Malawi Research Articles

Sulphate sorption and desorption characteristics of selected Malawi soils

The soils selected for this study represented major soil types in Malawi. They exhibited a wide range of physical and chemical properties. Their pH values ranged from 4.7 to 6.7 and their contents of clay fraction (<0.002 mm) ranged from 170 to 500 g kg-1, organic matter from 6.7 to 39.3 g kg-1, free Fe2O3 from 18.9 to 44.7 g kg-1, and free Al2O3 from 17.8 to 45.6 g kg-1. The soils varied widely in their SO4 sorption behaviour. Soil pH was negatively and significantly correlated (P<0.05) with the bonding energy (k) of SO4 by the soil, Langmuir sulphate sorption maximum (b) and maximum buffering capacity (MBC). Soil organic matter was positively and significantly related with k, b and MBC at the same level of significance (P<0.05). Free Al2O3 and Fe2O3 were positively and significantly related (P<0.001) with b and MBC. Free Fe2O3 and Al2O3 were positively and significantly correlated with k at P<0.01 and P<0.001 respectively. About 90 and 91% of the total variations in the sulphate sorption maxima were accounted for by free Al2O3 and Fe2O3 respectively. Key words: Sulphate, sorption, desorption, Langmuir, hysteresis, affinity.

Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi.

BackgroundSuicide is among the top causes of adolescent mortality worldwide. While correlates of suicidal behavior are better understood and delineated in upper-income countries, epidemiologic knowledge of suicidal behavior in low-income countries remains scant, particularly in the African continent. The present study sought to add to the epidemiologic literature on suicidal behavior in Africa by examining the behavioral correlates of suicide attempts among Malawi adolescents.MethodsA cross-sectional study using a nationally-representative sample extracted from publically-available data was conducted. Bivariate and multivariate analyses were performed to discern associations between suicide attempts and a host of behavioral variables. 2225 records were included in the study.ResultsAt the multivariate level, suicide attempters had significantly higher odds of being anxious, being physically bullied, having sustained a serious injury and having a greater number of lifetime sexual partners. Alcohol use (at an early age and within the past 30 days) was also associated with suicide attempts.ConclusionsThese findings have the potential to guide public health interventions geared toward suicide prevention in Africa and other, similar regions, as well as provide the impetus for future epidemiologic studies on suicidal behavior in low-income countries.

Participatory designing and implementation of an electronic medical record system in the adult emergency and trauma center at Queen Elizabeth Central Hospital, Blantyre, Malawi

Participatory designing and implementation of an electronic medical record system in the adult emergency and trauma center at Queen Elizabeth Central Hospital, Blantyre, Malawi

Evaluation of the quality of asthma management in the adult emergency and trauma center at Queen Elizabeth Central Hospital, Blantyre, Malawi

Evaluation of the quality of asthma management in the adult emergency and trauma center at Queen Elizabeth Central Hospital, Blantyre, Malawi

Stakeholders perspectives on paper-based and electronic clinical decision support systems in Malawi Africa

The objective of this paper is to explore the perceptions of key stakeholders involved and/or affected by existing paper-based decision support guidelines (known as Community Case Management (CCM)) and a proposed digitised mobile clinical decision support system (CDSS) of CCM in rural settings of Malawi, Africa. Data was collected using field notes and semi-structured interviews with 17 key stakeholders (i.e. clinical, technical, development aid support (NGO), government and community health workers both in Malawi, Europe and USA). Stakeholders provide a rich insight into the variety of both perceived benefits and challenges of the existing guidelines and the proposed electronic CDSS. It was found that all stakeholders believe that the CDSS will improve adherence to guidelines and subsequently result in better care for children. It is further envisioned that the time needed for administration with the current paper-based approach could be reduced using electronic, as opposed to manual, collation and sending of records. This paper acts to underpin the rationale and motivation for the development and rollout of an electronic CDSS to support community health workers in their assessment, classification and treatment of young children in rural settings in Malawi, Africa.

Implementation of routine viral load monitoring in Lesotho, Malawi, Mozambique and Zimbabwe: a cascade analysis

Implementation of routine viral load monitoring in Lesotho, Malawi, Mozambique and Zimbabwe: a cascade analysis

“When my hours are done, they are still calling me” a qualitative study of sex worker peer educators’ perspectives on their role in an HIV project in Mozambique and Malawi

“When my hours are done, they are still calling me” a qualitative study of sex worker peer educators’ perspectives on their role in an HIV project in Mozambique and Malawi

Weaving a Malawi sunrise: a woman, a school, a people

Weaving a Malawi sunrise: a woman, a school, a people

Perspectives of Wife‐Husband Pairs on Their Roles in Infant and Young Child Feeding Decision‐Making in the Context of Malawi's Prevention of Mother‐to‐Child HIV Transmission Program

Studies have examined the role of male involvement in HIV counseling and testing within prevention of mother‐to‐child transmission (PMTCT) programs, but there is no corresponding data on male involvement in infant and young child feeding (IYCF) decision‐making and its relation to adherence to HIV and infant feeding guidelines. Adherence to IYCF guidelines remains important for limiting HIV transmission through breast milk and improving child survival. We explored wives’ and husbands’ perceptions of husbands’ roles in feeding decision‐making and practice in the context of Malawi's Option B+ PMTCT program through in‐depth interviews conducted in the catchment areas of 2 urban and 2 rural government clinics in Lilongwe District. Participants were 15 wife‐husband pairs (interviewed separately), where the wife was ≥ 18 years, HIV‐positive, and had a child &lt; 24 months. The interviews were analyzed using thematic content analysis. Husbands were generally less well‐informed about IYCF recommendations than their wives, who were advised on IYCF during antenatal and PMTCT clinic visits. Most husbands and wives agreed that the wife was largely responsible for IYCF decision‐making and few husbands were involved in decisions about complementary feeding. Some husbands participated in decisions about when to stop breastfeeding the child because of their fears about the child becoming HIV infected, even if the wife was on antiretroviral therapy. In couples where the husband advised the wife on feeding, the wife usually said that she followed his wishes. Both wives and husbands wanted to avoid disagreements about IYCF because they were worried that such disagreements would harm the child's health and well being. For wives and husbands, the most important role of husbands in relation to IYCF was to purchase food or provide money for food for the child. Wives appreciated it when their husbands offered verbal support to encourage them to continue with the recommended IYCF practices. Wives whose husbands were supportive found it easier to follow breastfeeding recommendations, but adequate complementary feeding remained a challenge in the face of household food insecurity. In conclusion, Malawian husbands and wives reported highly gendered roles in relation to IYCF decision‐making in the context of HIV, but some women flagged their interest in having verbal, in addition to monetary, support from their husbands for IYCF practices. To address this gap, strategies should be tested for getting messages on IYCF to husbands through male‐friendly radio and community‐based programs or by encouraging them to participate in PMTCT visits with their wives.Support or Funding InformationNIH BIRCWH K12 program, UNC CFAR developmental award

Did drug availability in Malawian central hospitals improve after the conversion of central medical stores to a trust

Malawian public hospitals have reportedly been experiencing a lot of shortages in medicines and medical supplies in recent years. This was at least in part, attributed to the traditional placement of the drug supply system under the Ministry of Health, and therefore a change in the organizational set-up was implemented in 2011. This study aimed at finding out if the availability of medicines in central hospitals in Malawi improved after the change of Central Medical Stores (CMS) to a Trust (CMST). A retrospective cohort study was done to quantify the availability of selected essential medicines before and after the change of CMS from stock cards. A questionnaire was filled by 23 health professionals to assess their views on whether the change of CMST resulted in improved availability of medicines. The study was done at Queen Elizabeth Central Hospital (QECH), Kamuzu Central Hospital (KCH) and Central Medical Store Trust. The targeted study period was before the change of CMS (2010/2011) and after (2013/2014) the change to CMST. The results of the study showed considerable reduction in stock-out days for both KCH and the CMST (from an average of 80 and 16 days to 42 and 9 days, respectively), with CMST results being statistically significant (p=0.023). However, in QECH, there was no improvement (from 22 to 24 days). The view of most respondents was that there was no improvement in medicine availability after the change of CMS, which represented a certain contradiction to the results of the quantitative part. This may be attributed to the fact that the questionnaire targeted only participants from QECH and KCH and left out participants from CMST. The study indicated that the radical shift in the management of CMS was followed by an improvement of drug availability in CMST itself, and in one of the two investigated hospitals. The non-improvement in drug availability in hospitals calls for further investigation in the future to understand the reasons for this. Key words: Central medical stores, Malawi, medicine availability, essential medicine, autonomous supply agency, pharmaceutical logistics, supply chain.

Detection of enterotoxigenicE. coliin hospitalised children with and without diarrhoea in Blantyre, Malawi

Detection of enterotoxigenic<i>E. coli</i>in hospitalised children with and without diarrhoea in Blantyre, Malawi

Address Malata: advancing nursing and midwifery in Malawi

Address Malata: advancing nursing and midwifery in Malawi

A Qualitative Study to Inform the Design, Content and Structure of an Interactive SMS Messaging Service in Chikwawa, Malawi.

A Qualitative Study to Inform the Design, Content and Structure of an Interactive SMS Messaging Service in Chikwawa, Malawi.

Language policy in Malawi: A study of its contexts, factors for its development and consequences

The article examines the different factors and contexts which have influenced language policy in Malawi from the time of early missionaries to the present, and highlights the implications and consequences of the language policy—both politically, educationally and socially. However, given the conceptual framework of language policy and the historical, linguistic and cultural disposition of the Malawian society which emphasize education, the article has its main focus on the education system. In addition to intensive literature review and document analysis, semi-structured interviews, mainly with secondary school teachers, were conducted in Mzimba District in July 2014. The study ascertains that current language practices were founded on the framework and philosophies of various missionary groups which have highly influenced and affected the development of both indigenous and foreign languages in Malawi. It further discovered that the long-standing leadership of Hastings Kamuzu Banda has had a huge impact on language attitude, practices and the overall language policy. However, since the election of Bakili Muluzi and the new multi-party democracy, the policy has generally been characterised by linguistic pluralism although not much has been done to make it more favourable to vernacular languages due to lack of resources and improper implementation. The paper concludes that the implementation of language policy in Malawi, like in many other African countries, faces many challenges and is riddled with contradictions whether implicit or explicit. Keywords: Language of Learning and Teaching (LoLT), linguistic justice, vertical communication, language attitude, language policy, linguistic pluralism

AIDS and Religious Life in Malawi: Rethinking How Population Dynamics Shape Culture

AIDS and Religious Life in Malawi: Rethinking How Population Dynamics Shape Culture

Liming and fertiliser P interaction effects on some indices of fertility of selected Malawi acidic soils

Laboratory investigations were conducted to determine effects of liming materials and inorganic phosphatic fertilisers on some indices of soil fertility. Results showed that soil bulk density decreased with increasing additions of liming materials and that interaction effects of dolomitic limestone and mineral fertiliser P increased soil pH from 4.4 for the unlimed top-soils to 6.3 after 3 t ha‒1 of dolomitic limestone and 300 kg ha‒1 Super D (a compound fertiliser) were added. Inverse statistically significant relationships were observed between exchangeable Al and lime (P £ 0.01); exchangeable Al and pH (P £ 0.01); and exchangeable Al and extractable P (P £ 0.01). About 98% of the total variation in exchangeable Al was accounted for by the applied dolomitic limestone. The present investigations have demonstrated that the observed low fertility of the acidic soils may be attributed to its association with low P availability; reduced nutrients such as K, Mg and Ca; and adverse effects of exchangeable aluminium. Key words: Liming effects, exchangeable aluminium, indices of soil fertility.

Malawi: Suffering from Aid Loss

Malawi: Suffering from Aid Loss

A Cross-case Analysis of the Effects of EMR Deployment on Antenatal Care Services in Rural Health Centres in Malawi

Background and Purpose : The use of Electronic Medical Records in developing countries is considered important for monitoring and facilitating the achievement of health-related Millennium Development Goals. Many studies have analysed the effects of EMRs in supporting care provision in hospitals, mostly with a focus on HIV/AIDS services. However, there are limited studies on EMR use for maternal health services in small primary care facilities in rural settings. This paper aims to address this gap by presenting findings from evaluation of two EMR systems implemented to support Antenatal care in two rural health centres in Malawi. Methods : This study was undertaken as part of an Action Research project exploring the use of EMRs in Malawi. The paper presents a qualitative analysis of the effects of EMRs on Antenatal care services in two rural health centres. Data was collected through interviewing end-users and pregnant women, participant observation of health services, and analysis of Antenatal care data. Results : The study reveals that EMRs have the effects of redistributing work and increasing collaboration among different types of health workers; increasing attention and knowledge on the health domain, and redistributing risks in care and data quality. Conclusions : The findings highlight the need for EMR system designs that support coordination of work and provide for easy correction of errors. The study also shows that introducing EMRs can facilitate learning about the healthcare domain in addition to gaining computer skills. Keywords: Antenatal care, EMR systems, evaluation, effects, rural health centres, developing countries, Malawi, qualitative research.

Tale from Malawi

Tale from Malawi

Malawi in crisis: The 1959/60 Nyasaland state of emergency and its legacy

Malawi in crisis: The 1959/60 Nyasaland state of emergency and its legacy