Communities In Malawi Research Articles

Contribution of Inquiry-Based Learning to the Improvement of Biology Teaching and Learning in Malawi Community Day Secondary Schools

Contribution of Inquiry-Based Learning to the Improvement of Biology Teaching and Learning in Malawi Community Day Secondary Schools

Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi

BackgroundVoluntary medical male circumcision (VMMC) is becoming more popular as an important HIV prevention strategy. Malawi, with a high HIV and AIDS prevalence rate of 8.8% and a low male circumcision prevalence rate of 28% in 2016, is one of the priority countries recommended for VMMC scale-up. This paper investigates the attitudes and key challenges to VMMC adoption in a traditionally circumcising community in Malawi where male circumcision is culturally significant.MethodsA mixed design study using quantitative and qualitative data collection methods was carried out to determine the attitudes of 262 randomly selected males towards VMMC in a culturally circumcising community in Malawi. Statistical Package for the Social Sciences (SPSS) version 20 was used to analyse the quantitative data. To identify predictors of VMMC uptake, we used logistic regression analysis. To identify the themes, qualitative data were analysed using content analysis.ResultsThe findings indicate that, while more males in this community prefer medical circumcision, traditional circumcision is still practised. Panic (63%) perceived surgical complications (31%), and cost (27%) in accessing VMMC services were some of the barriers to VMMC uptake. Age and culture were found to be statistically significant predictors of voluntary medical male circumcision in the logistic analysis. According to qualitative data analysis, the key challenges to VMMC uptake were the involvement of female health workers in the circumcision team and the incentives provided to traditional circumcisers.ConclusionAccording to the findings of this study, VMMC services should be provided in a culturally competent manner that respects and considers existing cultural beliefs and practices in the community. Coordination between local leaders and health workers should be encouraged so that VMMC services are provided in traditional settings, allowing for safe outcomes, and increasing VMMC uptake.

A Re-conceptualization of the Effects of Remittances in Rural Communities in Malawi - The Case of T/A Malanda, Nkhata-Bay District

“a reconceptualization of the effects of remittances in rural communities in malawi” – a case of t/a malanda area, nkhata-bay

Diversity of Sources of Income for Smallholder Farming Communities in Malawi: Importance for Improved Livelihood

Agriculture is vital to global food production. Around 550 million smallholding households produce most of the world’s food, and many rely on livestock rearing for a living. Smallholder farms must survive and thrive to maintain and increase food production. Baseline information is vital for further extension service interventions. The goal of this Malawian study was to collect quantitative baseline data on crop and livestock production, agriproduct sales, and other indicators through a household survey, and to compare the efficacy (in terms of income) of using the concept of “Lead and Follow” farmer training programs. The baseline study survey was carried out in 44 sections of 11 extension planning areas from Malawi’s five districts (Dowa, Kasungu, Mchinji, Mzimba, and Rumphi). In total, 1131 smallholder households were interviewed. Crop production, livestock farming, and providing casual labor for others were all identified as significant sources of income for smallholders, implying that all agriproducts (the whole-farm approach) is equally important for improving smallholder livelihoods. On the one hand, the whole-farm approach should improve smallholders’ resilience regarding climate change and poverty. Lower agriproduct sales, on the other hand, indicated that links to the market were frequently poor but an increased market focus should help smallholders sell their produce at a fair margin. In terms of best practices adoption, both Lead and Follow farmers adopted similar farm practices (crops and livestock) to increase income. In general, no significant difference in income was calculated from many farm enterprises for both Lead and Follow farmers. However, the income from pigs and firewood was significantly higher for Follow farmers than for Lead farmers. Lead farmers reported significantly higher off-farm income sources. Significant changes are proposed to the “Lead farmer extension approach”.

Conservation agriculture improves adaptive capacity of cropping systems to climate stress in Malawi

ContextAdaptation to climate stress is an unprecedented challenge facing cropping systems. Most adaptation assessments focus on how adaptation options affect yields of a single crop under different weather or climate conditions. Yet, cropping systems often comprise more than one crop, and holistic assessments should consider all crops grown in a cropping system. One adaptation option is Conservation Agriculture that is commonly defined around a set of three principles: minimum mechanical soil disturbance, permanent soil organic cover, and crop species diversification. ObjectiveHere we estimated the statistical effect of Conservation Agriculture on cropping-system yields under historical climate conditions. MethodsThe cropping-system yields considered all crops grown including maize (Zea mays L.) and legumes in intercropping or rotation, or both. The climate conditions included conditions of heat stress for maize and precipitation balances during the maize growing season. Heat stress for maize was studied using growing degree days over 30 °C. Precipitation balance was the difference between precipitation and reference evapotranspiration. Data included 6296 yield observations from on-farm trials in farmer plots conducted over 14 seasons (2005–2006 to 2018–2019) in ten communities in Malawi. These yield data were coupled with daily weather data. We studied three treatments: (1) a Control Practice treatment where the soil was tilled, crop residues were removed, and there was no crop species diversification, (2) a No-Tillage treatment where the soil was not tilled, crop residues were retained, and there was no crop species diversification, and (3) a Conservation Agriculture treatment where the soil was not tilled, crop residues were retained, and there was crop species diversification through legume intercropping. The use of maize varieties and legume rotation changed over time; however, the treatments studied remained the same over the entire length of the on-farm trials period in all individual communities. Results and conclusionsResults of our study showed that heat stress for maize had a negative effect on cropping-system yields for non-stress-tolerant maize varieties and no legume rotation, although the Conservation Agriculture treatment reduced this negative effect compared with the Control Practice treatment. With the use of stress-tolerant maize varieties and legume rotation and Conservation Agriculture, our results suggest that heat stress for maize did not have a negative effect on cropping-system yields. SignificanceOur results demonstrate how Conservation Agriculture can improve the adaptive capacity of cropping systems and this provides urgently needed evidence on how farmers can adapt to climate stress.

A gender-differentiated analysis of climate-smart agriculture adoption by smallholder farmers: application of the extended technology acceptance model

The low adoption of climate-smart agriculture (CSA) technologies by farmers in developing regions where agrarian livelihoods are threatened by climate-related disasters remains a concerning enigma. Adoption patterns are not commensurate with merits of CSA on food security and climate resilience and attention to gender in relation to behavioral and attitudinal patterns in CSA adoption remains scarce. An exploratory-sequential mixed methods study was conducted, using a socio-psychological theoretical lens to test the applicability of the extended technology acceptance model in predicting CSA adoption among at-risk smallholder farming communities in Malawi and Zambia. Spearman’s rho correlation results show that relationship strengths between socio-psychological factors—perceptions on ease of use, usefulness and climate risk—differed between men and women householdheads. Results also show that social processes are central in influencing women’s decision-making on adoption. For practitioners and policy-makers, these findings reflect a critical need for gender-specific behavioral change communication strategies and inclusive participatory engagement. This will promote dialogue with diverse groups of smallholder-farmers aimed at changing negative, and leveraging on positive, behavior and attitudes toward new CSA technologies. CSA technology development for smallholder-farmers needs to appreciate the role of socio-psychological factors in adoption decisions. Further scientific research is required to establish causality between related socio-psychological factors.

Flesh and bones: Working with the grain to improve community management of water

• Working with the grain can make community management more effective but represents a methodological, empirical, and implementation challenge. • These challenges are centred through a study of community-managed water in rural Ethiopia, Malawi, and Uganda. • Working with the grain re-renders water management as a non-technical process of navigating and negotiating social relations. • There is a need to shift the focus away from development projects to the ongoing work of local governments. • This includes prioritising applied social science education among government staff and flexible working between local departments. Despite cogent critiques and limited successes, community-based management (CBM) remains central to policies for natural resource management and service delivery. Various approaches have been suggested to strengthen CBM by ‘working with the grain’ of existing social arrangements and relationships. For advocates, such approaches ensure that management arrangements are rooted in local realities and are therefore more likely to be effective. Implementing this approach is, however, methodologically, empirically, and operationally challenging. In this paper, we centre these challenges through a study of community-managed water in rural Ethiopia, Malawi, and Uganda. We examine water management arrangements by undertaking an in-depth social survey of 150 communities in the three countries. We also undertake yearlong studies in 12 communities in Malawi and Uganda involving 30 diary keepers. This focus on the local is complemented by country-level political economy analyses and district-level sustainability assessments. Our multi-country extensive-intensive research design uncovers the flesh and bones of CBM, and provides explanations for our findings. In Ethiopia, water management arrangements are more likely to be fleshed out – fully formed committees often working in conjunction with other institutions. In Malawi and Uganda, water management arrangements tend to be skeleton crews of key individuals. The position we adopt is located between advocacy and critique. We recognise the potential of working with the grain. We also recognise the considerable challenges of operationalising this approach without reducing it to another standardised checklist or toolbox. In an attempt to reconcile this tension, we identify practical entry points and sketch out requirements for a more socially informed, reflexive, and effective approach to working with the grain. Whether this can be operationalised within the logics of mainstream development, and whether it can ‘save’ the CBM model, remain open questions.

The association of HIV status with rural-urban differences in wealth in Malawi: 2004–2015/16

ABSTRACT This retrospective cross-sectional study examined the association of HIV status with wealth in Malawi using the 2004, 2010, and 2015/16 Malawi Demographic and Health Survey (MDHS) data. A harmonized wealth index was generated using factor analysis of the pooled data. Bivariate and multivariate linear regression models were estimated to examine the association of HIV status with wealth stratified by urban and rural communities in Malawi. The sample consisted of 33,484 individuals(3,419 were HIV positive and 30,065 HIV-negative). While only 52% of the participants were female, women constituted 61% of those who were HIV positive. Findings showed a positive association between HIV status and wealth in rural but not in urban locations. In rural locations, HIV status was significantly associated with increased wealth (β=0.11; 0.07, 0.15), whereas having more children in the household (β=−0.02; −0.03, −0.02) and being employed (β=−0.07; −0.09, −0.04) were associated with decreased wealth. Given our findings of increased HIV prevalence among those with a higher wealth index in rural Malawi, broadening HIV-prevention efforts to include programs that target the wealthy in Malawi might help mitigate new HIV infections. To effectively address HIV in Malawi, HIV programming policies must target women and men at all socioeconomic status levels.

A qualitative study exploring stakeholder perspectives on the use of biological samples for future unspecified research in Malawi

BackgroundThere is growing interest in the collection, storage and reuse of biological samples for future research. Storage and future use of biological samples raise ethical concerns and questions about approaches that safeguard the interests of participants. The situation is further complicated in Africa where there is a general lack of governing ethical frameworks that could guide the research community on appropriate approaches for sample storage and use. Furthermore, there is limited empirical data to guide development of such frameworks. A qualitative study to address this gap was conducted with key stakeholders in Malawi to understand their experiences and perspectives regarding storage and usage of samples for future research.MethodsThis study conducted 13 in-depth interviews with ethics committee members, regulators and researchers, and five focus group discussions with community representatives and clinical trial participants in Malawi. Interviews and focus group discussions were audio-recorded, transcribed verbatim, and thematically analysed.ResultsOn the current regulatory guidelines that governs the collection, storage and reuse of samples in Malawi, participants highlighted their different understanding of it, with some indicating that it prohibited the reuse and sharing of samples, while others believed it permitted.Views on the informed consent model used in Malawi, some stakeholders expressed that the current model limited options for sample contributors regarding future use. Researchers supported storing samples for future use in order to maximize their value and reduce research costs. However, they expressed concern over the exportation of samples highlighting that it could lead to misuse and would not support the development of research capacity within Malawi. They recommended use of broad consent or tiered consent and establishment of biobanks to address these concerns.ConclusionsStudy findings highlighted the need for a review of the current regulatory guideline and the development of infrastructure to support the use of stored biological samples for future use among the research community in Malawi. At the moment, there are ethical and practical concerns arising from the collection, storage and secondary use of biological samples make it hard to reconcile scientific progress and the protection of participants.

Understanding the adoption of climate-smart agriculture: A farm-level typology with empirical evidence from southern Malawi

Abstract Climate-smart agriculture (CSA) is increasingly important for advancing rural development and environmental sustainability goals in developing countries. Over the past decade, the international community has committed billions of dollars to support various practices under the banner of CSA. Despite this effort, however, CSA adoption remains low in many contexts. Lack of conceptual clarity about the range of potential farm-level CSA practices across contexts impedes understanding of CSA adoption in developing countries. Here we review relevant literature to develop a typology of farm-level CSA practices to facilitate analyses of CSA adoption. The typology consists of six categories, organized from least to most resource intensive: (1) residue addition, (2) non-woody plant cultivation, (3) assisted regeneration, (4) woody plant cultivation, (5) physical infrastructure, and (6) mixed measures. We use the typology to generate and test hypotheses about CSA adoption using primary household survey data from a large aid-funded CSA intervention area in southern Malawi. We then use recursive bivariate probit regression (controlling for endogeneity and selection bias) to estimate the effect of program participation on adoption across CSA categories. We find positive and statistically significant effects of program participation on adoption of CSA practices generally with the strongest effects on resource-intensive CSA categories. Results demonstrate the potential for wider application of the typology to build knowledge of the effectiveness of CSA promotion efforts across different social and environmental contexts. Our findings also suggest the importance of external support for the adoption of more resource-intensive CSA practices among rural households and communities in Malawi and elsewhere in the developing world.

Poverty and food security: drivers of insecticide-treated mosquito net misuse in Malawi

BackgroundOver the past decade, food insecurity, connected to erratic rains and reduced agricultural outputs, has plagued Malawi. Many households are turning to fishing to seek additional sources of income and food. There is anecdotal evidence that insecticide-treated net (ITN) recipients in Malawi are using their nets for purposes other than sleeping, such as for fishing, protecting crops, and displaying merchandise, among others. The objective of this qualitative study was to explore the factors leading residents of waterside communities in Malawi to use ITNs for fishing.MethodsThis study used qualitative and observational methods. Five waterside communities were identified, two each in the North, Central and Southern regions, representing a mix of lakeside and riverside settings. Fifteen focus group discussions were conducted with a total of 146 participants, including men, women, and community leaders.ResultsRespondents stated that they knew that ITNs should be slept under to protect from malaria. Respondents discussed financial hardships their communities were facing due to droughts, poverty, food scarcity, unemployment, and devaluation of the Malawian currency, the kwacha. Many described selling household goods, including clothes and cooking pots, to generate short-term income for their family. Though no respondents admitted to selling an ITN themselves, the practice was commonly known. Participants said that food shortages were forcing them to make difficult choices. Fishing with ITNs was reported to be common in the study sites, as a response to food insecurity, and was widely understood to be harmful over the longer term. Respondents felt that it was everyone’s responsibility to cut down on this practice, but that efforts to confiscate or burn nets and boats of those caught fishing with ITNs were counter-productive since boats, especially, were a required resource for a productive livelihood. Respondents feared that if the health workers, government officials and donors continued to see ITNs being misused for fishing, the distribution of free ITNs would end, which would worsen malaria in their communities.ConclusionsFaced with economic hardships and food security crises, participants reported being forced to look for alternative incomes to feed their families. This sometimes included selling or repurposing their belongings, including ITNs, for income. This issue is complex and will require a community-led multisectoral response to preserve health, fisheries, and livelihoods.

Mass Administration of Azithromycin to Prevent Pre-school Childhood Mortality: Boon or Bane?

A group of American researchers funded by the Bill and Melinda Gates Foundation examined the effect of mass administration of azithromycin, on mortality in pre-school children. This was done through a community-based randomized controlled trial (RCT) designated MORDOR-I, conducted in Malawi, Niger, and Tanzania [1]. MORDOR is an acronym for the French title of the study. Community clusters of children (1 month to 5-year-old) were randomized to receive either azithromycin (single dose 20 mg/kg, administered twice a year for 2 years) or identical placebo (in the same dosage schedule). The overall mortality rate (expressed as deaths per 1000 person years) was 13.5% lower in the treatment arm, with 95% confidence interval 6.7% to 19.8% (hence statistically significant). However, detailed analysis showed that only communities in Niger had statistically significant mortality reduction to the extent of 18% (95% CI 10%, 25.5%), whereas those in Malawi and Tanzania did not. Thus, the overall mortality reduction was largely due to the reduction in Niger. This significant intercountry difference was partly attributed to higher baseline mortality in Niger, and stronger effect of mass azithromycin administration in such settings [2]. The investigators then evaluated the administration of two doses of azithromycin (6 months apart) in children from both groups of communities in Niger only. Thus, communities in the original Azithromycin group (in MORDOR-I) received a total of 6 doses, whereas those in the original placebo group received 2 doses. This part of the study has been designated MORDOR-II [3], and is examined in detail here. Communities in Malawi and Tanzania that did not show mortality decline were not evaluated any further. The primary outcome in MORDOR-II [3] was the same as in MORDOR-I viz. all-cause mortality at the community level. Secondary outcomes included intra-group comparison of mortality. Although safety data were mentioned in the manuscript [3], the data were not presented. The results showed a comparable mortality rate (expressed as deaths per 1000 person-years) among children who received 6 doses of azithromycin over three years versus those who received 2 doses over 1 year. In contrast, the mortality after administration of 2 doses and 4 doses of azithromycin (versus similar doses of placebo) was 16.0% and 20.3% lower respectively, in the azithromycin group. Intra-group comparison showed that mortality in the original placebo group was 26.3 at the end of year 1 of MORDOR-I, 28.0 at the end of year 2 of MORDOR-I, and 24.0 at the end of MORDOR-II. This translated to an overall (statistically significant) 13.5% reduction in mortality between pre-MORDOR-I and post-MORDOR-II. In contrast, the intra-group comparison in the azithromycin group showed a 3.6% higher mortality after MORDOR-II, compared to before MORDOR-I (although the difference was not statistically significant). The authors reiterated their original conclusion that mass administration of azithromycin reduced mortality among pre-school children in Niger [1,3], and additional administration of two doses did not appear to wane this effect. However, there was no additional benefit on mortality with the third year of mass azithromycin administration.

The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi

BackgroundMalaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions.MethodsThis paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes.ResultsUsing education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members’ attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours.ConclusionThe HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs’ motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers’ motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.

Unrealized Educational Expectations and Mental Health: Evidence from a Low-Income Country.

The rapid expansion of schooling across low-income countries, combined with intensive governmental and nongovernmental efforts to promote education, has encouraged youth in these contexts to form exceptionally high educational expectations, despite immense structural barriers to achieving them. Consequently, many young people's educational expectations go unmet, driving concerns over the possible unintended consequences, including their elevated risk of mental health problems. At the same time, role transitions (e.g., marriage, parenthood) remain important elements of the transition to adulthood in many low-income countries, and may be a source of resilience-allowing youth to shift their identity away from education towards a new role. In this study, we explore the mental health implications of young women's unmet educational expectations, and the possible buffering impact of motherhood, in a low-income community in Malawi, in southeast Africa. Analyses of six years of longitudinal data show that young women's unmet expectations to continue school are associated with multiple indicators of mental health disadvantage across two points in time. In the short term, however, this is only true of young women who did not enter motherhood in the midst of their educational plans going unrealized: young women who became mothers-and thus achieved a key element of the transition to adulthood in this setting-experience fewer mental health disadvantages. The findings demonstrate the potential mental health consequences of young adults' expectations exceeding their outcomes while also highlighting a source of resilience.

Understanding gender dimensions of climate-smart agriculture adoption in disaster-prone smallholder farming communities in Malawi and Zambia

Purpose Through the application of traditional and contemporary feminist theories in gender mainstreaming, the purpose of this paper is to contribute to emergent debate on gender dimensions in climate-smart agriculture (CSA) adoption by smallholder farmers in disaster-prone regions. This is important to ensure that CSA strategies are tailored to farmer-specific gender equality goals. Design/methodology/approach An exploratory-sequential mixed methods research design which is qualitatively biased was applied. Key informant interviews and farmer focus group discussions in two study sites formed initial qualitative phase whose findings were explored in a quantitative cross-sectional household survey. Findings Findings shared in this paper indicate the predominant application of traditional gender mainstreaming approaches in CSA focusing on parochial gender dichotomy. Qualitative findings highlight perceptions that western gender approaches are not fully applicable to local contexts and realities, with gender mainstreaming in CSA seemingly to fulfil donor requirements, and ignorant of the heterogeneous nature of social groups. Quantitative findings establish that married men are majority adopters and non-adopters of CSA, while dis-adopters are predominantly de jure female household heads. The latter are more likely to adopt CSA than married women whose main role in CSA is implementers of spouse’s decisions. Access to education, intra-household power relations, productive asset and land ownership are socio-cultural dynamics shaping farmer profiles. Originality/value By incorporating African feminisms and intersectionality in CSA, value of this study lies in recommending gender policy reforms incorporating local gender contexts within the African socio-cultural milieu. This paper accentuates potential benefits of innovative blend of both contemporary and classic gender mainstreaming approaches in CSA research, practice and technology development in disaster-prone regions.

An implementation model to guide rural Malawian communities in the scaling-up of an effective HIV prevention programme: an implementation science study

Abstract Background Scaling-up of evidence-based programmes for HIV prevention in areas of high prevalence is a global priority. Many implementation models exist, but a major barrier is the lack of implementation models that are straightforward enough for use by community volunteers who have little education or research experience. Our previous findings have shown the efficacy of a peer-group HIV-prevention programme in Malawi. Now, to shift ownership of this programme from researchers to rural community volunteers, we have adapted an existing implementation model to guide rural Malawi community members in implementation of this programme. Here we describe communities' use of this three-step (Prepare, Roll-out, Sustain) Community Implementation Model (CIM). Methods We brought together district health, political, and traditional leaders, who agreed to support implementation of the programme; coordinating committees were formed in each community to organise implementation. We conducted workshops to develop leaders' capacities for following the CIM. The committee tracks progress every 6 months, recording the number of benchmarks met from a list of 28. Using a hybrid stepped-wedge design, we simultaneously evaluated three communities' use of the CIM to guide the implementation processes. Findings By Jan 17, 2019, all three communities had successfully begun implementation using the three-step CIM. During the Prepare step, each community established a coordinating committee, which planned and selected volunteers who were trained as peer group leaders. During Roll-out, peer leaders offered the programme. Two communities have begun the Sustain step, making and carrying out plans to continue and expand the programme. These two communities at the Sustain step have developed capacities needed to keep the programme going. One has submitted a proposal to obtain funding from our project budget; they will soon apply for local funding. The number of benchmarks achieved have steadily increased in all three communities and are shared with local leaders. All three communities have been highly enthusiastic and successful in carrying out the implementation. Interpretation The CIM is an effective and replicable model to guide future community implementations of this and other health promotion programmes. If the pattern of results seen from two of our three communities continue with the third community, we conclude that the model will support transfer of programme ownership from researchers to community members. Funding National Institutes of Health/National Institute for Nursing Research R01NR015409 and R01 NR08058.

Negative rumours about a vaginal ring for HIV-1 prevention in sub-Saharan Africa

Rumours may influence health-related behaviours, including the uptake of and adherence to HIV prevention products. This study assessed the safety and effectiveness of a vaginal ring delivering the antiretroviral dapivirine for HIV prevention in Africa. We explored negative rumours about study participation and the vaginal ring amongst study participants and their communities in Malawi, Uganda, South Africa and Zimbabwe. In total 214 women participated in either single or serial in-depth interviews, or a focus group discussion. Three key findings emerged in the data. Firstly, rumours reflected fears concerning the ring and trial participation. Given the historical-political context of the countries in which the trial was conducted, the ring’s investigational nature and its foreign origin, ring use was rumoured to cause negative health outcomes such as cancer and infertility and to be associated with practices such as witchcraft or Satanism. The salience of these rumours varied by country. Secondly, rumours reportedly affected participants’ adherence to the ring, and other women’s willingness to participate in the study. Finally, participants reported that participant engagement activities helped address rumours, resulting in enhanced trust and rapport between staff and participants.

The Arrival of Islam in Malawi

The Arrival of Islam in Malawi Abbas Saidi Mdoka, Dr Che Amnah Binti Bahari Abstract This paper seeks to shed more light on the question of when and how Islam arrived in Malawi, who introduced it and what was the motive for its inauguration. Thepaper also attempts to make an inquiryinto how Christian missionaries sitting aloof observed, processed and responded to the growth and developments of Islam within Muslim communities in Malawi. It will also discuss the social, economic and political implications on Muslims, due to their refusal to send children to missionary school on account of “Education for Christianity”. And how the church, carefully drafted contemptuous desolations for Muslims which were borne due to church‟s noble ambition to Christianize the already religious Muslims instead of strengthening their membership to the heathen hordes who at the time outnumbered both Muslims and Christians all together. The research data were obtained through library study of books, journal and articles on the history of both Islam and Christianity. Full Text: PDF DOI: 10.15640/jisc.v7n2a5

Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study.

SummaryBackgroundRotavirus is a major contributor to child mortality. The effect of rotavirus vaccine on diarrhoea mortality has been estimated in middle-income but not low-income settings, where mortality is high and vaccine effectiveness in reducing admissions to hospital is lower. Empirical population-based mortality studies have not been done in any setting. Malawi introduced monovalent rotavirus vaccine (RV1) in October, 2012. We aimed to investigate the impact and effectiveness of the RV1 vaccine in reducing diarrhoea-associated mortality in infants aged 10–51 weeks.MethodsIn this population-based cohort study, we included infants born between Jan 1, 2012, and June 1, 2015, in Mchinji, Central Malawi and analysed data on those surviving 10 weeks. Individual vaccination status was extracted from caregiver-held records or report at home visits at 4 months and 1 year of age. Survival to 1 year was confirmed at home visit, or cause of death ascertained by verbal autopsy. We assessed impact (1 minus mortality rate ratio following vs before vaccine introduction) using Poisson regression. Among vaccine-eligible infants (born from Sept 17, 2012), we assessed effectiveness (1 minus hazard ratio) using Cox regression.FindingsBetween Jan 1, 2012, and June 1, 2015, we recruited 48 672 livebirths in Mchinji, among whom 38 518 were vaccine-eligible and 37 570 survived to age 10 weeks. Two-dose versus zero-dose effectiveness analysis included 28 141 infants, of whom 101 had diarrhoea-associated death before 1 year of age. Diarrhoea-associated mortality declined by 31% (95% CI 1–52; p=0·04) after RV1 introduction. Effectiveness against diarrhoea-mortality was 34% (95% CI –28 to 66; p=0·22).InterpretationRV1 was associated with substantial reduction in diarrhoea-associated deaths among infants in this rural sub-Saharan African setting. These data add considerable weight to evidence showing the impact of rotavirus vaccine programmes.FundingWellcome Trust and GlaxoSmithKline Biologicals.

Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa

BackgroundWe hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations.MethodsIn this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses.ResultsA total of 1533 communities underwent randomization, 190,238 children were identified in the census at baseline, and 323,302 person-years were monitored. The mean (±SD) azithromycin and placebo coverage over the four twice-yearly distributions was 90.4±10.4%. The overall annual mortality rate was 14.6 deaths per 1000 person-years in communities that received azithromycin (9.1 in Malawi, 22.5 in Niger, and 5.4 in Tanzania) and 16.5 deaths per 1000 person-years in communities that received placebo (9.6 in Malawi, 27.5 in Niger, and 5.5 in Tanzania). Mortality was 13.5% lower overall (95% confidence interval [CI], 6.7 to 19.8) in communities that received azithromycin than in communities that received placebo (P<0.001); the rate was 5.7% lower in Malawi (95% CI, −9.7 to 18.9), 18.1% lower in Niger (95% CI, 10.0 to 25.5), and 3.4% lower in Tanzania (95% CI, −21.2 to 23.0). Children in the age group of 1 to 5 months had the greatest effect from azithromycin (24.9% lower mortality than that with placebo; 95% CI, 10.6 to 37.0). Serious adverse events occurring within a week after administration of the trial drug or placebo were uncommon, and the rate did not differ significantly between the groups. Evaluation of selection for antibiotic resistance is ongoing.ConclusionsAmong postneonatal, preschool children in sub-Saharan Africa, childhood mortality was lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo, with the largest effect seen in Niger. Any implementation of a policy of mass distribution would need to strongly consider the potential effect of such a strategy on antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation; MORDOR ClinicalTrials.gov number, NCT02047981.)