Machinga District Research Articles

Decentralisation of the Health System Derailed by Organisational Inertia in Machinga, Malawi.

Managing the transition of a health system (HS) from a centralised to a decentralised model has been touted as a panacea to the complex challenges in developing countries like Malawi. However, recent studies have demonstrated that decentralisation of the HS has had mixed effects in service provision with more dominant negative outcomes than positive results. The aim of this study was to develop a substantive grounded theory (GT) that elaborates on how activities of central decision-makers and local healthcare mangers shape the process of shifting the HS to a decentralised model in Machinga, Malawi. The study was qualitative in nature and employed the Straussian version of GT. Some participants were interviewed twice, and a total of 36 semi-structured interviews were conducted with 25 purposively selected participants using an interview guide. The interviews were conducted at the headquarters of the Ministry of Health (MoH) and other ministries and agencies, and in Machinga District. Data were analysed using open, axial, and selective coding processes of the GT methodology; and the conditional matrix and paradigm model were used as data analysis tools. The findings of this study revealed seven different activities, forming two opposing and interactional sub-processes of enabling and impeding patterns that derailed the decentralisation drive. The study generated a GT labelled "decentralisation of the HS derailed by organisational inertia," which elaborates that decentralisation of the HS produced mixed results with more predominant negative outcomes than positive effects due to resistance at the upper organisational echelons and members of the District Health Management Team (DHMT). This article concludes that organisational inertia at the personal and strategic levels of leadership entrusted with decentralising the HS in Malawi, contributed immensely to the derailment of shifting the HS from the centralised to the decentralised model of health service provision.

Community bylaws concerning sexual and reproductive health and rights in Machinga District, Malawi: to what extent are they responsive to young people’s needs?

BackgroundCommunity bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga District in southern Malawi are responsive to young people’s realities and SRHR needs.MethodsIn Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15–24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people’s SRHR (Phase 2). The drama was performed in the community, after which young women (18–24 years), young men (17–24 years), female and male parents discussed on what they saw in the drama, focusing on young people’s SRHR, in four focus group discussions (Phase 3). All transcripts were coded and thematically analysed and narratives were written on main themes.ResultsThree community SRHR bylaws, related to teenage pregnancy, child marriage, and sexual harassment and rape were identified and commonly accepted in the community. While these bylaws intend to reduce SRHR-related issues among young people, they are often not involved in bylaw formulation. The bylaws were associated with protection of girls, and a good reputation for boys, young men and traditional leaders. Bylaw enforcement faced problems, as fines were not in line with national laws, and wealthy offenders could avoid them through bribes. Effects of bylaws on teenage pregnancy rates seemed limited, while some positive effects on school readmission, prevention of child marriage, and reporting sexual harassment were reported.ConclusionsThe study revealed that community bylaws were accepted but not owned by young people, and had different effects on the rich versus the poor, and girls versus young men. Bylaws were associated with punishment in terms of money, which seemed to overpower their potential to promote rights and address social norms underlying SRHR issues of the youth.

Effect of antibiotic medicines availability on adherence to standard treatment guidelines among hospitalized adult patients in southern Malawi.

Antibiotic resistance is a global public health problem. High and inappropriate use of antibiotic therapy exacerbate the risk of antibiotic resistance. We assessed the effect of availability of antibiotic medicines on adherence to standard treatment guidelines among hospitalized adult patients in Southern Malawi. A cross-sectional study was done to assess the availability of 16 antibiotics among the first-line recommended treatments for common bacterial infections in Malawi. Data for up to six-month duration was extracted from stock card records in Machinga and Nsanje District Hospitals and Zomba Central Hospital. This was complemented by a retrospective review of 322 patient management files from medical wards to assess adherence to the Malawi Standard Treatment Guidelines (MSTG). Investigators abstracted data such as patient demographics, diagnoses, and prescribed therapy using a data collection form that resulted in analyzing 304 patient files. Data was entered into Microsoft excel and analyzed using STATA 14.1. Point availability, stock-out duration and adherence to treatment guidelines were presented in terms of frequencies and percentages. Chi-square test or Fisher's exact test was applied to assess the association between variables and adherence to treatment guidelines. Point availability of antibiotics was 81.5%, 87.7%, and 42.8% for Zomba Central, Machinga and Nsanje District Hospitals respectively. Over a period of six months, 12.5% of antibiotic medicines were stocked out for at least one day at Zomba (Median stock out days = 0, (IQR 0-0 days), while 64.3% were stocked out at Machinga (Median stock out days = 21, IQR 0-31 days) and 85.7% were stocked out at Nsanje District Hospital (Median stock out days = 66.5, IQR 18-113 days). Overall, adherence to MSTG was 79.6%, (95% CI, 73.3-84.9%). By facilities, adherence to guidelines at Zomba Central Hospital was 95.9% (95% CI, 89.7-98.9%) while at Nsanje and Machinga District Hospitals was 73.2% (95% CI, 59.7-84.2%) and 54.2% (95% CI, 39.2-68.6%) respectively. Adherence to treatment guidelines was associated with health facility, presence of laboratory test results, antibiotic spectrum, and WHO-AWaRe category of the medicine, p<0.005. Adherence was lower for antibiotics that were stocked out than antibiotics that were not stocked out during the study period (63.8%, 95% CI 48.5-77.3% vs 84.4%, 95% CI 77.7-89.8%), p< 0.002. We found unstable availability of antibiotic medicines in hospitals which might contribute to the sub-optimal adherence to standard treatment guidelines. This is a setback to efforts aimed at curbing antibiotic resistance in Malawi.

Assessing the Effectiveness of Children Safe Spaces (Children's Corners) on the Lives of Orphans and Vulnerable Children: A Case of Chanyungu Children's Corner in Machinga District

The HIV and AIDS epidemic is exerting the pressure on the immediate and extended family that the traditional care and support system has been stretched to the limit. Despite this, the family and the community are still the best providers of care and support to children. In response to the negative effects that children are facing, Government of Malawi introduced children’s corners as a community-based structure that, if properly implemented, can offer community parenting to address some of the children’s challenges. &#x0D; In exploring the effectiveness of these child safe spaces (children’s corners) on the psychosocial lives of orphans and vulnerable children, this study will be carried out in Chanyungu Village in Machinga District - Malawi. The researcher has an assumption of that children’s corners help to bring change in the lives of children such that if the programs are more targeted on the vulnerable children they can help to reverse the impact of vulnerability.&#x0D; This research will try to establish that vulnerable children acquire adequate information from children’s corners and it is this information that will help them change behaviour because they interact with their peers and share experiences. Previous studies done in other countries has also found that effective interventions such as peer education, resilience building are needed to help the vulnerable children maintain coping skills on challenges of life.

Blood-feeding patterns of Anopheles vectors of human malaria in Malawi: implications for malaria transmission and effectiveness of LLIN interventions

BackgroundAccess to human hosts by Anopheles mosquitoes is a key determinant of vectorial capacity for malaria, but it can be limited by use of long-lasting insecticidal nets (LLINs). In Malawi, pyrethroid-treated LLINs with and without the synergist piperonyl butoxide (PBO) were distributed to control malaria. This study investigated the blood-feeding patterns of malaria vectors and whether LLINs containing pyrethroid and PBO led to a reduction of human blood feeding than those containing only pyrethroids.MethodsMosquitoes were sampled inside houses from May 2019 through April 2020 by aspiration, pyrethrum spray catch, and light trap methods in two sites. One site (Namanolo, Balaka district) had LLINs containing only pyrethroids whereas the other (Ntaja, Machinga district) had LLINs with both pyrethroids and PBO. Anopheles species, their blood-meal host, and infection with Plasmodium falciparum were determined using PCR methods.ResultsA total of 6585 female Anopheles were sampled in 203 houses. Of these, 633 (9.6%) were blood-fed mosquitoes comprising of 279 (44.1%) Anopheles arabiensis, 103 (16.3%) Anopheles gambiae 212 (33.5), Anopheles funestus, 2 (0.3%), Anopheles parensis and 37 (5.8%) were unidentified Anopheles spp. Blood meal hosts were successfully identified for 85.5% (n = 541) of the blood-fed mosquitoes, of which 436 (81.0%) were human blood meals, 28 (5.2%) were goats, 11 (2.0%) were dogs, 60 (11.1%) were mixed goat-human blood meals, 5 (0.9%) were dog–human, and 1 was a mixed dog-goat. Human blood index (fraction of blood meals that were humans) was significantly higher in Namanolo (0.96) than Ntaja (0.89). Even though human blood index was high, goats were over-selected than humans after accounting for relative abundance of both hosts. The number of infectious Anopheles bites per person-year was 44 in Namanolo and 22 in Ntaja.ConclusionAlthough LLINs with PBO PBO may have reduced human blood feeding, access to humans was extremely high despite high LLIN ownership and usage rates in both sites. This finding could explain persistently high rates of malaria infections in Malawi. However, this study had one village for each net type, thus the observed differences may have been a result of other factors present in each village.

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.

Evaluating the merits of climate smart technologies under smallholder agriculture in Malawi

AbstractThe merits of three climate smart agriculture (CSA) technologies implemented by farmers were assessed in Machinga district of Malawi with respect to their soil quality and maize yield effects. Data were collected from farms implementing the three CSA technologies, namely conservation agriculture (CA), maize–pigeonpea (Maize‐PP) intercrops and a local organic and inorganic soil amendment known as Mbeya fertilization (Mbeya‐fert), from 2018 to 2019. With respect to resilience and adaptation, particulate organic matter, soil organic carbon (SOC), N, P, K, Ca and Mg all significantly improved while bulk densities were lowered under the three CSA systems. Higher annual biomass inputs and improved water infiltration from the Maize‐PP intercrops were observed. With respect to productivity, CA and Mbeya‐fert improved maize yields by 51 and 19%, respectively, compared to conventional farmer practices. With regard to climate change mitigation, increases in measured SOC in the top 20 cm depth compared to the conventional farmer practices amounted to 6.5, 12 and 10.5 t C ha−1 for CA, Mbeya‐fert, and Maize‐PP intercrops, respectively, over a period of 2–6 years. This suggests higher potential for carbon sequestration from CSA technologies. Furthermore, use of drought tolerant varieties, timely weeding and optimum plant populations, increased productivity. Improved gross margins from CSA practices were also apparent. Thus, employing these CSA technologies could enable farmers to be more resilient, productive and adapt better to climate change shocks leading to improved food security and livelihoods.

Supply the demand: Assessment of the feasibility of local non-urologists in relieving the burden of chronic indwelling catheters in a low-income country.

Despite the high prevalence rates of urinary retention in sub-Saharan Africa, regional deficiencies in urological care have culminated in inadequate medical management, and a backlog of urology cases. Our study examined the efficacy and safety of a surgical camp enlisting local non-urologists performing simple open prostatectomy on the rate of chronic catheter usage secondary to urinary retention. We reported on a prospective case series of patients with chronic indwelling catheters who underwent open simple prostatectomy during a one-week urology camp in the Machinga District of Malawi. All operations were performed by a locally trained general surgeon and a clinical officer. Twenty-three (47.9%) of 48 male patients with urinary retention assessed for eligibility for open simple prostatectomy were deemed eligible and underwent the procedure. Of the patients who underwent an open simple prostatectomy, histopathological findings demonstrated benign prostatic hyperplasia in 19 patients (82.6%), while six patients (26.1%) had coincidental malignancy. At postoperative followup, the entire cohort was catheter-free and reported regular sexual activity and the ability to return to work, while 87.0% noted improvements in social integration and 34.8% cited higher self-esteem. Two patients required treatment for infection and one patient experienced fascial dehiscence. Two months following prostatectomy, all patients were catheter-free and able to void independently. Local surgical practitioners without formal urology training can successfully perform open simple prostatectomy to relieve patients of chronic indwelling catheters and assist in addressing the disease burden in a low-resource setting.

Supply the demand: Assessment of the feasibility of local nonurologists in relieving the burden of chronic indwelling catheters in a low-income country.

Despite the high prevalence rates of urinary retention in sub-Saharan Africa, regional deficiencies in urological care have culminated in inadequate medical management and a backlog of urology cases. Our study examined the efficacy and safety of a surgical camp enlisting local non-urologists performing simple open prostatectomy on the rate of chronic catheter usage secondary to urinary retention. We reported on a prospective case series of patients with chronic indwelling catheters who underwent open simple prostatectomy during a one-week urology camp in the Machinga District of Malawi. All operations were performed by a locally trained general surgeon and a clinical officer. Twenty-three (47.9%) of 48 male patients with urinary retention assessed for eligibility for open simple prostatectomy were deemed eligible and underwent the procedure. Of the patients who underwent an open simple prostatectomy, histopathological findings demonstrated benign prostatic hyperplasia in 19 patients (82.6%), while six patients (26.1%) had coincidental malignancy. At postoperative followup, the entire cohort was catheter-free and reported regular sexual activity and the ability to return to work, while 87.0% noted improvements in social integration and 34.8% cited higher self-esteem. Two patients required treatment for infection and one patient experienced fascial dehiscence. Two months following prostatectomy, all patients were catheter-free and able to void independently. Local surgical practitioners without formal urology training can successfully perform open simple prostatectomy to relieve patients of chronic indwelling catheters and assist in addressing the disease burden in a low-resource setting.

Impact of program transfer from a non-governmental organization to a district health office: Evaluation of a program integrating water treatment and hygiene kits into reproductive health and HIV services, Machinga District, Malawi, 2010-2012.

BackgroundIn September 2009, the Machinga Integrated Antenatal Water Hygiene Kit Program began addressing problems of unsafe water, high infant mortality, and low antenatal care (ANC) attendance in Machinga District, Malawi. In March 2011, the supporting international non-governmental organization transitioned management of the program to the Machinga District Health Office (DHO). We evaluated maternal and HIV service use before and after program transition to the DHO.MethodsWe compared pre- and post-transition periods by examining data recorded in ANC and maternal registries in 15 healthcare facilities (HCFs) by proportion z-tests. We classified HCFs by size, using the median monthly patient volumes as the split for large or small facilities. We used logistic regression to evaluate changes in the use of ANC, maternal, and HIV services and their interactions with HCF size.ResultsThe percentage of women attending their first ANC visit during the first trimester was similar in the pre-and post-transition periods (9.3% vs 10.2%). Although the percentage of women with ≥4 ANC visits was similar from pre- to post-transition (26.0% vs 24.8%), the odds increased among women in small facilities (OR: 1.37, 95% CI: 1.24–1.51), and decreased among women in large facilities (OR: 0.80, 95% CI: 0.75–0.85). Although a similar percentages of pregnant women were diagnosed with HIV in all HCFs in the pre- and post-transitions periods (6.4% vs 4.8%), a substantially larger proportion of women were not tested for HIV in large HCFs (OR: 6.34, 95% CI: 5.88–6.84). A larger proportion of women gave birth at both small (OR: 1.30, 95% CI: 1.16–1.45) and large HCFs (OR: 1.55, 95% CI: 1.43–1.67) in the post-transition vs. the pre-transition period.ConclusionsThe evaluation results suggest that many positive aspects of this donor-supported program continued following transition of program management from a non-governmental organization to a DHO.

Diffusion of Handwashing Knowledge and Water Treatment Practices From Mothers in an Antenatal Hygiene Promotion Program to Nonpregnant Friends and Relatives, Machinga District, Malawi.

Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases in low- and middle-income countries. Integrating water treatment and hygiene products into antenatal clinic care can motivate water treatment and handwashing among pregnant women. Free water hygiene kits (water storage containers, sodium hypochlorite water treatment solution, and soap) and refills of water treatment solution and soap were integrated into antenatal care and delivery services in Machinga District, Malawi, resulting in improved water treatment and hygiene practices in the home and increased maternal health service use. To determine whether water treatment and hygiene practices diffused from maternal health program participants to friends and relatives households in the same communities, we assessed the practices of 106 nonpregnant friends and relatives of these new mothers at baseline and 1-year follow-up. At follow-up, friends and relatives were more likely than at baseline to have water treatment products observable in the home (33.3% vs. 1.2%, p < 0.00001) and detectable free chlorine residual in their water, confirming water treatment (35.7% vs. 1.4%; p < 0.00001). Qualitative data from in-depth interviews also suggested that program participants helped motivate adoption of water treatment and hygiene behaviors among their friends and relatives.

Exploring Hybrid Third Spaces in the Place Mappings of Malawian Youth

This article is based on a study of Malawian youths’ understandings of place in relation to knowledge and practice and considers some implications for education. The study was conducted at Chinduzi Junior Farmer Field and Life Skills School in Machinga district in Malawi from September 2010 through January 2011. Data collection methods included place mapping and associated focus group discussions. The data were analysed following Collier and Collier’s (1986) method for analysing photographs. Youth mappings of their favourite places suggested aspects of both hope and despair. From the youths’ discussions, a sense of belonging was evident in the social relationships associated with the activities performed in their favourite places. The drawings also exhibited gendered features. Overall, the drawings and associated discussions revealed that the youth are largely rooted in their socio-cultural interactions within their community, but also influenced by globalisation – hence they operate within what Homi Bhabha (1994) calls ‘hybrid third spaces’. In these spaces, they use their imagination to create optimistic futures. These findings have implications for environment-related education. People are part of and shaped by place; at the same time, they shape place through everyday social practices. Thus, studies on environment-related education in a particular local context need to take into account variations in experience based on learners’ diverse backgrounds. Pedagogical engagements should consider the socio-cultural experiences of learners in particular contexts.

Assessing bed net damage: comparisons of three measurement methods for estimating the size, shape, and distribution of holes on bed nets

BackgroundMeasuring the physical condition of long-lasting insecticidal nets (LLINs) under field conditions is of great importance for malaria control programmes to guide decisions on how frequently to replace LLINs. Current guidelines by the World Health Organization Pesticide Evaluation Scheme (WHOPES) propose a proportionate hole index (pHI) for assessing LLIN condition by counting the number of holes the size of a thumb, fist, head, and larger than a head. However, this method does not account for irregular hole shapes or exact hole sizes which could result in inaccurate decisions about when to replace LLINs.MethodsLLINs were collected during a 2013 health facility-based malaria case control study in Machinga District, Malawi. To evaluate the accuracy of the pHI, the physical condition of 277 LLINs was estimated by the WHOPES method and then compared with two more thorough measurement methods: image analysis of digital photographs of each LLIN side; and for 10 nets, ruler measurements of the length, width, and location of each hole. Total hole counts and areas per net were estimated by each method, and detailed results of hole shapes and composite pictures of hole locations were generated using image analysis.ResultsThe WHOPES method and image analysis resulted in similar estimates of total hole counts, each with a median of 10 (inter-quartile range (IQR) 4–24 and 4–23, respectively; p = 0.004); however, estimated hole areas were significantly larger using the WHOPES method (median 162 cm2, IQR 28–793) than image analysis (median 13 cm2, IQR 3–101; p < 0.0001). The WHOPES method classified fewer LLINs in ‘good condition’ compared to image analysis (42% vs 74%). The ruler method detected significantly more holes than image analysis did (p = 0.002) in 10 LLINs; however, total hole area was not significantly different (p = 0.16). Most holes were not circular but roughly 2–5 times longer in one direction. The lower quarter of LLIN sides was found to have the most holes.ConclusionsThe WHOPES method overestimated total hole area, likely because holes are elongated rather than circular, suggesting further adjustments to the pHI formula may be warranted when considering LLIN replacement strategies.

The effect of holes in long-lasting insecticidal nets on malaria in Malawi: results from a case\u2013control study

BackgroundLong-lasting insecticidal nets (LLINs) are a cornerstone of malaria prevention. Holes develop in LLINs over time and compromise their physical integrity, but how holes affect malaria transmission risk is not well known.MethodsAfter a nationwide mass LLIN distribution in July 2012, a study was conducted to assess the relationship between LLIN damage and malaria. From March to September 2013, febrile children ages 6–59 months who consistently slept under LLINs (every night for 2 weeks before illness onset) were enrolled in a case–control study at Machinga District Hospital outpatient department. Cases were positive for Plasmodium falciparum asexual parasites by microscopy while controls were negative. Digital photographs of participants’ LLINs were analysed using an image-processing programme to measure holes. Total hole area was classified by quartiles and according to the World Health Organization’s proportionate hole index (pHI) cut-offs [< 79 cm2 (good), 80–789 cm2 (damaged), and > 790 cm2 (too torn)]. Number of holes by location and size, and total hole area, were compared between case and control LLINs using non-parametric analyses and logistic regression.ResultsOf 248 LLINs analysed, 97 (39%) were from cases. Overall, 86% of LLINs had at least one hole. The median number of holes of any size was 9 [interquartile range (IQR) 3, 22], and most holes were located in the lower halves of the nets [median 7 (IQR 2, 16)]. There were no differences in number or location of holes between LLINs used by cases and controls. The median total hole area was 10 cm2 (IQR 2, 125) for control LLINs and 8 cm2 (IQR 2, 47) for case LLINs (p = 0.10). Based on pHI, 109 (72%) control LLINs and 83 (86%) case LLINs were in “good” condition. Multivariable modeling showed no association between total hole area and malaria, controlling for child age, caregiver education, and iron versus thatched roof houses.ConclusionsLLIN holes were not associated with increased odds of malaria in this study. However, most of the LLINs were in relatively good condition 1 year after distribution. Future studies should examine associations between LLIN holes and malaria risk with more damaged nets.

Overcoming Barriers to Uptake of Voluntary Medical Male Circumcision in a Traditionally Circumcising Community in Machinga District, Malawi

Introduction: Voluntary medical male circumcision (VMMC) reduces chances of contracting HIV during heterosexual intercourse in males, and risk of cervical cancer in their female sexual partners. However, its uptake among traditionally circumcising communities, where male circumcision carries a cultural significance, has not been studied. Previous research has focused on barriers to uptake of VMMC in non-circumcising communities. This study was conducted to determine socio-cultural barriers to VMMC uptake in order to identify culture-sensitive and evidence-based interventions to increase its uptake. Methodology: This exploratory mixed methods cross-sectional study generated quantitative data from 262 randomly sampled sexually active men; and qualitative data through four focus-group discussions with 58 purposely selected male participants and 10 key informants. Results: The study established that only 6.3% (n = 15) of those circumcised (90.8%, n = 238) were circumcised in clinical setting. Limited access to VMMC services, cost, pain, being attended to by female providers and cultural influences were the major hindrances to uptake of VMMC. Conclusion: Although there is a paradigm shift of preference from traditional male circumcision to VMMC in this community, its uptake is low. The study recommends that besides introducing mobile VMMC services, the Ministry of Health should collaborate with traditional circumcisers and local leaders to provide gender-and-culture-sensitive safer medical male circumcision services.

The Effects of Sex Education on the Risky Sexual Behaviour of School Going Adolescents

Adolescents are at a high risk for a number of health consequences associated with early and unsafe sexual activity including infection with HIV/AIDS, sexually transmitted infections (STIs) and unintended pregnancies. The amplified sexual risk-taking behaviour among adolescents culminates into thinking that perhaps lack of knowledge pertaining to sex and sexuality provokes adolescents into undertaking sexual risks. Consequently, sex education was introduced as a means of introducing youths in the field of sexual and reproductive health in Malawi to help them go for informed decisions. The use of several interventions countrywide is cited to have decreased the rates of sexual activity in some adolescents, however, despite the positive trend many adolescents remain at risk for unintended pregnancy, STIs and HIV/AIDS infection. This study empirically evaluates how sex education has impacted risky sexual behaviours undertaken by the schooling youths in the Machinga district particularly in three schools namely: Mbenjere, Ntaja and Nsanama Community Day Secondary Schools. Both qualitative and quantitative techniques were employed in the study. Questionnaire and focus group discussions served as data collection tools. Results of the study revealed that a good number of schooling youths had enough sexual knowledge but still undertook sexual risks. The study however concludes that sex education is failing to positively impact schooling youth’s behaviour because of some cultural and personal factors which seems to contradict the whole purpose of sex and sexuality education amongst youths in Machinga.

The effectiveness of long-lasting, insecticide-treated nets in a setting of pyrethroid resistance: a case-control study among febrile children 6 to 59 months of age in Machinga District, Malawi.

BackgroundThe escalating level of mosquito resistance to pyrethroid insecticides threatens the effectiveness of insecticide-treated nets (ITNs) for malaria control in Malawi. An evaluation of the effectiveness of ITNs for preventing malaria in children aged 6–59 months old, after 1 year of mass distribution of LLINs was conducted in Machinga District, Malawi, an area of moderate pyrethroid resistance.MethodsA facility-based, case–control study among children 6–59 months was conducted in an area of pyrethroid resistance between March and September 2013 in Machinga District. Cases and controls were children with fever who sought care from the same hospital and tested positive and negative, respectively, for malaria parasites by microscopy.ResultsA high proportion of both cases (354 of 404 or 87.6 %) and controls (660 of 778 or 84.8 %) slept under an ITN the night before the survey. In univariable logistic regression, older age (24–59 months versus 6–23 months, p < 0.001), sleeping on the floor versus a mattress (p < 0.001), and open versus closed house eaves (p = 0.001) were associated with increased odds of malaria, whilst secondary education of the caretaker, having windows on multiple walls, and being in the least poor wealth quintile (p < 0.001 for each) reduced the odds of malaria; ITN use was not associated with malaria (p = 0.181). In multivariable analysis, older age (p < 0.001) and secondary education of the caregiver (p = 0.011) were the only factors significantly associated with malaria.ConclusionThis study did not find a significant personal protective effect of ITNs. However, high use of ITNs in the community and recent findings of lower malaria incidence in ITN users compared to bed net non-users from a cohort study in the same area suggest that ITNs provide community protection to both users and non-users alike in this area.

Youth clubs’ contributions towards promotion of Sexual and Reproductive Health Services in Machinga District, Malawi

Background: In Malawi more than 50% of the population are young people less than 24 years old. Adolescents and young people face a lot of sexual and reproductive health (SRH) challenges such as unplanned and early pregnancies, sexually transmitted infections (STIs) including HIV and AIDS and abusive intimate relationships. Provision of SRH services through Youth clubs is one strategy that has potential to contribute to addressing the SRH challenges. We conducted a study in Machinga district, southern Malawi to assess the contributions of youth clubs towards promotion of SRH services.Methods: A cross sectional study was conducted in 2014 among youths aged 15 – 24 years. The participants were drawn from Machinga boma and Liwonde Township. We used both quantitative and qualitative methods. Quantitative data were collected using questionnaires, while Focus Group Discussions (FGDs) and Key informant interviews were used to collect qualitative data. Quantitative data were analysed by estimating proportions and Chi square tests while thematic content analysis was used for qualitative data. The study was approved by University of Malawi’s College of Medicine Research and Ethics Committee (COMREC).Results: Frequently offered services in youth clubs were HIV and AIDS education reported by 48.4% of the study participants, STI education (16.7%), family planning(16.7%) and life skills education (9.7%). On service utilisation there was no association between attendance to youth clubs and HIV Testing Counselling (χ2 =0.76, p=0.4) and there was no association between attendance to the youth clubs and family planning utilisation (χ2 =3.1, p=0.3). Condom use was the most used contraceptive method among the study participants. Misconception, accessibility and poor attitude of health workers were some of the factors reported as contributing to low utilisation of family planning methods. All youth club participants, reported by 89 study participants and only 29.4% of club non-attendees had adequate SRH knowledge. The services provided by health workers to youth clubs reported by study participants were HIV and AIDS education, HIV testing and counselling (HTC) and condom distribution.Conclusion: Our findings highlight the need of youth clubs to promote SRH services.Efforts should be made to ensure that the identified challenges are dealt with to ensure effective participation of youth clubs.

Home visits to assess the reliability of caregiver-reported use of insecticide-treated bednets by children in Machinga District, Malawi.

A malaria cohort study was conducted among young children in Machinga District, Malawi, following distribution of insecticide-treated bednets (ITNs) in May 2012. To assess ITN use, two independently sampled subsets of children (211 during survey 1 [December 2012-January 2013] and 325 during survey 2 [September-October 2013]) were randomly selected to compare the proportions of positive and negative agreement between caregiver verbal reports at monthly interviews with visual observation of the ITN at home visits. Caregiver-reported ITN use was consistently high during both surveys (98.1% and 96.0%, respectively; P = 0.17). Home visit-based ITN use fell significantly (P < 0.001) from survey 1 (98.6%) to survey 2 (88.6%). The proportions of positive agreement between caregiver report and home visit in the first and second surveys were 98.8% (95% confidence interval [CI] 97.6-99.8%) and 93.3% (95% CI 91.2-95.3%), respectively. The proportions of negative agreement in the first and second surveys were 28.6% (95% CI 0-75.0%) and 20.0% (95% CI 0.1-35.0%), respectively. ITN use by children was high in Machinga District, and caregiver reports and home visits with visual confirmation of the net demonstrated a high level of agreement for use of ITNs, but a low level of agreement when ITNs were not used.

Effectiveness of Intermittent Preventive Treatment With Sulfadoxine-Pyrimethamine During Pregnancy on Maternal and Birth Outcomes in Machinga District, Malawi

Malaria during pregnancy is associated with low birth weight and increased perinatal mortality, especially among primigravidae. Despite increasing prevalence of malarial parasite resistance to sulfadoxine-pyrimethamine (SP), SP continues to be recommended for intermittent preventive treatment in pregnancy (IPTp). Women without human immunodeficiency virus infection were enrolled upon delivery. Data on the number of SP doses received during pregnancy were recorded. The primary outcome was placental infection demonstrated by histologic analysis. Secondary outcomes included malaria parasitemia (in peripheral, placental, cord blood specimens) at delivery and composite birth outcome (small for gestational age, preterm delivery, or low birth weight). RESULTS.: Of 703 women enrolled, 22% received <2 SP doses. Receipt of ≥ 2 SP doses had no impact on histologically confirmed placental infection. IPTp-SP was associated with a dose-dependent protective effect on composite birth outcome in primigravidae, with an adjusted prevalence ratio of 0.50 (95% confidence interval [CI], .30-.82), 0.30 (95% CI, .19-.48), and 0.18 (95% CI, .05-.61) for 1, 2, and ≥ 3 doses, respectively, compared with 0 doses. IPTp-SP did not reduce the frequency of placental infection but was associated with improved birth outcomes. Few women received no SP, so the true effect of IPTp-SP may be underestimated. Malawian pregnant women should continue to receive IPTp-SP, but alternative strategies and antimalarials for preventing malaria during pregnancy should be investigated.