Kasungu District Research Articles

Hedging irrigated maize crop yields using temperature derivatives in Malawi

Agriculture production yield varies with weather changes. This causes farmers incur loses. For instance, extreme temperature leads to low maize yield. This study describes incomplete temperature weather derivatives in agriculture markets and applies risk management hedging techniques. It focuses on hedging crop yield against extreme temperatures during irrigation, farming which is done without greenhouse. This study's primary goal is to hedge irrigated maize crop yields using temperature derivatives. This is achieved firstly by modelling a daily average temperature stochastical model. Then, deriving statistical properties of the model based on 1990–2020 Kasungu District Temperature historical data. Lastly, pricing temperature derivatives to hedge maize crop yield. This study uses 1990–2020 Kasungu District Temperature historical data. Then a stochastically Ornstein-Uhlenbeck process with the time-varying speed of reversion, seasonal mean, and local volatility that depends on the local average temperature was proposed. Based on the average temperature model, down and output barrier option pricing models for average temperature and growing degree day (GDD) are applied. The study results shows that when the GDD is above the barrier level the barrier option does not knock out. Hence gives the holder the right to buy the underlying asset since it does not reach or fall below a predefined level over the option's lifetime. If the GDD does not exceed the barrier level, then the farmer will not have to pay the premium because the option is invalid. On the same note, the farmer will have to exercise his right by paying the premium of calculated premium when the GDD exceeds the barrier level. In return for this, the farmer gets paid off which happens to be the difference between GDD and barrier multiplied $1. In line with Malawi's 2063 Millennium Development Goals (MDGs), this study acts as an eye opener for the government to put a policy on whether derivatives should be practised in our country hence, increase cash holding by improving the situation of the farmer and country.

Factors influencing adoption and use of Tephrosia vogelii in Malawi: Role of by-laws and other drivers

Soil nutrient deficiency poses great challenge to efforts aimed at improving agricultural productivity in Southern Africa. Agroforestry fertilizer tree technologies have potential to improve soil productivity in cropping systems. As such understanding the socio-economic and biophysical drivers in promoting adoption, and use of Tephrosia vogelii (T. vogelii) would provide requisite knowledge to stakeholders who promote integration of fertilizer tree technologies. This study conducted an analysis of effectiveness of by-laws, other socio-economic drivers, and biophysical factors in promoting the adoption and use of T. vogelii in Kasungu district in the central region of Malawi. The study used multistage sampling technique and data from 432 farmers. A Double Hurdle model was used where Probit regression and Truncated regression models were incorporated in the first and second hurdle, respectively. The study found that by-laws, seed availability, frequency of extension officer's visits before planting, technology provider and field characteristics influenced adoption and utilization intensity of T. vogelii in Kasungu district, Malawi. Awareness creation on developed by-laws and enforcement, promoted the adoption of intercropping of T. vogelii in the maize-based cropping system.

Defining community-led monitoring and its role in programme-embedded learning: lessons from the Citizen Science Project in Malawi and South Africa.

Programme Science (PS) and community-led monitoring (CLM) intersect in unexpected and promising ways. This commentary examines a CLM initiative in Malawi and South Africa to highlight the crucial role of CLM in bolstering the PS framework. By leveraging data sources often overlooked by conventional research and evaluation approaches, CLM emerges as a pivotal element in enhancing programme effectiveness. This paper delineates the fundamental principles of CLM, presents programme outcomes derived from CLM methodologies and contextualizes these findings within the broader framework of PS. The Citizen Science Project implements CLM continuously at 33 health facilities: 14 in Malawi (eight in Kasungu District and six in Dedza District), and 19 in South Africa (all in the West Rand District), representing a total catchment area of 989,848 people. Monitoring indicators are developed in an iterative process with community groups. The indicators are unique to each country, but both focus on the uptake of health services (quantitative) and barriers to access (qualitative). Monthly clinic records surveys capture 34 indicators in Malawi and 20 in South Africa and are supplemented by qualitative interviews with care recipients and healthcare workers. Qualitative interviews provide additional granularity and help confirm and explain the more macro trends in service coverage as described in quantitative data. The resulting data analysis reveals key themes that help stakeholders and decision-makers to solve problems collaboratively. Noteworthy outcomes include a substantial increase in multi-month dispensing of antiretroviral therapy (ART) during COVID-19 (from 6% to 31%) with a subsequent recovery surpassing of HIV service benchmarks in Malawi post-pandemic. While quantifying direct impact remains challenging due to the project's design, CLM proves to be a robust methodology that generates credible data and produces impactful outcomes. Its potential extends beyond the health sector, empowering community leadership and fostering interventions aligned with community needs. As CLM continues to evolve, its integration into PS promises to improve relevance, quality and impact across diverse disciplines.

Small dams drive Anopheles abundance during the dry season in a high malaria burden area of Malawi.

This study explores the influence of small dams on the exposure to malaria vectors during the dry season in Kasungu district, Malawi, an area recently identified as high priority for malaria interventions by the National Malaria Control Programme. Small dam impoundments provide communities with a continuous supply of water for domestic and agricultural activities across sub-Saharan Africa and are considered vital to food security and climate change resilience. However, these permanent water bodies also create ideal breeding sites for mosquitoes in typically arid landscapes. The study focuses on a specific dam impoundment and its vicinity, aiming to assess its spatial and temporal influence on indoor vector densities. From May to August 2021, CDC light traps were used to measure indoor mosquito densities for two consecutive nights per month in three communities located at increasing distances from the dam (0, ~1 and ~2 km). Simultaneously, drone imagery was captured for each community, enabling the identification of additional standing water within approximately 400 m of selected households. Larval sampling was carried out within the impoundment periphery and in additional water bodies identified in the drone imagery. Generalised linear mixed models (GLMMs) were employed to analyse the indoor Anopheles abundance data, estimating the effects of household structure (open/closed eaves), month, temperature and water proximity on malaria vector exposure. Throughout 685 trapping nights, a total of 1256 mosquitoes were captured, with 33% (412) being female Anopheles. Among these, 91% were morphologically identified as Anopheles funestus s.l., and 5% as Anopheles gambiae s.l. Catches progressively decline in each consecutive trapping month as the environment became drier. This decline was much slower in Malangano, the community next to the dam, with abundance being notably higher in June and July. Further, the majority of An. gambiae s.l. were caught in May, with none identified in July and August. Anopheles larvae were found both in the impoundment and other smaller water bodies such as irrigation wells in each survey month; however, the presence of these smaller water bodies did not have a significant impact on adult female mosquito catches in the GLMM. The study concludes that proximity to the dam impoundment was the primary driver of differences between survey communities with the abundance in Chikhombwe (~1 km away) and Chiponde (~2 km away) being 0.35 (95% confidence interval [CI], 0.19-0.66) and 0.28 (95% CI, 0.16-0.47) lower than Malangano, respectively, after adjusting for other factors. These findings underscore the importance of targeted interventions, such as larval source management or housing improvements, near small dams to mitigate malaria transmission risks during the dry season. Further research is needed to develop cost-effective strategies for vector control within and around these impoundments.

Potential contribution of agronomic practices and conservation agriculture towards narrowing smallholders’ yield gaps in Southern Africa: lessons from the field

Summary Smallholders in Southern Africa continue to grapple with low maize productivity despite this being the staple food crop. This study sought to analyze and isolate the relative contribution of agronomic practices to maize yields obtained by smallholders in Malawi and Mozambique using data generated from on-farm trials testing the performance of conservation agriculture cropping systems. The trials were implemented in two communities, namely Kasungu district in Malawi and Sussundenga district in Mozambique, and ran for seven consecutive growing seasons starting in 2010–2011. Maize yield was measured annually in the on-farm trials, which included a ‘control treatment’ representing an improved farm practice, and in neighboring fields managed by the same farmers on their own, hence representing a ‘true farm practice’. Results indicated that maize yield increased linearly with increasing plant population at harvest at both sites. On average, an increase in plant population at harvest by 1000 plants ha–1 resulted in an increase in maize yield of 90 and 63 kg ha–1 at Kasungu and Sussundenga, respectively. The greatest maize yields were obtained when plant population at harvest exceeded 40 000 plants ha–1. Yet, the plant population at harvest was below the generally recommended optimum for most of the cropping systems studied and in most growing seasons. Furthermore, the use of agronomic practices alone without conservation agriculture (i.e., improved varieties, fertilizer management, and timely weed control) resulted in maize yield gains of as much as 54% and 43% relative to the ‘true farm practice’ at Kasungu and Sussundenga, respectively. Overall, the proportion of these yield increases relative to the ‘true farm practice’ accounted for by agronomic practices amounted to 53–70% and 57–85% at Kasungu and Sussundenga for the highest to the lowest-yielding cropping system. Although conservation agriculture significantly improved maize yield at both sites, such increases were smaller in magnitude compared to the yield gains derived from improved agronomic practices. The study suggests that considerable strides toward narrowing maize yield gaps in Southern Africa can be achieved through improvement of current crop management practices, let alone adhering to the conservation agriculture principles of minimum tillage, residue retention, and crop diversification.

Assessing the Impact of Client Knowledge and Demand on Service Provision from Antenatal to Postnatal Care - An Implementation Science Design

Background: In low resource countries suboptimal clinical care has been identified a contributor to maternal and infant mortality. This study aimed to test the impact of a community intervention promoting client demand on provision of care during ANC, labour and the first postnatal contact (PNC). Methods: This was implementation science research in Kasungu district of Malawi using a quasi-experimental design with an intervention site where mothers were exposed to a package of interventions aiming to improve knowledge and demand. The results were compared with a site where there was no intervention in the same district. The intervention included checklists for mothers, posters and a Radio Distance Learning (RDL) program. The study used mixed methods (qualitative and quantitative). A total of 1040 mothers participated in individual interviews. Sixteen Focus Group Discussions (FGDs) were conducted with 128 mothers and 8 Key Informant Interviews were conducted with health workers. Health passports were used to check service provision at both comparison and intervention sites. In addition, mothers’ checklists were used at the intervention site to verify service provision. Quantitative data were processed in Stata 16.0 using binomial regression and two-sample proportion tests. NVivo 12 was used to process qualitative data for thematic analysis through coding and merging or creation of new codes. Results: At the intervention site there a 21.9% mean increase in knowledge of demandable services in ANC (43.3% to 56.1%, p<0.001,), intrapartum services for the mother (20.6%, 41.8% to 62.6%, p=0.003,) and the neonatal services before discharge (17.5%, 47% to 64.5%, p=0.0039). For PNC, changes were non-significant. Overall, women at the intervention site were 50% more likely than women at the comparison site to demand a service in the continuum of care (RR = 1.5). Actual service provision was increased at the intervention sites across all elements of the continuum, including laboratory testing, clinical examination of mothers and newborns and provision of essential interventions such as oxytocin for prevention of postpartum haemorrhage, chlorhexidine for umbilical cord care and vitamin K. Conclusion: The intervention positively contributed to increased knowledge on care practices, attitudes towards demand, actual demand for care practices, services provision and service satisfaction.

Measuring equity of access to eye health outreach camps in rural Malawi.

IntroductionEquity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi.MethodsBetween April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps.ResultsA total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men.ConclusionsOur study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

Tobacco Contract Farming, Crop Diversification and Household Relations in the Central Region of Malawi

This article examines crop diversification and household relations within a contract farming scheme in the Central region of Malawi. It discusses a pilot study that formally included wives to grow soya as part of a tobacco contract in Kasungu district. The article assesses whether this intervention improved benefits for the firm (through higher repayment rates), the farm (through higher yields for key crops) and the family (through greater well-being). Club-level data suggest that repayment rates remained the same. Comparisons between participating and non-participating households show a lack of accord between spouses: husbands asserted that maize yields and household well-being declined; wives highlight how they withdrew labour from soya, not maize, as they lost some control over this crop. Both spouses agreed that soya production and yields declined sharply but also that the firm should continue contracting wives to grow soya through a separate contract. Using data from both spouses offers a window on non-cooperation within households, with practical relevance for firms wishing to diversify the crops they are supporting via contract farming initiatives.

Examining study participants\u2019 decision-making and ethics-related experiences in a dietary community randomized controlled trial in Malawi

BackgroundThe participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of high-quality research. When participants make a fair, informed, and voluntary decision to enroll in a study, they agree to fulfill their roles. However, supporting study participants to fulfill study requirements is an important ethical obligation for researchers, yet evidenced as challenging to achieve. This paper reports on participants’ motivations to volunteer and remain part of a dietary study conducted in Kasungu District, Malawi.MethodsWe conducted twenty in-depth interviews (with chiefs, religious leaders, trial participants, and health surveillance assistants), five systematic ethnographic observations, and fourteen focus group discussions with trial participants and their partners. Interviews were audio-recorded and transcribed verbatim. We used a grounded theory methodology to analyse data that included coding, detailed memo writing, and data interpretation.FindingsThe findings reveal that many participants had concerns during the trial. Thematically, experiences included anxieties, mistrust of researchers, rumours, fears of exploitation, and misconceptions. Anonymous concerns collected from the participants were reported to the trial team which enabled the researchers to appropriately support participants. Despite initial concerns, participants described being supported and expressed motivation to take up their role.ConclusionThese findings highlight a diverse map of multiple notions of what is ethically relevant and what can impact participation and retention within a study. The study has revealed how embedding a responsive approach to address participants’ concerns and ethical issues can support trust relationships. We argue for the need to employ embedded ethics strategies that enhance informed consent, focus on participants’ needs and positive experiences, and support researchers to fulfill their roles. This work highlights the need for research ethics committees to focus on the risks of undue influence and prevent exploitation especially in settings with a high asymmetry in resources and power between researcher and participant groups.Trial Registration: The Addressing Hidden Hunger with Agronomy (Malawi) trial was registered on 5th March 2019 (ISCRTN85899451).

A GIS-based approach for identifying suitable sites for rainwater harvesting technologies in Kasungu District, Malawi

A GIS-based approach for identifying suitable sites for rainwater harvesting (RWH) technologies was developed and applied in Kasungu District, Malawi. Data were obtained from reports, socio-economic survey documents of the area and maps. Field surveys were conducted in the villages of Chipala Extension Planning Area (EPA), in order to identify and evaluate the performance of existing RWH interventions, and determine factors for locating suitable areas for RWH. Observed soil moisture content was used to assess the water retention performance of the prevalent RWH technologies: contour tied ridging and soil mulching. A GIS-based Soil Conservation Service Curve Number (SCS-CN) method was used to map runoff potential for areas with RWH technologies, using physical factors of rainfall, land use, soil type and slope to estimate runoff potential. This was then integrated in a GIS database, with social-economic factors in the form of household income level and environmental factors, including impacts of implementing RWH, to determine the suitability of land areas for RWH in Kasungu District. One way analysis of variance (ANOVA) was used to test the impact of identified technologies by comparing the moisture content measurements for each of the identified technologies at 5% level of significance. The ANOVA results showed a statistically significant difference in the moisture measurements for the three technologies identified (P < 0.05). The RWH suitability map for the study area showed that 0.2% of the area considered had very high potential, 33.5% high, 55.9% moderate, 10.1% marginal and 0.3% not suitable for in-field RWH. The model was verified by locating the existing RWH on the suitability map obtained from GIS: 81% of RWH were located in the highly and moderately suitable areas whilst only 13% were located in areas of low suitability. Hence the developed model can reliably be used to predict potential areas for RWH.

The application of drones for mosquito larval habitat identification in rural environments: a practical approach for malaria control?

BackgroundSpatio-temporal trends in mosquito-borne diseases are driven by the locations and seasonality of larval habitat. One method of disease control is to decrease the mosquito population by modifying larval habitat, known as larval source management (LSM). In malaria control, LSM is currently considered impractical in rural areas due to perceived difficulties in identifying target areas. High resolution drone mapping is being considered as a practical solution to address this barrier. In this paper, the authors’ experiences of drone-led larval habitat identification in Malawi were used to assess the feasibility of this approach.MethodsDrone mapping and larval surveys were conducted in Kasungu district, Malawi between 2018 and 2020. Water bodies and aquatic vegetation were identified in the imagery using manual methods and geographical object-based image analysis (GeoOBIA) and the performances of the classifications were compared. Further, observations were documented on the practical aspects of capturing drone imagery for informing malaria control including cost, time, computing, and skills requirements. Larval sampling sites were characterized by biotic factors visible in drone imagery and generalized linear mixed models were used to determine their association with larval presence.ResultsImagery covering an area of 8.9 km2 across eight sites was captured. Larval habitat characteristics were successfully identified using GeoOBIA on images captured by a standard camera (median accuracy = 98%) with no notable improvement observed after incorporating data from a near-infrared sensor. This approach however required greater processing time and technical skills compared to manual identification. Larval samples captured from 326 sites confirmed that drone-captured characteristics, including aquatic vegetation presence and type, were significantly associated with larval presence.ConclusionsThis study demonstrates the potential for drone-acquired imagery to support mosquito larval habitat identification in rural, malaria-endemic areas, although technical challenges were identified which may hinder the scale up of this approach. Potential solutions have however been identified, including strengthening linkages with the flourishing drone industry in countries such as Malawi. Further consultations are therefore needed between experts in the fields of drones, image analysis and vector control are needed to develop more detailed guidance on how this technology can be most effectively exploited in malaria control.

Detection Of Fecal Coliforms In Water Used In Formal And Informal Food Outlets In Kasungu District, Malawi

Poor sanitary practices are common amongst many food handlers posing a health risk to consumers. Maintenance of high quality water is one of the most important aspects of ensuring consumer safety. Therefore, regular water testing is critical in public food outlets where bacterial contamination may cause outbreak of disease. The study aimed at analyzing water samples obtained from the formal and informal food outlets for the presence of fecal coliforms that are indicative of poor sanitation that result in foodborne infections amongst consumers. Using a cross-sectional design, water samples from participating food outlets (N=40) were analyzed using the membrane filtration method. Samples were filtered, under vacuum, through a cellulose acetate membrane of 0.45 μm pore size. Fecal coliforms exceeding permissible range were detected in 15 test samples (N=40). The median (IQR) concentrations of fecal coliforms (FC/100ml) in dishwashing water was 1(136) and 145(340) for the formal and informal food outlets respectively. The median (IQR) for drinking water was 0(0) with a minimum and maximum range of 0 and 14 FC/100mls. The study established a positive correlation between fecal coliforms and electrical conductivity, and total dissolved solids (p<0.05) in dish washing water used at both formal and informal food outlets. Contamination was attributed to lack of running water, poor pest control and unwholesome practices in many food outlets. Based on the study findings, it is concluded that electrical conductivity, total dissolved solids and turbidity values may be used to deduce the presence of fecal coliforms in water. The study recommends that water drawn from unprotected sources must be boiled or treated at the point of use before it can be safely used in food outlets. Periodic water testing and sanitary supervisions for all food outlets must be mandatory to ensure compliance with minimum set standards.

Drivers of food consumption among overweight mother-child dyads in Malawi.

To address the increase in overweight and obesity among mothers and children in sub-Saharan Africa, an understanding of the factors that drive their food consumption is needed. We hypothesized food consumption in Malawi is driven by a combination of factors, including season, food accessibility (area of residence, convenience of purchasing food, female autonomy), food affordability (household resources, food expenditures, household food insecurity), food desirability (taste preferences, body size preferences), demographics, and morbidity. Participants in Lilongwe and Kasungu Districts were enrolled across three types of mother-child dyads: either the mother (n = 120), child (n = 80), or both (n = 74) were overweight. Seven-day dietary intake was assessed using a quantitative food frequency questionnaire during the dry and rainy seasons. Drivers associated with intake of calories, macronutrients, and 11 food groups at p<0.1 in univariate models were entered into separate multivariate linear regression models for each dietary intake outcome. Mother-child dyads with an overweight child had a higher percent of calories from carbohydrates and lower percent of calories from fat compared to dyads with a normal weight child (both p<0.01). These mothers also had the highest intake of grains (p<0.01) and their children had the lowest intake of oil/fat (p = 0.01). Household food insecurity, maternal taste preferences, and maternal body size preferences were the most consistent predictors of food group consumption. Household food insecurity was associated with lower intake of grains, fruits, meat and eggs, oil/fat, and snacks. Maternal taste preferences predicted increased consumption of grains, legumes/nuts, vegetables, fish, and oil/fat. Maternal body size preferences for herself and her child were associated with consumption of grains, legumes/nuts, dairy, and sweets. Predictors of food consumption varied by season, across food groups, and for mothers and children. In conclusion, indicators of food affordability and desirability were the most common predictors of food consumption among overweight mother-child dyads in Malawi.

Chieftaincy in Malawi: Reinvention, Re-emergence or Resilience? A Kasungu Case Study

As African states emerged from colonial rule and adopted the trappings of western parliamentary government, many nationalist politicians regarded chieftaincy as an archaic institution, either to be abandoned or reduced to ceremonial. Nevertheless, it has become clear that chiefs endure and not merely as cultural ornaments; indeed, in Malawi and elsewhere, they are still the main conduits for communication between the central state and the grassroots, and they continue to play an important role in development initiatives, local dispute resolution and, since the 1990s, as players in the ‘new democracy’, locally and at the national level. This article contributes to investigations into the nature of chieftaincy from precolonial times to the present, using a Malawian example, to ask how far the tenacity of this institution can be attributed to its reinvention, re-emergence or resilience. It examines chieftaincy in one area of Kasungu district in central Malawi from its establishment in the 18th century through the colonial and post-colonial periods up to the present to explore its nature over time. It concludes that the institution endures through a combination of reinvention, resilience and re-emergence. Chieftaincy survives through invoking tradition and adapting to specific historical circumstances but also by virtue of the personal qualities of officeholders. This case study illustrates the dynamism of chiefly governance.

Can selenium deficiency in Malawi be alleviated through consumption of agro-biofortified maize flour? Study protocol for a randomised, double-blind, controlled trial

BackgroundMicronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic biofortification (agro-biofortification) – and this may contribute to alleviating deficiencies. The Addressing Hidden Hunger with Agronomy (AHHA) trial aims to establish the efficacy of this approach for improving Se status in rural Malawi.MethodsA double-blind, randomised, controlled trial will be conducted in a rural community in Kasungu District, Central Region, Malawi. The hypothesis is that consumption of maize flour agro-biofortified with Se will increase serum Se concentration. We will recruit 180 women of reproductive age (WRA) (20–45 years) and 180 school-age children (SAC) (5–10 years) randomly assigned in a 1:1 ratio to receive either maize flour enriched through agro-biofortification with Se or a control flour not enriched with Se. Households will receive flour (330 g per capita per day) for 12 weeks. The primary outcome is Se concentration in serum (μg/L). Serum will be extracted from venous blood samples drawn at baseline (prior to flour distribution) and end-line. Selenium concentration will be measured by using inductively coupled plasma mass spectrometry.DiscussionFindings will be communicated to policy stakeholders and participating communities and reported in peer-reviewed journals.Trial registrationThe Addressing Hidden Hunger with Agronomy (Malawi) trial is registered (5th March 2019; ISCRTN85899451).

Food Purchasing Decisions in Overweight Mother-child Dyads in Malawi (FS01-05-19)

ObjectivesAs obesity increases in sub-Saharan Africa, information is needed about factors influencing food choices in households with overweight members. The objective of this study was to assess women’s food purchasing decisions in overweight mother-child dyads in Malawi. MethodsWe enrolled 50 mother-child (age 6–59 months) dyads in which either the mother, the child, or both were overweight in Lilongwe and Kasungu Districts. Research assistants accompanied each woman on a food shopping trip and filled out a structured observation form on the types of food purchased and locations of purchases. Upon returning to the woman’s home, research assistants conducted an in-depth interview about the factors that influenced the woman’s purchases, including asking them to sort 12 factors into piles that always, sometimes, or never influence their food purchasing choices. ResultsObservations showed that women most often purchased small quantities of foods needed to prepare relish (the dish accompanying the staple food), such as tomatoes (76%), green leafy vegetables (66%), cooking oil (56%), onions (44%), and fish (41%) at outdoor markets. Pile sorts and open-ended responses revealed that taste, cost, and food quality were the strongest factors influencing food purchases. Women explained that if a food is too expensive, they buy a smaller quantity or buy something else (e.g., fish instead of meat). Cooking food that their family enjoys eating influenced the foods women bought. Adding tomatoes, onions, and oil to relish was commonly described as making the food tastier. To make the child happy, >50% of the women said they buy food, such as sweets, packaged snacks, fruit, or fried food (e.g., doughnuts), specifically for their child. ConclusionsCost, taste, and food quality were the most important drivers of women’s food purchasing choices. Women used some of their minimal funds to buy unhealthy foods for their children, despite their overall emphasis on food cost and quality. These findings can be used by programs to reinforce healthy and decrease unhealthy food purchases. Funding SourcesDrivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Food Purchasing Decisions in Overweight Mother-child Dyads in Malawi (FS01-05-19)

ObjectivesAs obesity increases in sub-Saharan Africa, information is needed about factors influencing food choices in households with overweight members. The objective of this study was to assess women’s food purchasing decisions in overweight mother-child dyads in Malawi. MethodsWe enrolled 50 mother-child (age 6–59 months) dyads in which either the mother, the child, or both were overweight in Lilongwe and Kasungu Districts. Research assistants accompanied each woman on a food shopping trip and filled out a structured observation form on the types of food purchased and locations of purchases. Upon returning to the woman’s home, research assistants conducted an in-depth interview about the factors that influenced the woman’s purchases, including asking them to sort 12 factors into piles that always, sometimes, or never influence their food purchasing choices. ResultsObservations showed that women most often purchased small quantities of foods needed to prepare relish (the dish accompanying the staple food), such as tomatoes (76%), green leafy vegetables (66%), cooking oil (56%), onions (44%), and fish (41%) at outdoor markets. Pile sorts and open-ended responses revealed that taste, cost, and food quality were the strongest factors influencing food purchases. Women explained that if a food is too expensive, they buy a smaller quantity or buy something else (e.g., fish instead of meat). Cooking food that their family enjoys eating influenced the foods women bought. Adding tomatoes, onions, and oil to relish was commonly described as making the food tastier. To make the child happy, >50% of the women said they buy food, such as sweets, packaged snacks, fruit, or fried food (e.g., doughnuts), specifically for their child. ConclusionsCost, taste, and food quality were the most important drivers of women’s food purchasing choices. Women used some of their minimal funds to buy unhealthy foods for their children, despite their overall emphasis on food cost and quality. These findings can be used by programs to reinforce healthy and decrease unhealthy food purchases. Funding SourcesDrivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Body Size Preferences and Food Choice Among Normal and Overweight Mothers and Children in Malawi (P10-070-19)

ObjectivesOverweight in mothers and children in sub-Saharan Africa is rapidly increasing and may be related to body size preferences. The objective of this study was to measure mothers’ preferences for their own and their child’s body size and how they relate to food choices. MethodsWe enrolled 271 mothers and their children (6–59 months) in Lilongwe and Kasungu Districts. Based on standard body-mass index and weight-for-height z-score cutoffs, 78 mothers (29%) were normal weight and 193 (71%) were overweight; 120 children (44%) were normal weight and 151 (56%) were overweight. Interviewers used a set of 7 adult female and 7 child body silhouette drawings and a semi-structured question guide to measure mothers’ perceptions of their own and their child’s preferred and healthy body sizes and how their preferences affected food choices. We performed chi-squared tests comparing body size perceptions and grouped open-ended responses by weight status. ResultsMothers’ selection of silhouettes that represented their body size preferences (67% normal weight, 68% overweight preferred overweight) and perceptions of a healthy body size (96% normal weight, 94% overweight selected overweight as healthy) did not differ by their weight status. A higher percentage of mothers of overweight than normal weight children preferred overweight child body sizes (70% vs. 48%, P = 0.003). Mothers’ perceptions of a healthy child body size (89% normal weight, 94% overweight selected overweight as healthy) did not differ by the child’s weight status. To attain a larger body size, mothers said they could eat or feed the child larger quantities or more frequently and increase consumption of fatty/oily foods and drinks (such as sodas, sweetened yoghurt, and milk), but many cannot afford to do this. ConclusionsMalawian mothers had strong preferences for overweight body sizes for themselves and mixed preferences for their children. Their desired strategies for increasing weight indicate that body size preferences may drive food choice but could be limited by cost. Funding SourcesDrivers of Food Choice (DFC) Competitive Grants Program, funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health.

Pregnancy Outcomes at Kasungu Maternity Ward in Central Malawi—A Review of Maternity Ward Register

Health care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. The pregnancy outcomes at Kasungu District Hospital Maternity Ward have not been documented. Additionally, MDHS does not capture data regarding, prematurity, APGAR scores, and causes of maternal deaths and causes of neonatal deaths. Using Kasungu District Hospital Maternity Ward register, we aimed to describe the pregnancy outcomes at Kasungu Maternity Ward. From March 2016 to February 2017, data were available for 10,842 deliveries. The calculated Perinatal Mortality Rate (PMR) was about 77/1000 births and the Maternal Mortality Ratio (MMR) was 318 deaths per 100,000 live births. The Spontaneous Vertex Delivery (SVD) rate was 86% and the caesarean section rate was 10%. 1734 (16%) of all deliveries were premature borne between 28 and 36 gestation weeks. 1182 (11%) deliveries had missing APGAR scores and 81 neonates were born with 5 min Apgar scores less than 7. Adverse pregnancy outcomes occur at Kasungu Hospital Maternity Ward. More effort and resources are needed to decrease their occurrence.

Patterns of Pediatric Malaria Incidence and Outcomes in Kasungu, Malawi in 2016

Malawi is resource poor country in Africa with one of the highest infant and child mortality rates in the world. Malaria is one of the major causes of morbidity and mortality among children in Malawi. Studies have shown barriers to care of sick children and the formal health sector has shown sub-optimal patient assessments and overreliance on antibiotic treatment of a child with fever. In 2017, a team of students from Korea and USA audited clinic registers of six health centres under the hospital’s administration of Kasungu District in Malawi for the year of 2016. The clinics were included in the study were those that contributed to the largest number of patients in the district annually. The aim of the audit was to examine treatment outcomes of all children presenting with fever and on whom a definitive diagnosis or presumptive diagnosis of malaria was made at the 6 chosen clinics in Kasungu for improvement of health information system for the district health office. The number of children with malaria ranged between 80 and 440 per month, with the peak occurring between the rainy months of February to May. Peak mortality rate occurred in September and November at 21%. Patients presented with multiple symptoms of fever, convulsion, pallor, vomiting, cough, diarrhea, abdominal pain and headache. Average mortality rate differed between traditional authorities, ranging from 4% to 15%. Off-season high mortality finding promotes more studies looking into socioeconomic and hospital support. Multiple symptoms among patients treated for malaria is a common finding emphasizing the need to integrate household practices for malaria prevention, good malaria case management and linkage with community care of childhood illness (CCM) programs at the clinics in the district.