Chiradzulu District Research Articles

Road to Resettlement: Understanding Post-disaster Relocation and Resettlement Challenges and Complexities Through a Serious Game

Resettlement and relocation are among the most difficult policies to put into practice, but they may be the best ways to minimize future risks to settlements exposed to natural hazards both before and after disaster events. As climate-related disasters and forced migration become increasingly common worldwide, governments, humanitarian or development actors, and policymakers must now prioritize the implementation of a dignified and effective resettlement program as part of their planning and management responsibilities. Much of this effectiveness depends on the stakeholders and beneficiaries’ understanding and knowledge of the different resettlement phases, culture and customs of affected populations, activities, and the associated implementation challenges, costs, and benefits. Serious games are used in a variety of contexts to increase awareness, train and build capacity in stakeholders and beneficiaries. This article presents a serious game developed to educate practitioners, local agencies, students, and the public to understand the complexities and challenges involved in a successful resettlement. The game is based on a real proposed resettlement project initiated in the Chiradzulu District in southern Malawi after Cyclone Freddy in March 2023, which caused widespread flooding and landslides, forcing some villages to relocate permanently. The progression in the Road to Resettlement Game consists of six primary levels: land and site preparation, housing and livelihood, water, sanitation, and hygiene, health, education, and protection. These levels are meant to be completed in a sequence that adheres to the principles of resettlement. By engaging in the serious table-top board game, players gain an understanding of the resettlement activities, their sequence, and the associated practical (technical and social) and financial challenges.

Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Causes, outcomes and diagnosis of acute breathlessness hospital admissions in Malawi: protocol for a multicentre prospective cohort study.

Hospital admission due to breathlessness carries a significant burden to patients and healthcare systems, particularly impacting people in low-income countries. Prompt appropriate treatment is vital to improve outcomes, but this relies on accurate diagnostic tests which are of limited availability in resource-constrained settings. We will provide an accurate description of acute breathlessness presentations in a multicentre prospective cohort study in Malawi, a low resource setting in Southern Africa, and explore approaches to strengthen diagnostic capacity. Primary objective: Delineate between causes of breathlessness among adults admitted to hospital in Malawi and report disease prevalence. Secondary objectives : Determine patient outcomes, including mortality and hospital readmission 90 days after admission; determine the diagnostic accuracy of biomarkers to differentiate between heart failure and respiratory infections (such as pneumonia) including brain natriuretic peptides, procalcitonin and C-reactive protein. This is a prospective longitudinal cohort study of adults (≥18 years) admitted to hospital with breathlessness across two hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Chiradzulu, Malawi. Patients will be consecutively recruited within 24 hours of emergency presentation and followed-up until 90 days from hospital admission. We will conduct enhanced diagnostic tests with robust quality assurance and quality control to determine estimates of disease pathology. Diagnostic case definitions were selected following a systematic literature search. This study will provide detailed epidemiological description of adult hospital admissions due to breathlessness in low-income settings, which is currently poorly understood. We will delineate between causes using established case definitions and conduct nested diagnostic evaluation. The results have the potential to facilitate development of interventions targeted to strengthen diagnostic capacity, enable prompt and appropriate treatment, and ultimately improve both patient care and outcomes.

Multimorbidity-associated emergency hospital admissions: a "screen and link" strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol.

The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Inclusion of persons living with disabilities in a district-wide sanitation programme: A cross-sectional study in rural Malawi.

Community-led total sanitation (CLTS) is embraced as a key strategy to achieve universal sanitation coverage (Sustainable Development Goal 6.2). Although inclusion is identified as a predictor of CLTS success, people living with disabilities are often excluded from community sanitation programmes and there is limited research exploring CLTS participation amongst people living with disabilities. This study aims to explore the extent to which people living with disabilities participated in a CLTS intervention delivered in rural Malawi using standard approaches. This cross-sectional study was conducted in the Chiradzulu district of Malawi. A household questionnaire was administered to collect information about CLTS participation. Multivariable logistic regression was performed to compare participation in different CLTS activities between households with (n = 80) and without a member with a disability (n = 167), and between household members with (n = 55) and without a disability (n = 226). No difference in CLTS participation was observed at the household-level, but there were marked differences in CLTS participation between household members with and without a disability. Household members without a disability felt they could give more input in triggering activities (OR = 3.72, 95%CI 1.18-11.73), and reported higher participation in the transect walk (OR = 4.03, 95%CI 1.45-11.18), community action planning (OR = 2.89, 95%CI 1.36-6.13), and follow-up visits (OR = 3.37, 95%CI 1.78-6.40) compared to household members with disabilities. There was no difference in the likelihood of being invited to triggering (OR = 0.98, 95%CI 0.41-2.36), attending triggering (OR = 2.09, 95%CI 0.98-4.46), or participating in community mapping (OR = 2.38, 95%CI 0.71-7.98) between household members with and without a disability. This study revealed intra-household inequalities in CLTS participation. To improve participation in CLTS interventions, facilitators should be trained on action steps to make CLTS more inclusive. Further research could include an in-depth analysis of predictors of CLTS participation amongst people living with disabilities, including disability types, severity and age.

Fluoride Levels in Borehole Water: The Case of Chiradzulu District in Malawi

Aims: The objective of this study was to determine the levels of fluoride in borehole water samples.
 Study Design: The total of eight samples were collected from five villages in Chiradzulu and transported in cooler ice-bath to the laboratory for the analysis.
 Place and Duration of Study: The study was conducted in the Department of Chemistry and Chemical Engineering Laboratories, at University of Malawi in the month of June.
 Methodology: The ion selective electrode technique was used to assess fluoride levels. Physicochemical water parameters were measured with multi-meters. 
 Results: The results obtained ranged from 2.26 to 3.08 mg/L, 136 to 561 mg/L, 261-1212 μs/cm and 6.27 to 6.97, for Fluorides, TDS, conductivity and pH, respectively. Levels of fluorides exceeded permissible limits for borehole water established by WHO and were below the standards for MBS
 Conclusion: The results attained in the scope of the study support coloration of teeth observed amongst individuals in study communities, helping to understand that groundwater is not suitable for consumption. Therefore, the study provides recommendation for urgent implementation of defluoridation measures to provide clean and safe water for the existing community members.

Assessment of particulate matter exposure on ambient air and its impact on workers at two granite quarry mines at Njuli, Southern Malawi.

Quarrying activities are among the significant sources of pollution caused by particulate matter (PM) in ambient air. Besides affecting the environment, PM exposure is one of the leading causes of respiratory illnesses worldwide. The current study, unique to Malawi, aimed to understand the impact of particulate matter on ambient air and the possible effects on workers' health at Njuli in Blantyre and Chiradzulu districts. The study measured concentrations of particulate matter in ambient air, conducted a chemical analysis of fallen dust, and surveyed respiratory symptoms. Results showed higher exposures to particulate matter at a Terrastone mine (126µg/m3 highest exposure) than a Mota Engil mine (83µg/m3 highest exposure), attributed to poor management practices at Terrastone mine. Higher PM readings (0-85.98µg/m3) were observed for sites located downwind of the mines than sites located upwind (0-59µg/m3), demonstrating the impact of quarrying operations at the mines; differences were, however, not statistically significant (P 0.165, Terrastone, P 0.678 Mota Engil). The observed amount of PM in ambient air was consistent with the scale of quarrying and processing operations at both mines, 0-56.2µg/m3 in pre-operational phases, 0-126.1µg/m3 during operations, and 0-56µg/m3 after closure of operations; differences were statistically significant only at Terrastone mine P 0.003. The impact of season variation was observed following lower PM readings recorded during the rainy season than those obtained during the dry season at both mines. Analysis of health symptoms revealed that a higher proportion of workers at the Terrastone mine experienced respiratory symptoms compared to the Mota Engil mine.

Status of information, education, and communication as perceived by clients receiving antenatal care at Chiradzulu District Hospital in Malawi

BackgroundInformation, education, and communication is a strategy to spread awareness through communication channels to a target audience to achieve a desired positive result. Women are supposed to receive information, education, and communication at each contact with the health worker during antenatal care. In Malawi, information, education, and communication for antenatal care is inadequate despite high antenatal care coverage. Most women do not receive it as stipulated. This could be one of the reasons that maternal and neonatal mortality is high. The provision of information, education, and communication is supposed to help in reducing maternal mortality because it is intended to develop positive attitudes towards health behaviours to support pregnant women accessing health services when required. This study, therefore, assessed the status of information, education, and communication as perceived by clients receiving antenatal care at Chiradzulu District Hospital in Malawi.MethodsA descriptive study design with a sample of 384 pregnant women attending antenatal care was used. The sample size for the study was calculated using Lemeshow, Hosmer, Klar and Rwanga's formula. Systematic random sampling method was used to select the study participants. Data were analysed using a statistical package for social sciences software version 20.0.ResultsFindings revealed that information, education, and communication provided during antenatal care were inadequate. Most information was offered. However, no topic was rated adequate by 80% of the respondents according to the Likert Scale that was used. The majority of the respondents (71.4%, n = 274) (95% CI 66.5. 75.8) preferred to receive information, education, and communication from midwives who are in the category of skilled attendants. Results further showed that more than half of the respondents participated passively and spent little time receiving information, education, and communication.ConclusionThe findings signify that information, education, and communication provided to women receiving antenatal care at Chiradzulu District Hospital had some gaps. It was inadequate and some topics were not taught. The target audience participated passively. It is recommended that midwives should provide the information, education, and communication and must have adequate contact time with the women. This is so because they are believed to be trusted sources of information.

Adherence to Hand Hygiene among Nurses and Clinicians at Chiradzulu District Hospital, Southern Malawi.

Healthcare associated infections (HAIs) are a burden in many countries especially low-income countries due to poor hand hygiene practices in the healthcare settings. Proper hand hygiene in the healthcare setting is an effective way of preventing and reducing HAIs, and is an integral component of infection prevention and control. The objective of this study was to determine adherence to hand hygiene guidelines and associated factors among nurses and clinicians. A quantitative cross-sectional study was conducted at Chiradzulu District Hospital (Malawi) where stratified random sampling was used to obtain the sample of 75 nurses and clinicians. Data were collected using self-administered questionnaires (n = 75), observation checklists (n = 7) and structured observations (n = 566). The study findings confirmed low adherence to hand hygiene practice among healthcare workers (HCWs) in Malawi. Overall, higher hand hygiene practices were reported than observed among nurses and clinicians in all the World Health Organization’s (WHO) five critical moments of hand hygiene. This calls on the need for a combination of infrastructure, consumables (e.g., soap) and theory driven behavior change interventions to influence adoption of the recommended hand hygiene behaviors. However, such interventions should not include demographic factors (i.e., age, profession and ward) as they have been proven not to influence hand hygiene performance.

Viral suppression and HIV-1 drug resistance 1 year after pragmatic transitioning to dolutegravir first-line therapy in Malawi: a prospective cohort study

Many countries are now replacing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line antiretroviral therapy (ART) with a regimen containing tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD). Recognising laboratory limitations, Malawi opted to transition those on NNRTI-based first-line ART to TLD without viral load testing. We aimed to assess viral load and HIV drug resistance during 1 year following transition to TLD without previous viral load testing. In this prospective cohort study, we monitored 1892 adults transitioning from NNRTI-based first-line ART to the TLD regimen in the Médecins Sans Frontières-supported decentralised HIV programme in Chiradzulu District, Malawi. Eligible adults were enrolled between Jan 17 and May 11, 2019, at Ndunde and Milepa health centres, and between March 8 and May 11, 2019, at the Boma clinic. Viral load at the start of the TLD regimen was assessed retrospectively and measured at month 3, 6, and 12, and additionally at month 18 for those ever viraemic (viral load ≥50 copies per mL). Dolutegravir minimal plasma concentrations (Cmin) were determined for individuals with viraemia. Drug-resistance testing was done at the start of TLD regimen and at viral failure (viral load ≥50 copies per mL, followed by viral load ≥500 copies per mL; resistance defined as Stanford score ≥15). Of 1892 participants who transitioned to the TLD regimen, 101 (5·3%) were viraemic at TLD start. 89 of 101 had drug-resistance testing with 31 participants (34·8%) with Lys65Arg mutation, 48 (53·9%) with Met184Val/Ile, and 42 (40·4%) with lamivudine and tenofovir disoproxil fumerate dual resistance. At month 12 (in the per-protocol population), 1725 (97·9% [95% CI 97·1-98·5]) of 1762 had viral loads of less than 50 copies per mL, including 83 (88·3% [80·0-94·0]) of 94 of those who were viraemic at baseline. At month 18, 35 (97·2% [85·5-99·9]) of 36 who were viraemic at TLD start with lamivudine and tenofovir disoproxil fumarate resistance and 27 (81·8% [64·5-93·0]) of 33 of those viraemic at baseline without resistance had viral load suppression. 14 of 1838 with at least two viral load tests upon transitioning had viral failure (all with at least one dolutegravir Cmin value <640 ng/mL; active threshold), suggesting suboptimal adherence. High baseline viral load was associated with viral failure (adjusted odds ratio [aOR] 14·1 [2·3-87·4] for 1000 to <10 000 copies per mL; aOR 64·4 [19·3-215·4] for ≥10 000 copies per mL). Two people with viral failure had dolutegravir resistance at 6 months (Arg263Lys or Gly118Arg mutation), both were viraemic with lamivudine and tenofovir disoproxil fumarate resistance at baseline. High viral load suppression 1 year after introduction of the TLD regimen supports the unconditional transition strategy in Malawi. However, high pre-transition viral load, ongoing adherence challenges, and possibly existing nucleoside reverse transcriptase inhibitor resistance can lead to rapid development of dolutegravir resistance in a few individuals. This finding highlights the importance of viral load monitoring and dolutegravir-resistance surveillance after mass transitioning to the TLD regimen. Médecins Sans Frontières. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Cervical cancer screening coverage and its related knowledge in southern Malawi

BackgroundCervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened.MethodsA population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status.ResultsThe percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC.ConclusionMost of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.

Factors Influencing Community Participation in Forestry Management in Chiradzulu District, Malawi

Community participation in forestry management is a good approach to protecting forests and woodlands. This study was carried out to assess factors affecting community participation in forestry management in Chiradzulu District. The study employed a mixed-method approach where qualitative and quantitative data were collected. Results showed that there is an almost equal percentage of female and male respondents who participated in forestry management. The Logit model analysis shows that education variables are positive and statistically significant proving that education influences participation in forestry management and hence education is an important variable in determining households’ participation in forestry. Only the age group of 45 - 59 years was significant but had a negative coefficient with a moderate marginal effect at 59% (r = 0.59) implying that many people in this age group participated in forestry activities than other age groups. When the size of household land ownership was used as a proxy to indicate household wealth and then correlated with participation in forestry activities, a positive and significant correlation between households that owned 1 - 2 acres and 3 - 5 acres of land and their participation in forestry activities was observed. It can be concluded that the size of land owned is one of the key factors that determine households’ participation in forestry management. Furthermore, a connection between land size distribution and effects on environmental resources was evident.

Unmet need of essential treatments for critical illness in Malawi.

Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

Implementation and operational feasibility of SAMBA I HIV-1 semi-quantitative viral load testing at the point-of-care in rural settings in Malawi and Uganda.

We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load=SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. Between August 2013 and December 2016 a total of 60889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.

Factors associated with mobile phone ownership and potential use for rabies vaccination campaigns in southern Malawi

BackgroundRabies is a fatal but preventable viral disease, which causes an estimated 59 000 human deaths globally every year. The vast majority of human rabies cases are attributable to bites from infected domestic dogs and consequently control of rabies in the dog population through mass vaccination campaigns is considered the most effective method of eliminating the disease. Achieving the WHO target of 70% vaccination coverage has proven challenging in low-resource settings such as Sub Saharan Africa, and lack of public awareness about rabies vaccination campaigns is a major barrier to their success. In this study we surveyed communities in three districts in Southern Malawi to assess the extent of and socio-economic factors associated with mobile phone ownership and explore the attitudes of communities towards the use of short message service (SMS) to inform them of upcoming rabies vaccination clinics.MethodsThis study was carried out between 1 October–3 December 2018 during the post-vaccination assessment of the annual dog rabies campaign in Blantyre, Zomba and Chiradzulu districts, Malawi. 1882 questionnaires were administered to households in 90 vaccination zones. The surveys gathered data on mobile phone ownership and use, and barriers to mobile phone access. A multivariable regression model was used to understand factors related to mobile phone ownership.ResultsMost survey respondents owned or had use of a mobile phone, however there was evidence of an inequality of access, with higher education level, living in Blantyre district and being male positively associated with mobile phone ownership. The principal barrier to mobile phone ownership was the cost of the phone itself. Basic feature phones were most common and few owned smartphones. SMS was commonly used and the main reason for not using SMS was illiteracy. Attitudes to receiving SMS reminders about future rabies vaccination campaigns were positive.ConclusionsThe study showed a majority of those surveyed have the use of a mobile phone and most mobile phone owners indicated they would like to receive SMS messages about future rabies vaccination campaigns. This study provides insight into the feasibility of distributing information about rabies vaccination campaigns using mobile phones in Malawi.

IMPACT OF MICROFINANCE ON SOCIO-ECONOMIC EMPOWERMENT OF WOMEN THROUGH SOCIAL WORK: EVEDENCE FROM MALAWI

This ‘study’ seeks to explore the influence of microfinance on ‘women’ empowerment and the contribution of the ‘social work’ profession point of view. This paper used a qualitative research design, ‘focus group discussions’ and an interview schedule guide was used to obtain data. The ‘study’ was conducted in Chiradzulu district in Malawi, and 100 women from four villages of Traditional Authority Nkalo participated in this study. The results of this ‘study’ presented in a manner that reflects the themes which were ‘grouped’ into four ‘domains’, financial security, ‘socio-economic’ empowerment and role of ‘social work’ on microfinance groups.

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.

The Prevalence of Diabetes Mellitus among People Living with HIV/AIDS Receiving Anti-Retroviral Therapy in Chiradzulu District, Malawi: A Cross – Sectional Study

The Prevalence of Diabetes Mellitus among People Living with HIV/AIDS Receiving Anti-Retroviral Therapy in Chiradzulu District, Malawi: A Cross – Sectional Study

Knowledge and Practices of Cervical Cancer and Its Prevention Among Malawian Women.

Malawi has the highest incidence of cervical cancer in the world. Due to various challenges the country faces in terms of cervical cancer control, women have a poor chance to survive this disease. The purpose of our study was to describe the knowledge and practices of cervical cancer and its screening as well as the educational preferences of women living in a rural community in the Chiradzulu District. We conducted a survey among women between the ages 30 and 45, used convenience sampling, a calculated sample size (n = 282) and structured interviews to collect the data. A questionnaire adapted from a previous study served as data collection instrument. The data were analysed in Microsoft Excel and chi-square (p < .05) was used to investigate the relationships between the variables. Content analyses analysed the open-ended questions. The mean age of the sample was 36.1 (SD ± 5.1) and the highest percentage (37.4%; n = 98) belonged to the Yao ethnic group. The majority attended primary school (66.0%; n = 173), were married (74.4%; n = 195) and depended on a small business as source of income (55.7%; n = 146). Most of the women (93.4%; n = 247) had heard of cervical cancer and the visual inspection with acetic acid (VIA) screening programme (67.9%; n = 178) but only 22.9% (n = 60) indicated they had been screened. Lack of knowledge of the screening programme was the most common reason for not being screened. Having a demonstration of the VIA procedure was the most popular educational method (92.0%; n = 241) which gives a fresh approach to educational programmes aimed at preventing cervical cancer.

Patients’ Perceptions of Health Information Given by Nurses and Clinicians at Discharge at Chiradzulu District Hospital in Malawi, Sub-Saharan Africa

Background: Hospital discharge information is a critical component of preparation to facilitate patient transition from hospital to home. Numerous studies elsewhere provide evidence that patients and families encounter a variety of problems after discharge from hospital such as difficulties with functional abilities and carrying out personal care. These problems are often attributed to having unmet informational needs at discharge. Objective: The main objective of the study was to assess patients’ perceptions of the health information provided by nurses and clinicians at discharge. Methods: The study was conducted at Chiradzulu District Hospital in Malawi. A qualitative method of data collection (in-depth interviews) was used. Convenience sampling method was used to select patients into the study. Data was analyzed using Nvivo 9 software. Findings: The study found that most patients were given information by nurses and clinicians on how to perform self-care at home on discharge from hospital. The study revealed that most patients perceived the discharge information as relevant in assisting them with home care. In addition, the study found that most patients perceived it as inadequate. The study also found that the factors that facilitated patients understanding of information were clear explanation of information and use of understandable language by information providers. Barriers included lack of encouragement from information providers to make patients speak, incomprehensive information provided to the patients and patients fear of asking information providers’ questions. Conclusion: Nurses and clinicians should make sure that all patients are given some discharge information to help them to manage their self care at home. Those patients who are at high risk for readmission should be given detailed information.