Ontario, Canada.

An outbreak of type emm59 invasive group A Streptococcus (iGAS) disease was declared in 2008 in Thunder Bay District, Northwestern Ontario, 2 years after a countrywide emm59 epidemic was recognized in Canada. Despite a declining number of emm59 infections since 2010, numerous cases of iGAS disease continue to be reported in the area. We collected clinical information on all iGAS cases recorded in Thunder Bay District from 2008 to 2013. We also emm typed and sequenced the genomes of all available strains isolated from 2011 to 2013 from iGAS infections and from severe cases of soft tissue infections. We used whole-genome sequencing data to investigate the population structure of GAS strains of the most frequently isolated emm types. We report an increased incidence of iGAS in Thunder Bay compared to the metropolitan area of Toronto/Peel and the province of Ontario. Illicit drug use, alcohol abuse, homelessness, and hepatitis C infection were underlying diseases or conditions that might have predisposed patients to iGAS disease. Most cases were caused by clonal strains of skin or generalist emm types (i.e., emm82, emm87, emm101, emm4, emm83, and emm114) uncommonly seen in other areas of the province. We observed rapid waxing and waning of emm types causing disease and their replacement by other emm types associated with the same tissue tropisms. Thus, iGAS disease in Thunder Bay District predominantly affects a select population of disadvantaged persons and is caused by clonally related strains of a few skin and generalist emm types less commonly associated with iGAS in other areas of Ontario.

Longer-Term Follow-Up of Kenyan Men Circumcised Using the ShangRing Device.

ObjectivesTo ascertain clinical sequelae, client satisfaction and sexual behavior 2+ years after male circumcision using the ShangRing device.MethodsWe enrolled 199 men from the Kenya sites (Homa Bay district) participating in a 2012 study of the ShangRing device used in routine male circumcision services (N = 552). We enrolled men who had had the ShangRing placed successfully, and over-sampled men who had had an adverse event and/or were HIV-positive during the field study. In the present study, each participant was examined and interviewed by a study clinician, and penile photographs were taken to document longer-term cosmetic results and any abnormal findings.Results194 men were included in the analysis. The mean and median times between circumcision and the longer-term follow-up visit in this study were 31.8 and 32 months, respectively. Four men (2.1%) had signs/symptoms of a sexually transmitted infection (STI). Virtually all (99.5%) of the men were very satisfied with the appearance of their circumcised penis, and all would recommend a ShangRing circumcision to friends or family members. The most prevalent reported advantage of the circumcision was the ease of bathing and enhanced cleanliness of the penis (75.8%). 94.3% of the men did not cite a single negative feature of their circumcision. 87.5% of men reported more sexual pleasure post-MC, the most common reason being more prolonged intercourse. The majority of men (52.6%) reported one sexual partner post-MC, but more than a quarter of the men (28.1%) reported an increased number of partners post-MC. Less than half of the men (44.3%) reported using condoms half of the time or more, but the great majority of condom users stated that condom use was much easier post-MC, and 76.9% of users said they used condoms more after circumcision than before.ConclusionsThis study supports the safety and acceptability of ShangRing male circumcision during 2–3 years of follow-up. It should allay worries that the ShangRing procedure could lead to delayed complications later than the observation period of most clinical studies.Trial RegistrationClinicalTrials.gov NCT01567436

Patient and caregiver preferences for home dialysis—the home first study: a protocol for qualitative interviews and discrete choice experiments

IntroductionThe number of patients requiring dialysis continues to increase worldwide imposing a substantial social and economic burden on patients, their families and healthcare systems. Compared with facility-based dialysis, dialysis performed...

The Hawke's Bay Condom Card Scheme: a qualitative study of the views of service providers on increased, discreet access for youth to free condoms.

The incidence of sexually transmitted infections and unplanned pregnancies in adolescence is of concern. The Hawke's Bay District Health Board, New Zealand, set up a pilot condom card scheme ('the Scheme') to allow 13- to 24-year-olds, deemed suitable for the Scheme, to access free condoms from pharmacies on presentation of a Condom Card. Our study explored the views of service providers of a pilot Condom Card Scheme. Qualitative interviews were conducted with 17 service providers (nurses, pharmacists, pharmacy staff) between February and April 2013. Our findings showed that the Scheme was viewed positively by service providers, who indicated almost universal support for the Scheme to continue. However, participants noted a perceived lack of advertising, low number of sites for collection of condoms, lack of flexibility of the Scheme's criteria relating to who could access the scheme and issues with some pharmacy service providers, all of which led to a number of recommendations for improving the Scheme. The views of service providers indicate broad support for the continuation of the Scheme. Canvassing young people's suggestions for improving the Scheme is also essential.

BLOOD GROUPS AND HAEMOGLOBIN VALUES AMONGST THE EWA GE AND OROKAIVA PEOPLE OF THE NORTHERN DISTRICT OF PAPUA

HPHE Northern District of Papua comprises an area of about 8,000 square miles, 1 lying between the north-east coast and the central mountains of the Owen Stanley Range. To the south, it adjoins the Milne Bay District, and to the north the Morobe District of New Guinea. The coastline is about 150 miles long. The width of the district is in general only 50-70 miles, and in this short distance the land rises from sea-level to over 10,000 feet. The coastal plain is more marked in the northern half of the District, the southern part being of a more broken and mountainous character.

Socio-economic and demographic factors related to HIV status in urban informal settlements in the Eastern Cape, South Africa

The prevalence of HIV&AIDS is embedded in social and economic inequity and the relationship between social determinants and HIV incidence is well established. The aim of this study was to determine which socio-economic and demographic factors are related to HIV status in the age group 18 to 49 years in informal settlements in the Eastern Cape, South Africa. This cross-sectional study was conducted in 3 informal settlements (n = 752) during March 2013 within the Nelson Mandela Bay and Buffalo City districts. A proportional cluster sample was selected and stratified by area and formal plot/squatter households in open areas. Respondents who volunteered to participate had to provide informed written consent before trained, bilingual peer educators interviewed them and completed the structured questionnaire. HIV status was determined and information on demographic and socio-economic variables was included in the bivariate analysis. The prevalence of HIV was higher, at 17.3%, than the 2011 estimated national prevalence among the general population in South Africa. The level of education (χ2 = 5.50, df = 1, p < 0.05), geographical site (χ2 = 7.41, df = 2, p < 0.05), gender (χ2 = 33.10, df = 1, p < 0.0005), household food insecurity (χ2 = 4.77, df = 1, p < 0.05), cooking with cast iron pots (χ2 = 15.0, df = 3, p < 0.05) and availability of perceived ‘wealth’ indicators like mobile telephones and refrigerators (χ2 = 9.67, df = 2, p < 0.05) were significantly associated with HIV-status. No significant associations could be demonstrated between household income, the number of people living in the household and the availability of electricity/water and HIV status. As the observed levels of HIV prevalence underlined gender bias and failure to graduate from high school, future interventions should focus on HIV prevention in female schoolchildren. However, HIV infection is also prevalent among wealthier individuals in informal settlements, which indicates that renewed efforts should be made to improve sexual risk behaviour within this group.

Identification of the potential opportunities, barriers, and threats within the sector in taking up sanitation as a business: rural sanitation in Nkhata Bay District (Malawi)

Private sector participation in sanitation marketing provides a great opportunity to improve rural sanitation access. Although a number of opportunities for private sector participation within the sanitation sector exist, there are numerous barriers and threats to taking up sanitation as a business. This Note from the Field identifies these opportunities, barriers, and threats in Nkhata Bay District, a rural area of Malawi. These insights emerge from a wider research project entitled ‘Private sector participation in the delivery of sanitation and hygiene services’. This note provides background information on the research project on private sector participation and the project location. It goes on to describe the data collection process and present two examples of business activities in the district sanitation sector, before listing the opportunities, barriers, and threats identified and the recommendations that emerge from them.