Blantyre City Research Articles

English

The study aimed at assessing the effects of sports gambling among the youths of Blantyre City in Southern Malawi. In this study, the sample size was made up of 30 youths compromising 19 males and 11 females. They were randomly selected by the researcher through probability sampling. Questionnaires were used to collect data for the study. The study achieved a 100% response rate.  The study revealed that 84.2% of the youths involved in sports betting are not aware of any of the rules or regulations protecting them as bettors, 68% of them do not invest in the money they get. Asked how this activity has affected them either negatively or positively, it is discovered it has brought more harm than good. A total of 9 of the respondents were affected by addiction, 5 of the respondents had financial constraints caused by betting, 3 of the respondents agreed that it wasted their time and 8 of them said that it affected them positively as it helps them spend their leisure time. The study established that sports betting is an activity that can jeopardize the social and moral welfare of the youths; hence, more research on sports betting addiction is needed about the youths to examine more the effects associated with this activity in Blantyre; and that more protection must be devised for the youths through the main stakeholders to safeguard their moral, social and academic welfare. The government policy should be more strengthened and tightened by increasing the eligible age for bettors and that more awareness about pathological betting is needed among the youths of Blantyre.   Key words: Gambling, betting, youths, effect, sports.

Barriers to product innovation among the manufacturing micro, small and medium enterprises in Malawi

Most micro, small, medium enterprises in Malawi struggle to grow and survive despite their critical role in the socio-economic development of the country. One major contributing factor is their inability to innovate. This study was therefore aimed at investigating the innovation barriers affecting the manufacturing MSMEs. The study was conducted among the 45 manufacturing MSMEs operating in the Malawi’s commercial city of Blantyre. The study adopted a case study approach and employed both quantitative and descriptive approaches. Empirical data was collected using a semi-structured questionnaire and one- on- one interview. The results of the study revealed that factors such as market competition, difficulty in accessing loans, inadequate government support, labour laws, taxes and regulations in the external environment, and inadequate financial resources, lack of qualified personnel, and poor financial performance within the enterprises hamper innovation activities within the MSMEs. Results of the study also revealed that despite government efforts to promote MSMEs innovativeness, most MSMEs do not participate in such government interventions and worse still some are not even aware of the existence of such interventions. The study therefore recommends that government should intensify its efforts to provide financial support in form of soft loans, entrepreneurial training to MSMEs and promote innovation in MSMEs through relevant policies. Key words: Micro small medium enterprises (MSMEs), innovation, barriers, manufacturing.

Healthcare workers' perceptions on collaborative capacity at a Referral Hospital in Malawi.

BackgroundLack of collaborative capacity results in provision of fragmented health services that do not meet the needs of patients. Collaborative capacity refers to the extent to which providers have influence over other healthcare workers’ decision-making, and can be assessed by measuring perceptions of task interdependence, quality of interaction and collaborative influence. However, each healthcare worker may present differing perceptions that can influence their ability to collaborate effectively during provision of care. No studies that specifically assessed healthcare workers’ perception of collaborative capacity in Malawi were identified.AimTo assess the perceptions of healthcare workers regarding collaborative capacity in Malawi.SettingThe study was conducted at a tertiary public hospital in Blantyre city, Malawi.MethodsThe study employed a quantitative cross-sectional correlational design. The instrument used was a Care Coordination survey that had been used previously in similar studies in the United States of America. Descriptive statistics as well as univariate and multivariate analysis were computed using Statistical Package for Social Science (SPSS) program version 21.0 (IBM, Armonk, NY, USA).ResultsA total of 384 healthcare workers participated in the study, with a response rate of 100%. There were differences in perceptions of collaborative capacity based on the cadre of the respondent (p < 0.005). Medical staff reported higher mean scores on quality of interaction (2.94) and collaborative influence (2.65), whereas technical support staff reported the lowest mean scores across all three measures of collaborative capacity (≤ 2.4).ConclusionDifferences in perceptions about collaborative capacity suggest the need for interventions to enhance interprofessional collaboration.ContributionThe study will inform strategies to promote interprofessional collaboration.

Application of Systems-Approach in Modelling Complex City-Scale Transdisciplinary Knowledge Co-Production Process and Learning Patterns for Climate Resilience

Literature shows that much research has been conducted on the co-production of climate knowledge, but it has neither established a standardized and replicable model for the co-production process nor the emergent learning patterns as collaborators transition from the disciplinary comfort-zone (disciplinary and practice biases) to the transdisciplinary third-space. This study combines algorithmic simulation modelling and case study lessons from Learning Labs under a 4-year (2016–2019) climate change management project called Future Resilience of African CiTies and Lands in the City of Blantyre in Malawi. The study fills the research gap outlined above by applying a systems-approach to replicate the research process, and a Markov process to simulate the learning patterns. Results of the study make a number of contributions to knowledge. First, there are four distinct evolutionally stages when transitioning from the disciplinary comfort-zone to the transdisciplinary third-space, namely: Shock and resistance to change; experimenting and exploring; acceptance; and integration into the third-space. These stages are marked by state probabilities of the subsequent stages relative to the initial (disciplinary comfort-zone) state. A complete transition to the third-space is marked by probabilities greater than one, which is a system amplification, and it signifies that there has been a significant increase in learning among collaborating partners during the learning process. Second, a four-step decision support tool has been developed to rank the plausibility of decisions, which is very hard to achieve in practice. The tool characterizes decision determinants (policy actors, evidence and knowledge, and context), expands the determinants, checks what supports the decision, and then rates decisions on an ordinal scale of ten in terms of how knowledge producers and users support them. Third, for a successful transdisciplinary knowledge co-production, researchers should elucidate three system-archetypes (leverage points), namely: Salient features for successful co-production, determinant of support from collaborators, and knowledge co-production challenges. It is envisioned that academics, researchers, and policy makers will find the results useful in modelling and replicating the co-production process in a methodical and systemic way while solving complex climate resilience development problems in dynamic, socio-technical systems, as well as in sustainably mainstreaming the knowledge co-produced in policies and plans.

Using data-driven approaches to improve delivery of animal health care interventions for public health

Rabies kills ∼60,000 people per year. Annual vaccination of at least 70% of dogs has been shown to eliminate rabies in both human and canine populations. However, delivery of large-scale mass dog vaccination campaigns remains a challenge in many rabies-endemic countries. In sub-Saharan Africa, where the vast majority of dogs are owned, mass vaccination campaigns have typically depended on a combination of static point (SP) and door-to-door (D2D) approaches since SP-only campaigns often fail to achieve 70% vaccination coverage. However, D2D approaches are expensive, labor-intensive, and logistically challenging, raising the need to develop approaches that increase attendance at SPs. Here, we report a real-time, data-driven approach to improve efficiency of an urban dog vaccination campaign. Historically, we vaccinated ∼35,000 dogs in Blantyre city, Malawi, every year over a 20-d period each year using combined fixed SP (FSP) and D2D approaches. To enhance cost effectiveness, we used our historical vaccination dataset to define the barriers to FSP attendance. Guided by these insights, we redesigned our vaccination campaign by increasing the number of FSPs and eliminating the expensive and labor-intensive D2D component. Combined with roaming SPs, whose locations were defined through the real-time analysis of vaccination coverage data, this approach resulted in the vaccination of near-identical numbers of dogs in only 11 d. This approach has the potential to act as a template for successful and sustainable future urban SP-only dog vaccination campaigns.

Financial Impact of the Corona Virus Pandemic from January to June the Case of Blantyre Small and Medium Entrepriises

Each and every business concern must maintain adequate amount of finance for their smooth running of the business concern and also maintain the business carefully to achieve the goal of the business concern. The business goal can be achieved only with the help of effective management of finance. We can’t neglect the importance of finance at any time at and at any situation. Financial management is very important in the field of increasing the wealth of the investors and the business concern. Ultimate aim of any business concern will achieve the maximum profit and higher profitability leads to maximize the wealth of the investors as well as the nation. There is higher rate of business stagnation of businesses due to its product cycle being affected due to economic downturn, mostly we expect business to grow from introduction, growth ,maturity then if not well managed may decline, The other stagnation has been created because of challenges of globalizations, the emergency of COVID 19 which started in Wuhan migrated to the whole world through those involved in international business. Qualitative research was done to explore the financial impacts of covid 19 from January to june 2020,the case of Blantyre city persperctive,Blantyre was chosen because it is a commercial city has all people of Malawian ethnic background and more of International business it gave a true reflection of Malawi small and medium enterprises stand. Quantitative data was collected using questionnaires, interviews, media and observations were also used to achieve the objectives. Managers of small and medium enterprises were interviewed to represent the organization to give a broader picture of the organization ,15 SME’s and 10 entrepreneurs were interviewed to have a picture on the other side of an individual. A deductive approach was used ,theories of international business and income inequality were used to assist in the finding out the problem.

High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi

Background: In low-income countries, like Malawi, important public health measures including social distancing or a lockdown have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCWs) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. Methods: We recruited 500 otherwise asymptomatic HCWs from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. Results: A total of 84 participants tested positive for SARS-CoV-2 antibodies. The HCWs with positive SARS-CoV-2 antibody results came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 8.2 - 16.5]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was eight times the number of reported deaths. Conclusions: The high seroprevalence of SARS-CoV-2 antibodies among HCWs and the discrepancy in the predicted versus reported deaths suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.

High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi

Background: In low-income countries, like Malawi, important public health measures including social distancing or a lockdown have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCWs) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. Methods: We recruited 500 otherwise asymptomatic HCWs from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. Results: A total of 84 participants tested positive for SARS-CoV-2 antibodies. The HCWs with positive SARS-CoV-2 antibody results came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 8.2 - 16.5]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was eight times the number of reported deaths. Conclusions: The high seroprevalence of SARS-CoV-2 antibodies among HCWs and the discrepancy in the predicted versus reported deaths suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.

Application of Process Intensification in the Treatment of Pit Latrine Sludge from Informal Settlements in Blantyre City, Malawi.

Many developing countries lack the infrastructure needed for the treatment of fecal sludge. One limitation in implementing available treatment options is the limited availability of land in the urban areas of these countries. This paper investigated the application of process intensification as a way of reducing the land area required to dewater and sanitize pit latrine sludge from informal settlements in Blantyre City, Malawi. The intensification of the sludge treatment process was achieved by enhancing dewatering through the application of additives and by combining the dewatering and sanitization stages. Nine combinations of sludge, lime and rice husk dosages, in addition to a control, were simultaneously loaded on unplanted drying bed units to dewater for 29 days. The study found a significant reduction of 21% to 73% in the land area required to dewater and sanitize pit latrine sludge. From the study, process intensification was shown to have the potential to significantly reduce the land area required to dewater and sanitize pit latrine sludge from informal settlements in Malawi cities. This makes it an option that can be implemented close to informal settlements, despite land limitation in these areas.

An Analysis of Urban Land Use/Land Cover Changes in Blantyre City, Southern Malawi (1994–2018)

Rapid and unplanned urban growth has adverse environmental and social consequences. This is prominent in sub-Saharan Africa where the urbanisation rate is high and characterised by the proliferation of informal settlements. It is, therefore, crucial that urban land use/land cover (LULC) changes be investigated in order to enhance effective planning and sustainable growth. In this paper, the spatial and temporal LULC changes in Blantyre city were studied using the integration of remotely sensed Landsat imageries of 1994, 2007 and 2018, and a geographic information system (GIS). The supervised classification method using the support vector machine algorithm was applied to generate the LULC maps. The study also analysed the transition matrices derived from the classified map to identify prominent processes of changes for planning prioritisation. The results showed that the built-up class, which included urban structures such as residential, industrial, commercial and public installations, increased in the 24-year study period. On the contrary, bare land, which included vacant lands, open spaces with little or no vegetation, hilly clear-cut areas and other fallow land, declined over the study period. This was also the case with the vegetation class (i.e., forests, parks, permanent tree-covered areas and shrubs). The post-classification results revealed that the LULC changes during the second period (2007–2018) were faster compared to the first period (1994–2007). Furthermore, the results revealed that the increase in built-up areas systematically targeted the bare land and avoided the vegetated areas, and that the vegetated areas were systematically cleared to bare land during the study period (1994–2018). The findings of this study have revealed the pressure of human activities on the land and natural environment in Blantyre and provided the basis for sustainable urban planning and development in Blantyre city.

Determinants of high residual post-PCV13 pneumococcal vaccine-type carriage in Blantyre, Malawi: a modelling study

BackgroundIn November 2011, Malawi introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant schedule. Four to 7 years after introduction (2015–2018), rolling prospective nasopharyngeal carriage surveys were performed in the city of Blantyre. Carriage of Streptococcus pneumoniae vaccine serotypes (VT) remained higher than reported in high-income countries, and impact was asymmetric across age groups.MethodsA dynamic transmission model was fit to survey data using a Bayesian Markov-chain Monte Carlo approach, to obtain insights into the determinants of post-PCV13 age-specific VT carriage.ResultsAccumulation of naturally acquired immunity with age and age-specific transmission potential were both key to reproducing the observed data. VT carriage reduction peaked sequentially over time, earlier in younger and later in older age groups. Estimated vaccine efficacy (protection against carriage) was 66.87% (95% CI 50.49–82.26%), similar to previous estimates. Ten-year projected vaccine impact (VT carriage reduction) among 0–9 years old was lower than observed in other settings, at 76.23% (CI 95% 68.02–81.96%), with sensitivity analyses demonstrating this to be mainly driven by a high local force of infection.ConclusionsThere are both vaccine-related and host-related determinants of post-PCV13 pneumococcal VT transmission in Blantyre with vaccine impact determined by an age-specific, local force of infection. These findings are likely to be generalisable to other Sub-Saharan African countries in which PCV impact on carriage (and therefore herd protection) has been lower than desired, and have implications for the interpretation of post-PCV carriage studies and future vaccination programs.

Analysis of Mobile Telecommunication Networks’ Coverage and Internet Capacity to Support mHealth Applications in Blantyre City: A Case of TNM and Airtel Networks

Analysis of Mobile Telecommunication Networks’ Coverage and Internet Capacity to Support mHealth Applications in Blantyre City: A Case of TNM and Airtel Networks

Assessment of the impact on paediatric rabies at Queen Elizabeth Central Hospital, Blantyre, Malawi, following a mass canine rabies vaccination programme

Purpose: Background: Rabies is a common infection in the domestic and wild animal population of Malawi. Significant numbers of children die a terrible death each year as a consequence. Many more individuals are bitten by potentially infected dogs each month and require post exposure vaccination. However, rabies is a preventable infection against which there is a good vaccine for both animals and humans. Previous work suggests that if canine vaccine coverage can reach 70%, there will be consequent fall in human incidence. Objectives: To determine the impact of a comprehensive canine vaccine campaign on paediatric rabies cases. Methods & Materials: Retrospective case note analysis. All historic paediatric rabies cases presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, between May 2012 and May 2017, have been identified and analysed. Data analysis compared paediatric rabies case numbers pre and post a comprehensive canine vaccine campaign which commenced in May 2015, in the Blantyre District. Results: In total 14 paediatric rabies cases were found during the study period. More males than females were affected (males: 10 (71%); females: 4 (29%)). The average age was seven years (range 3–11). The average length of stay in hospital was three days until death (range 1–7). Geographical locations of dog bites since data collection (May 2012) included Limbe, Lundu, Bangwe, Chileka, Mulanje, Muwalo, Nkhataumbera, Thyolo, Zomba, Mpemba and Mangochi region (four were unknown). Since May 2015 only two patients were admitted to QECH, but none of them came from Blantyre city nor district. Conclusion: This study underlines the importance of eliminating human rabies through canine rabies vaccination. Further funding of these campaigns will prevent unnecessary child deaths.

A Biowaste Treatment Technology Assessment in Malawi

In the city of Blantyre, much of the generated municipal waste is biowaste, typically mixed with other waste fractions and disposed at the city’s dumpsite. Energy and nutrients could be recovered; however, with many biowaste options available, choosing what technology to implement is difficult. Selecting Organic Waste Treatment Technology (SOWATT) is a tool that supports decision making for selecting a biowaste treatment option considering social, technical, and environmental aspects. SOWATT was used to evaluate options for Blantyre’s Limbe Market. Anaerobic digestion, black soldier fly processing, slow pyrolysis, in-vessel composting, windrow composting, vermicomposting, and wet-biomass-briquetting were considered as options. The performance of each alternative was assessed based on five objectives by government, NGO, and market-based stakeholders in order to determine the most acceptable option for the greatest number of people: something that is rarely done, or if it is the preferences are not rigorously quantified (e.g., stakeholder workshops) and/or weighted against specific objectives. However, given the novelty of the ranking-solicitation process, some participants struggled with the variety of options presented, and further iterations of SOWATT will address this limitation. Ultimately, vermicomposting scored highest of all alternatives and could best achieve the five objectives as prioritized by the stakeholders when implemented.

Household-level and surrounding peri-domestic environmental characteristics associated with malaria vectors Anopheles arabiensis and Anopheles funestus along an urban\u2013rural continuum in Blantyre, Malawi

BackgroundMalaria is increasing in some recently urbanized areas that historically were considered lower risk. Understanding what drives urban transmission is hampered by inconsistencies in how “urban” contexts are defined. A dichotomized “urban–rural” approach, based on political boundaries may misclassify environments or fail to capture local drivers of risk. Small-scale agriculture in urban or peri-urban settings has been shown to be a major risk determinant.MethodsHousehold-level Anopheles abundance patterns in and around Malawi’s commercial capital of Blantyre (~ 1.9 M pop.) were analysed. Clusters (N = 64) of five houses each located at 2.5 km intervals along eight transects radiating out from Blantyre city centre were sampled during rainy and dry seasons of 2015 and 2016. Mosquito densities were measured inside houses using aspirators to sample resting mosquitoes, and un-baited CDC light traps to sample host seeking mosquitoes.ResultsOf 38,895 mosquitoes captured, 91% were female and 87% were Culex spp. Anopheles females (N = 5058) were primarily captured in light traps (97%). Anopheles abundance was greater during rainy seasons. Anopheles funestus was more abundant than Anopheles arabiensis, but both were found on all transects, and had similar associations with environmental risk factors. Anopheles funestus and An. arabiensis females significantly increased with distance from the urban centre, but this trend was not consistent across all transects. Presence of small-scale agriculture was predictive of greater Anopheles spp. abundance, even after controlling for urbanicity, number of nets per person, number of under-5-year olds, years of education, and season.ConclusionsThis study revealed how small-scale agriculture along a rural-to-urban transition was associated with An. arabiensis and An. funestus indoor abundances, and that indoor Anopheles density can be high within Blantyre city limits, particularly where agriculture is present. Typical rural areas with lower house density and greater distance from urban centres reflected landscapes more suitable for Anopheles reproduction and house invasion. However, similar characteristics and elevated Anopheles abundances were also found around some houses within the city limits. Thus, dichotomous designations of “urban” or “rural” can obscure important heterogeneity in the landscape of Plasmodium transmission, suggesting the need for more nuanced assessment of urban malaria risk and prevention efforts.

Formalization of Informal Waste Pickers’ Cooperatives in Blantyre, Malawi: A Feasibility Assessment

Poor road networks, inadequate financial resources and low levels of political will mean that many developing countries, especially their unplanned settlements, struggle with solid waste management. Recently, Informal Waste Pickers (IWPs) have been incorporated into waste management cooperatives by formalizing their operations as a strategy to improve the quality and efficiency of waste management in such areas. This study was conducted in Zingwangwa, an unplanned settlement in Blantyre, Malawi, to understand whether the formalization of IWPs into cooperatives could be effective and/or accepted as a way of managing Municipal Solid Waste in unplanned urban settlements in Malawi. Thirty-four IWPs in Zingwangwa were identified and interviewed using a structured questionnaire; personnel from the Blantyre City Council and middlemen were interviewed as key informants. We determined that IWPs experience challenges in all dimensions of their lives: low material prices with exploitative price fluctuations, negative public perception and a lack of transportation are a few of their struggles. Furthermore, a fear of decreased income, conflicts during proceeds sharing, free riding behaviors and an attachment to their independence mean that IWPs are unlikely to form a cooperative on their own though some would be willing to join if a third party initiated the formalization process.

Colonial Remaking of Society–Nature Relations in Southern Africa: Reconfiguring Subjectivities, Producing a Commodified Waterscape in Blantyre City, 1850s–1890s

ABSTRACTThis paper seeks to build on scholarship that historicises the commodification of water in Africa. It foregrounds this phenomenon as part of broader processes of colonial remaking of society–nature relations. An empirical analysis is developed that illustrates how the British colonists’ condescending attitudes to indigenous social-ecologies, as well as the attendant exclusionary practises relating to colonisers versus colonised body-space interactions, not only formed the moral and material justification for subjugating the “inferior other” but also provided legitimating narratives for entrenching a racially differentiated urbanism, imposing western sanitation attitudes and introducing modernist ways of capturing and domesticating water at Blantyre. These marked a watershed moment in reconfiguring water–society interactions from being quotidian activities performed by the indigenes to produce water as a use-value/basic need, to that mediated by the circulation of money, modernist public health concerns and water technologies primarily intended to serve the interests of the minority white settlers; thus setting in stone the production of Blantyre town in Malawi as an alienated and commodified waterscape.

The ‘poisoned chalice’ of state ownership of water infrastructure in contemporary Blantyre, Malawi

ABSTRACTThe remunicipalisation of water in the global south has heightened a sense of optimism among left-leaning scholars and activists. This is widely heralded as a triumph over neo-liberal privatisation and therefore seen as putting water back into public hands. This article takes a critical view of this trend. It contends that insofar as remunicipalisation is conflated with state ownership, it may in other contexts not necessarily lead to water going back into public hands. An empirical account is presented of how state ownership in Malawi has been imbricated in commercialisation rationalities that have in turn undermined the establishment of an egalitarian public water network in Blantyre City. The article uncovers the extent to which the dominance of private capitalist interests in Malawi’s economy, lack of public financing and over-reliance on debt from global-local financial markets have systemically compromised the efficacy of the state in mediating the politics of water production and distribution.

Risk factors for &lt;i&gt;Anopheles&lt;/i&gt; mosquitoes in rural and urban areas of Blantyre District, southern Malawi

Although urban malaria transmission is low and seasonal, it remains a major public health problem. This study aimed at demonstrating the presence of Anopheles mosquitoes and their potential to transmit malaria in urban settings. Two cross-sectional surveys were carried out in Blantyre District, Malawi, during the dry and wet seasons of 2008 and 2010, respectively. A map of Blantyre was divided into a grid of 400 cells, of which 60 cells were randomly selected. Five households located within 100 m from the centre of each selected cell were enrolled, a standard questionnaire was administered, and indoor resting mosquitoes were sampled. In 2008 and 2010, a total of 960 and 1045 mosquitoes were collected, respectively. Anopheles funestus comprised 9.9% (n = 95) and 10.3% (n = 108) during the two surveys, respectively. Anopheles gambiae sensu lato (s.l.) was rarely detected during the second survey (n = 6; 0.6%). Molecular identification was performed on samples collected during the first survey, and An. funestus sensu stricto (s.s.) was the only sibling species detected. All the Anopheles mosquitoes were collected from households located in rural areas of Blantyre and none from urban areas. In univariate analysis, the presence of open eaves was associated with increased Anopheles prevalence, both during the dry (incidence rate ratio, IRR = 4.3; 95% CI 2.4 - 7.6) and wet (IRR = 2.47; 95% CI 1.7 - 3.59) seasons. Chances of detecting Anopheles spp. decreased with increasing altitude (IRR = 0.996; 95% CI 0.995 - 0.997) and during the dry season, but increased during the wet season (IRR = 1.0017; 95% CI 1.0012 - 1.0023). These factors remained significant following a multiple Poisson regression analysis. No association was found between insecticide-treated bednet ownership and the number of Anopheles mosquitoes detected. The presence of An. funestus s.s and An. gambiae s.l. in the periphery of Blantyre city was an indication that malaria transmission was potentially taking place in these areas.

Patterns and determinants of malaria risk in urban and peri-urban areas of Blantyre, Malawi.

BackgroundAlthough malaria disease in urban and peri-urban areas of sub-Saharan Africa is a growing concern, the epidemiologic patterns and drivers of transmission in these settings remain poorly understood. Factors associated with variation in malaria risk in urban and peri-urban areas were evaluated in this study.MethodsA health facility-based, age and location-matched, case–control study of children 6–59 months of age was conducted in four urban and two peri-urban health facilities (HF) of Blantyre city, Malawi. Children with fever who sought care from the same HF were tested for malaria parasites by microscopy and PCR. Those testing positive or negative on both were defined as malaria cases or controls, respectively.ResultsA total of 187 cases and 286 controls were studied. In univariate analyses, higher level of education, possession of TV, and electricity in the house were negatively associated with malaria illness; these associations were similar in urban and peri-urban zones. Having travelled in the month before testing was strongly associated with clinical malaria, but only for participants living in the urban zones (OR = 5.1; 95% CI = 1.62, 15.8). Use of long-lasting insecticide nets (LLINs) the previous night was not associated with protection from malaria disease in any setting. In multivariate analyses, electricity in the house, travel within the previous month, and a higher level of education were all associated with decreased odds of malaria disease. Only a limited number of Anopheles mosquitoes were found by aspiration inside the households in the peri-urban areas, and none was collected from the urban households.ConclusionTravel was the main factor influencing the incidence of malaria illness among residents of urban Blantyre compared with peri-urban areas. Identification and understanding of key mobile demographic groups, their behaviours, and the pattern of parasite dispersal is critical to the design of more targeted interventions for the urban setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1623-9) contains supplementary material, which is available to authorized users.