Malawi Experience Research Articles

AFTERLIVES: Humanitarian Histories and Critical Subjects in Mozambique

This article draws from fieldwork conducted with the staff, volunteers and recipients of programs run by NGOs in Morrumbala, a rural district in central Mozambique. During the Mozambican conflict in the 1980s and early 1990s, a majority of district residents lived in refugee camps in Malawi. This article explores how recipients and volunteers draw on nostalgic memories of humanitarian experience in Malawi to critique and make claims on the humanitarian regimes that now provide services in Morrumbala. Anthropological literature has shown that refugee experience can be central to processes of political subjectification, becoming the grounds through which claims are articulated on neoliberal regimes of rights and services. These memories, and the nostalgic humanitarian lexicon they deploy, point to the historicity of humanitarian experience. As Morrumbala residents engage new configurations of aid and welfare today, the afterlives of previous interventions also allow for ambivalent and critical engagements with humanitarian practice in the present.

Bright Futures in Malawi's New Dawn: Educational Aspirations as Assertions of Identity.

Imagined futures, once a vital topic of theoretical inquiry within the sociology of culture, have been sidelined in recent decades. Rational choice models cannot explain the seemingly irrational optimism of youth aspirations, pointing to the need to explore other alternatives. This article incorporates insights from pragmatist theory and cognitive sociology to examine the relationship between imagined futures and present actions and experiences in rural Malawi, where future optimism appears particularly unfounded. Drawing from in-depth interviews and archival sources documenting ideological campaigns promoting schooling, the author shows that four elements are understood to jointly produce educational success: ambitious career goals, sustained effort, unflagging optimism, and resistance to temptation. Aspirations should be interpreted not as rational calculations, but instead as assertions of a virtuous identity, claims to be "one who aspires."

Malaria elimination in Malawi: Research needs in highly endemic, poverty-stricken contexts

Malaria control in the impoverished, highly endemic settings of sub-Saharan Africa remains a major public health challenge. Successes have been achieved only where sustained, concerted, multi-pronged interventions have been instituted. As one of the world‘s poorest countries, Malawi experiences malaria incidence rates that have remained high despite a decade of gradually expanding and more intensive prevention efforts. The Malawi International Center for Excellence in Malaria Research (ICEMR) is beginning work to augment the knowledge base for reducing Plasmodium transmission and malaria morbidity and mortality. Among ICEMR goals, we intend to better assess patterns of infection and disease, and analyze transmission by Anopheles vector species in both urban and rural ecological settings. We will evaluate parasite population genetics and dynamics, transmission intensities and vector ecologies, social and environmental determinants of disease patterns and risk, and human–vector–parasite dynamics. Such context-specific information will help to focus appropriate prevention and treatment activities on efforts to control malaria in Malawi. In zones of intense and stable transmission, like Malawi, elimination poses particularly thorny challenges – and these challengers are different from those of traditional control and prevention activities. Working toward elimination will require knowledge of how various interventions impact on transmission as it approaches very low levels. At present, Malawi is faced with immediate, context-specific problems of scaling-up prevention and control activities simply to begin reducing infection and disease to tolerable levels. The research required to support these objectives is critically evaluated here.

Tackling Health Workforce Shortages During Antiretroviral Treatment Scale-up—Experiences From Ethiopia and Malawi

In many sub-Saharan countries, the health workforce shortage has been a major constraint in the scale-up of antiretroviral treatment. This human resource crisis has led to profound adjustments of the antiretroviral treatment care delivery model in several countries in the region. It also inspired some governments to take swift measures to substantially increase human resources capacity. This article draws on the experience of Malawi and Ethiopia, which have been able to successfully increase their health workforce over a relatively short period, allowing scaling up of antiretroviral treatment. Additional international HIV funding and strong political commitment made possible this exceptional response. Both countries implemented a combination of measures to tackle the human resource crisis: the delegation of medical and administrative tasks to lower health cadres and lay workers, the introduction of new health cadres, the reinforcement of pre-service training, and improving health staff remuneration. In particular, the involvement of community and lay health workers in HIV-related service delivery substantially increased the health workforce. The involvement of lay cadres has important long-term implications. To sustain results, continued political commitment, ongoing training and supervision to maintain quality of care, and strategies to avoid attrition among lay cadres will be essential. Although task shifting and involvement of lay cadres allowed bridging of the human resource gap in a short time, other strategies have to be considered simultaneously, and all interventions must be maintained over a longer period to yield results.

From researcher to farmer: partnerships in integrated aquaculture—agriculture systems in Malawi and Cameroon

The potential for integrating aquaculture with agriculture has been widely recognized as a means of improving the use of inputs, diversifying output and economic opportunity, and enabling smallholder producers to maintain and strengthen livelihoods. This paper describes the outcomes of this approach and explains the extent to which it has been taken up and has led to sustained and self-generated capacity. Based in particular on experience in Malawi, Ghana and Cameroon, it also considers implications more widely in the region. The overall picture is that this is a partial and still emerging success story, linked as much with the social and economic drivers surrounding smallholder farmers as with the development support approach adopted.

Scaling up and sustaining community-based care for preschool and school-age children – successes and challenges in Malawi

Community-based organizations (CBOs) are an important model for the care of orphans and other vulnerable children whose life and development are threatened by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and poverty. However, data are lacking on the challenges and solutions enabling successful expansion of these programs to the national level. This article presents some of the experiences encountered by Malawi in the expansion of their network of CBOs. Challenges addressed by CBO, intergovernmental organisation (IGO) and government leaders centred on developing a shared understanding of goals and solutions as well as on obtaining, training and retaining sufficient care providers. The implications of Malawi's experience in these areas for the effectiveness of other programs are discussed.

Anne Mills—nurturing a generation of health economists

Anne Mills—nurturing a generation of health economists

Positioning Nutrition at the Center of the Development Agenda: The Malawi Experience

Positioning Nutrition at the Center of the Development Agenda: The Malawi Experience

Similarities and mutual understanding: exchange experiences in Malawi for host and guest students

A Malawian nursing college and a Norwegian university college have agreed to cooperate in facilitating clinical exchanges for nursing students at their respective institutions. This study describes the experiences of students in an innovative exchange. Norwegian and Malawian nursing students shared clinical placement in pairs of two in Malawi for 8 weeks. This study shows that both host and guest students benefit from the clinical placement as it enhances development of clinical competence. The design of the study is phenomenological/hermeneutical. The theoretical foundation is based upon Campinha-Bacote's model for the development of cultural competence. All participating nursing students were interviewed. Their stories provided the rationale for the three main categories that are discussed. Students experience both similarities and differences in practice, but similarities are regarded as the stronger impression. Learning relational skills is the primary learning outcome, but learning how to nurse patients is also an important outcome. During the exchange period all students developed cultural competence. This way of organizing shared placements for guest and host students from different countries is valuable for all students. It also met the curricular demands in both countries.

Burkitt lymphoma treatment: the Malawi experience

The objective of the Malawi Burkitt lymphoma (BL) studies was to develop effective and affordable treatment in a setting of limited resources. In the Malawi Pilot Study 44 BL patients with St Jude stages I, II and III were treated with medium intensity chemotherapy based on the sequence and drugs used in the LMB 89 protocol. The 57% overall survival rate was however associated with treatment toxicity related deaths in 32% of patients. Forty of ninety two patients with confirmed BL discharged from hospital alive and treated with cyclophosphamide (CPM) only, were found alive on home visit 29–104 months later. In the Malawi 2002 (146 patients) and 2003 (149 patients) studies i.v or oral CPM 40 mg/kg was given at 7-day intervals × 3 together with intrathecal methotrexate (MTX), followed in stages III and IV by 3 more doses of CPM at 14-day intervals. The projected Kaplan-Meier survival ranged from 45–52%. In the Malawi 2006 study (40 patients) all stages were treated with CPM 40 mg/kg on day 1, followed by CPM 60 mg/kg on days 8, 18 and 28 together with intrathecal MTX. Nineteen (48%) patients remained in continuous remission after median 454 days. The chemotherapy drug cost was inferior 50 US dollars. Twenty eight patients with an incomplete response to primary chemotherapy or who had a relapse, were offered a BL Rescue Protocol consisting of CPM 60 mg/kg, vincristine 1.5 mg/m2 and intrathecal MTX 12.5 mg plus hydrocortisone 12.5 mg on days 1, 8, 18 and 28. Twenty achieved a remission and 10 (36%) remained in remission for median 487 days. An overall cure rate of about 65% can thus be achieved by treatment with the Malawi 2003 BL protocol followed by the Malawi rescue protocol when needed.

Developing national treatment policy for falciparum malaria in Africa: Malawi experience

The emergence and spread across sub-Saharan Africa of Plasmodium falciparum resistant to the inexpensive antimalarials chloroquine and sulfadoxine-pyrimethamine has worsened the health and hampered the socio-economic development of affected countries, a situation that calls for urgent review of malaria treatment policies in these countries. The Roll Back Malaria (RBM) initiative promotes strong partnerships for implementing effective malaria control measures. The development of clear policies to guide such implementation at country level offers a way of assessing the achievement of set milestones in this collaborative venture. In this article we describe the policy development process for the treatment of falciparum malaria in Africa, based on experience in Malawi, where the first-line drug treatment was recently changed from sulfadoxine-pyrimethamine to an artemisinin combination therapy.

Research, Therapy, and Bioethical Hegemony: The Controversy over Perinatal AZT Trials in Africa

Abstract:Research on zidovudine (AZT) for pregnant women in Africa sparked worldwide debate in the late 1990s. The debate ultimately led to the rewriting of international ethics guidelines, in at least one case specifically to prohibit use of a placebo group (the most controversial aspect of the research) when known effective treatment is available. I draw upon clinical experience in Malawi and theoretical perspectives from anthropology to reframe the controversy. The dominant bioethical position constructed research and therapy as ethically distinct. This distinction ensured that inequalities of power and resources were perpetuated, not remedied, by the AZT debates.

Bridge-building in Malawi: a student expedition

A group of students from Imperial College London spent two years working on the design and construction of a footbridge for a remote village in northern Malawi. This exciting project allowed the students to develop engineering and organisational skills while working on a structure that would bring real benefit to an impoverished community. The team faced considerable challenges throughout, both in terms of the low-technology construction and in learning to deal with logistical, social and cultural issues. This paper discusses the need for the bridge, a range of issues raised by the construction process and the outcomes of the project. It also offers some recommendations to those taking part in similar projects in the future, based on the team's experiences in Malawi.

Trends of Rainfall and Maize Productivity in Malawi

Daily rainfall data between 1966 and 2005 across all Agricultural Development Areas (ADDs) in Malawi was investigated to determine changes in selected rainfall characteristics and their impact on Maize productivity. Rainfall indices analyzed included rainfall amounts (annual and seasonal), onset, cessation, dry spells and length of rainy season. Man Kendal’s trend test was applied to the time series of these indices to detect any trends in the time series. WaterRequirement Satisfaction Index (WRSI) for maize crop was used to study the spatial-temporal variation of maize productivity and thus its linkage to rainfall. Definition of onset and cessation adopted from the Department of Meteorological Service (DMS) Malawi was used in demarcating seasons to extract seasonal rainfall amount, length and other parameters. The results of the study indicate that with the exception of Karonga ADD located at the Northern tip of the country there were no significant trends in all variables related to crop productivity including onset, cessation, rainfall amount and dry spells. The spatial and temporal variability of maize production in Malawi was captured quite well by the WRSI. The relationship between long-term average WRSI and maize yield (tonnes/ha) for different stations in Malawi had a correlation coefficient of 0.82 while the relationship of countrywide average WRSI and maize yield had a correlation coefficient of 0.75. Areas with low long term average WRSI like Shire valley also showed low productivity while those with higher WRSI like Mzimba and Salima ADD had a good yield. On average Malawi has sufficient rainfall to sustain rain-fed maize crop as most of the time (67%) rain-fall is enough to give an average yield. It was also foundout that Malawi experience droughts and hence food shortages when WRSI value is close to or below 60%.

Starter Packs: A Strategy to Fight Hunger in Developing Countries? Lessons from the Malawi Experience 1998–2003 edited by Sarah Levy

<i>Starter Packs: A Strategy to Fight Hunger in Developing Countries? Lessons from the Malawi Experience 1998–2003</i> edited by Sarah Levy

Emergency nursing experience in Malawi

Malawi has a population of 13 million with the vast majority of its people living in the rural areas. Government health facilities are the main providers of health care services in the country with a few private facilities charging for their services. Emergency medical care in Malawi is offered in all health care delivery areas, however the quality offered and its accessibility is compromised especially in rural areas. Every health care professional receives a component of emergency training during their generic programme although there are very limited specialized emergency professionals. Working as a nurse in the emergency department in Malawi is a challenging experience due to these various difficulties.

Starter Packs: A strategy to fight hunger in developing countries? Lessons from the Malawi experience 1998–2003, edited by Sarah Levy

Starter Packs: A strategy to fight hunger in developing countries? Lessons from the Malawi experience 1998–2003, edited by Sarah Levy

Trying to make a difference: The Malawi experience of a Tuberculosis (TB) nurse specialist

The incidence of Tuberculosis (TB) in the world is on the rise and is a major public health threat affecting a third of the world’s population. TB is reportedly the second most common illness causing death in Sub-Saharan Africa, second only to HIV/AIDS. The developing world is most vulnerable, with factors like poverty, malnutrition, overcrowding, poor access to healthcare services and limited or lack of diagnostic facilities and trained healthcare personnel all compounding the extent of this global epidemic. While there may be many studies on medical management of the illness, there is very little understanding and lack of standardized terms, protocols and models of care that describe nurses’ efforts in TB management. Thus, a study into factors that impact on nursing management of TB patients in Malawi and Australia was a quest to investigate the impact of nursing care on patients’ well-being. It involved collecting data from Australia and Malawi to compare and contrast how different environments impinge on patients’ care and outcomes.

How are health professionals earning their living in Malawi?

BackgroundThe migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied.MethodsThe present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods.ResultsHealth professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work.ConclusionMany health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects.

Starter Packs: a strategy to fight hunger in developing countries? Lessons from the Malawi experience 1998–2003 edited by S. LEVY Wallingford: Cabi Publishing, 2005. Pp. 295. £55.00.

Starter Packs: a strategy to fight hunger in developing countries? Lessons from the Malawi experience 1998–2003 edited by S. LEVY Wallingford: Cabi Publishing, 2005. Pp. 295. £55.00. - Volume 44 Issue 4