Systems In Malawi Research Articles

Protecting public health using environmental impact assessment in Malawi

Development that does not adequately consider human health may pass increased disease burden costs to surrounding communities. EIA as a tool of sustainable development can be used to protect public health. The aim of this paper is to look at coverage of health impacts in the EIA system in Malawi. Under the current EIA system, EIA can be used to protect public health in Malawi. In EIA reports relationships between projects and determinants of health are merely discussed as they relate to conformance with legislation and standards. There is a need to promote specialised methods to tackle health impacts and also greater involvement of health institutions and professionals in EIA. In Malawi, it is possible to assess the impacts on health adequately within the EIA context and not necessarily in a distinct and stand-alone health impact assessment.

Who Talks to Whom in Malawi's Agricultural Research Information Network?

Purpose: The sector-wide approach currently dominates as the strategy for developing the agricultural sector of many African countries. Although recognised that collaborative agricultural research is vital in ensuring success of sector-wide agricultural development strategies; there have been few efforts to understand the dynamics of national agricultural research/development networks in Africa. This study fills this gap by analysing the dynamics of networking and interactions between institutions in the National Agricultural Research System in Malawi. Design/Methodology/Approach: The study sampled actors in the National Agricultural Research System in Malawi, which included the main public agricultural research department, academic institutions, semi-autonomous research institutions, private companies and international agricultural research institutions. Data was analysed using Social Network Analysis. Findings: Results demonstrate that public agricultural research departments play a central coordinating role in facilitating information sharing; with other actors remaining on the periphery. However, it also shows the important role other actors play to relay information to a wider network of stakeholders. These secondary information pathways can play a very crucial role in ensuring successful implementation of the national agricultural research agenda. Practical implication: Policy-makers are called upon to integrate other research actors into the mainstream national agricultural research information network. This is vital as other research actors are, at the global level, increasingly taking up a greater role in financing and disseminating research and research results. Originality/Value: The study contributes greatly towards knowledge needed for continuing the transformation of African agricultural research; and aligning the African agricultural research vision and practice with the emerging global agricultural research paradigm.

Electronic data capture in a rural African setting: evaluating experiences with different systems in Malawi

Background As hardware for electronic data capture (EDC), such as smartphones or tablets, becomes cheaper and more widely available, the potential for using such hardware as data capture tools in routine healthcare and research is increasing. Objective We aim to highlight the advantages and disadvantages of four EDC systems being used simultaneously in rural Malawi: two for Android devices (CommCare and ODK Collect), one for PALM and Windows OS (Pendragon), and a custom-built application for Android (Mobile InterVA – MIVA). Design We report on the personal field and development experience of fieldworkers, project managers, and EDC system developers. Results Fieldworkers preferred using EDC to paper-based systems, although some struggled with the technology at first. Highlighted features include in-built skip patterns for all systems, and specifically the ‘case’ function that CommCare offers. MIVA as a standalone app required considerably more time and expertise than the other systems to create and could not be customised for our specific research needs; however, it facilitates standardised routine data collection. CommCare and ODK Collect both have user-friendly web-interfaces for form development and good technical support. CommCare requires Internet to build an application and download it to a device, whereas all steps can be done offline with ODK Collect, a desirable feature in low connectivity settings. Pendragon required more complex programming of logic, using a Microsoft Access application, and generally had less technical support. Start-up costs varied between systems, and all were considered more expensive than setting up a paper-based system; however running costs were generally low and therefore thought to be cost-effective over the course of our projects. Conclusions EDC offers many opportunities for efficient data collection, but brings some issues requiring consideration when designing a study; the decision of which hardware and software to use should be informed by the aim of data collection, budget, and local circumstances.

Alliances, Coalitions and the Weakening of the Party System in Malawi

In nascent democracies, like that in Malawi, with presidential regimes and plurality electoral systems, the emergence of fragmented political party systems is inevitable, characterised by ethnically polarised political behaviour, fragile institutions and minority governments. This ultimately leads to volatile and contentious legislative-executive relations, weak political party cohesion and the stagnation of democratic consolidation. Malawi's system inherently offers neither incentives for coalition formation nor mutual interdependence between the executive and the legislature. Hence, the latent conflicts, persistent governance crises, inertia and grinding executive-legislative confrontations. Among political actors and across minority regimes in Malawi recourse to coalition politics has not been embraced as an optimal democratic instrument and formal strategy for state governability since 1994. The Mutharika minority government (2004-2009), which was persistently frustrated by parliamentary paralysis, survived on the floorcrossing inducements of opposition legislators, extended judicial injunctions and the presidential prorogation of Parliament. In addition, the brief 'experiments' with government coalitions, 'collusions' and electoral alliances weakened cohesion within partner parties and hardly increased national cohesion, but promoted state governability and yielded marginal gains in democratic consolidation. This article argues that political institutions that are designed to encourage formal political coalitions and discourage floorcrossing (parliamentary systems and proportional electoral laws) serve to mitigate against state instability and enhance democratic consolidation.

Regulation of political parties and party functions in Malawi: Incentive structures and the selective application of the rules

The party system in Malawi has been characterised by instability and fragmentation since the reintroduction of multiparty democracy in 1993. In part this instability is rooted in the legal framework regulating political parties as organisations and the functions that parties perform in a democracy. The article outlines the constitutional and legal framework of political parties. But more important is how regulation of functions such as candidate nomination, campaigning and representation in parliament interacts with the structure of the political system, leading to party system instability. Moreover, the effect of regulation of political parties and their activities is strongly influenced by ‘selective’ application of the formal regulations and weak party organisations. Formal rules meant to strengthen political parties have therefore not functioned as intended.

Grafting: Balancing Control and Cultivation in Information Infrastructure Innovation

This paper proposes grafting as a new perspective on information infrastructure (II) innovation. We introduce the organic notion of grafting to help explore innovation processes in settings where control is distributed and episodic. Our case study follows the implementation of mobile phone-based reporting of routine data from sub-district health facilities in Malawi. Initial grafting work entails the careful alignment of available resources, capacities, and interests through the proposition of an information system (IS) innovation (e.g., mobile phone-based reporting). The nurturing of the implementation involves collaborative efforts spanning technological, professional, geographical, and organizational boundaries. This work is taken forward by the identification of opportunities for merging an innovation with existing socio-technical arrangements (e.g., health management information systems in Malawi) in such a way that the parts continue to grow.

Estimating aboveground tree biomass in three different miombo woodlands and associated land use systems in Malawi

Trees outside forests support smallholder farmers' livelihoods and play a critical role in the global carbon cycle. However, their contribution to climate change mitigation through carbon storage is not obvious because of limited information regarding their extent, and inadequate methods for biomass quantification. This study evaluated the distribution of aboveground biomass (AGB) in three 100 km2 benchmark sites in Kasungu, Salima, and Neno districts in Malawi. In 67 sample plots covering 37 cultivated fields and 30 woodland plots, a total of 2481 trees were inventoried over 6 ha. Tree species documented were 56 in Kasungu, 35 in Salima and 33 in Neno. The corresponding values of the Shannon diversity index and its standard error (SE) were 3.45 (0.01) for Kasungu, 2.78 (0.01) for Salima and 2.73 (0.01) for Neno. The three most dominant species in terms of biomass were Faidherbia albida (47.8%), Piliostigma thonningii (11%), and Mangifera indica (9%), all found in cultivated fields. Large trees with diameter at breast height (DBH) >40 cm formed only 3% of the total population inventoried in Salima, but held over 80% of the biomass. These high biomass trees were hardly found in Kasungu and Neno. Smaller trees (DBH < 10 cm) dominated all the sites, representing 93% of all the trees measured. These stock 14, 1, and 67% of the biomass in Kasungu, Salima, and Neno, respectively. The biomass estimates established in this study provide a useful reference against which future estimates can be compared, and sets a baseline for calculating changes in carbon stocks over time.

Evaluating the effectiveness of inter-regional trade and storage in Malawi’s private sector maize markets

This paper evaluates the effectiveness of the private sector maize marketing system in Malawi using threshold autoregression models. Two dimensions of maize market performance are evaluated: (1) inter-regional trade and spatial price transmission; and (2) storage and seasonal price relationships. In both cases, threshold autoregression models which account for nonlinearities predicted by economic theory are applied. Results indicate that spatial price transmission and seasonal price patterns in private sector maize markets in Malawi are generally consistent with long-run competitive inter-regional trade and storage behavior, and that in most cases shocks to long-run equilibrium are arbitraged away quickly. This suggests the private sector in Malawi is generally doing a good job of transporting maize from surplus to deficit regions and smoothing maize consumption between harvests.

Allometry for Biomass Estimation in Jatropha Trees Planted as Boundary Hedge in Farmers’ Fields

Regrowth and planted trees in agricultural landscapes are rarely protected from clearing under national Forest Acts. There is, therefore, some question over the long-term security of any value they might provide to biodiversity and the global carbon cycle. Engaging landholders in carbon credits that are conditioned on planted areas being maintained into the future could improve the situation. To begin carbon trading, landholders need precise and accurate estimates of the carbon sequestered by the trees in their fields. Accurate estimates of carbon stocks depend to a greater degree on the availability and adequacy of the allometric equations that are used to estimate tree biomass. The present study has developed an allometric model for estimating the woody biomass of Jatropha trees planted as boundary hedges in agricultural landscapes under smallholder farming systems in Malawi. The predictive performance of the model was assessed and was subsequently compared with the published Jatropha models. The results showed that the statistical fits of our model were generally good, enabling one to use it with confidence for estimating wood biomass in Jatropha stands from which they were derived. The published Jatropha models consistently overestimated the woody biomass by as much as 55%, rendering them unsuitable for application in estimating woody biomass in our study sites.

Maize-based conservation agriculture systems in Malawi: Long-term trends in productivity

In Malawi and throughout much of Africa, maize yields have declined over the past several decades due to continuous cultivation, often in monocropping with little or no inputs. As a result, soil degradation has been aggravated by the loss of valuable top soil caused by rainwater runoff due to the absence of effective conservation practices. To combat this trend, Conservation Agriculture (CA) systems were introduced using a pointed stick or hand hoe to plant directly into untilled soil with crop residues as surface mulch. The objective of this study was to compare the effects of different cropping systems (CA and conventional) on soil physical and chemical parameters and long-term maize productivity in target communities of the southern and central regions of Malawi. This study analysed the effects of CA on soil parameters and maize yield over eight cropping seasons. The biophysical variability of the communities was explored through principal component analysis. Results showed that maize yields in CA systems were strongly affected by rainfall infiltration, which was 24–40% greater compared with the conventional ridge and furrow system. In some cases, maize yields in CA plots were double that of conventional tillage plots. The larger water infiltration observed in CA plots relative to conventional tillage indicated that CA systems may increase access to soil water by the crop and offset the negative effects of seasonal dry spells. Yield benefits of CA over conventional tillage systems were greater especially from the 5th season although, in some instances, greater yields on CA were recorded almost immediately. CA can be practiced in diverse environments from sandy to clay soils, nutrient rich to infertile soils and from low to high rainfall areas as long as adequate inputs (fertilizer, herbicides and labour) are available with good extension support to farmers, especially in the initial years.

Genetic and morphological studies ofNothobranchius(Cyprinodontiformes) from Malawi with description ofNothobranchius wattersisp. nov.

Molecular and morphological data were used to explore evolutionary differentiation among populations of Nothobranchius in the Lake Malawi-upper Shire River and the Lakes Chilwa-Chiuta drainage systems in Malawi. The aim of the study was to test the hypothesis that Nothobranchius of the Malawi-Shire system constitute a separate evolutionary group from Nothobranchius kirki. Mitochondrial and nuclear sequence data show a strongly supported phylogenetic split into two monophyletic groups separating the Lake Malawi basin fish from N. kirki. Unlike N. kirki, Lake Malawi-Shire fish do not deviate from neutrality and express an excess of rare haplotypes and mutations in terminal branches, characteristic of recently expanded populations. Further, the two groups significantly differ in morphology. Two body characters (dorsal-fin base length and pre-pelvic-pre-anal distance) are significantly different between the two species in both sexes. Several other characters are significantly different in either male or female comparisons with respect to both standard and head lengths, and robust morphological differentiation is detected by multivariate analysis. The two groups are readily distinguished on the basis of male colouration, especially in scale centres and the caudal fin. On the basis of this differentiation at the molecular and morphological levels, in addition to colouration, the Lake Malawi-Shire fish are hereby formally recognized as constituting a new species, Nothobranchius wattersi. This distinction is in agreement with the geomorphologic and recent climatic history in the region.

O619 THE QUALITY OF PUBLIC AND PRIVATE MATERNAL HEALTH SYSTEMS IN MALAWI

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S479-S480 Free communication (oral) presentations O619 THE QUALITY OF PUBLIC AND PRIVATE MATERNAL HEALTH SYSTEMS IN MALAWI M. Sharan, M. SharanSearch for more papers by this authorS. Ahmed, S. AhmedSearch for more papers by this authorA. Malata, A. MalataSearch for more papers by this authorK. Rogo, K. RogoSearch for more papers by this author M. Sharan, M. SharanSearch for more papers by this authorS. Ahmed, S. AhmedSearch for more papers by this authorA. Malata, A. MalataSearch for more papers by this authorK. Rogo, K. RogoSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61049-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S479-S480 RelatedInformation

Comparative mortality and predation in relation to egg production traits of Rhode Island Red, Black Australorp and Hyblack laying hens in scavenging production systems of rural Malawi

1. Black Australorp (BA), Rhode Island Red (RIR), and Hyblack (HB) birds were used in farm and field scavenging systems in Malawi, to study mortality through disease and predation in relation to laying performance. 2. Predation was higher in BA than HB. 3. Mortality through disease was higher in RIR than BA and HB. 4. Crossbred HB birds show the lowest combination of mortality and predation, suggesting a heterosis effect. 5. Mortality did not differ on farms and in field environments, suggesting an inability to improve biosecurity in farm conditions. 6. There was a positive relationship between eggshell strength and mortality. Calcium depletion from the birds’ bones, limiting foraging and escaping ability may be the explanation, which ultimately increases susceptibility to disease and predation.

Simplified methods of determining treatment retention in Malawi: ART cohort reports vs. pharmacy stock cards.

Rapid scale-up of antiretroviral therapy (ART) has challenged the health system in Malawi to monitor large numbers of patients effectively. To compare two methods of determining retention on treatment: quarterly ART clinic data aggregation vs. pharmacy stock cards. Between October 2010 and March 2011, data on ART outcomes were extracted from monitoring tools at five facilities. Pharmacy data on ART consumption were extracted. Workload for each method was observed and timed. We used intraclass correlation and Bland-Altman plots to compare the agreeability of both methods to determine treatment retention. There is wide variability between ART clinic cohort data and pharmacy data to determine treatment retention due to divergence in data at sites with large numbers of patients. However, there is a non-significant trend towards agreeability between the two methods (intraclass correlation coefficient > 0.9; P > 0.05). Pharmacy stock card monitoring is more time-efficient than quarterly ART data aggregation (81 min vs. 573 min). In low-resource settings, pharmacy records could be used to improve drug forecasting and estimate ART retention in a more time-efficient manner than quarterly data aggregation; however, a necessary precondition would be capacity building around pharmacy data management, particularly for large-sized cohorts.

Bacterial infections in Lilongwe, Malawi: aetiology and antibiotic resistance

BackgroundLife-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data.MethodsCulture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi.ResultsBetween July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were Staphylococcus aureus, Escherichia coli, Salmonella species and Streptococcus pneumoniae, whereas Streptococcus pneumoniae and Cryptococcus neoformans were most frequently detected from cerebrospinal fluid. Haemophilus influenzae was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility.ConclusionsThere is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.

Seeds and Subsidies: The Political Economy of Input Programmes in Malawi

This article provides a critical account of the cereal seed systems in Malawi, in both a historical and contemporary context, with particular reference to the three input support programmes implemented since the late 1990s to date. The centrality of the question of food security in the country's electoral politics in a post‐liberalisation context has created a seed industry dominated by multinational seed companies, who offer farmers a narrow range of products, mainly hybrid maize, and in which alternative cereal seed systems, such as millet and sorghum are at the verge of extinction. The interests of seed companies, donors and government have, for different reasons, thus coincided to create a seed industry which has a narrow product portfolio and distributes benefits to only a very small proportion of the population. The dominant players in Malawi's ‘Green Revolution Alliance’ shape the major policy directions, not always for the benefit of smallholder farmers.

Agroforestry Tree Seed Production and Supply Systems in Malawi

A sustainable agroforestry tree germplasm supply system is vital to resource-constrained smallholder farmers who depend on agroforestry to improve the productivity of their farm enterprises. Successful adoption of agroforestry hinges on the development of a sustainable agroforestry tree germplasm supply system. This paper reviews the agroforestry tree seed supply system in Malawi, with a view to determining its sustainability and quality. Currently, more than 90% of the documented agroforestry tree seed distributed to farmers is produced by smallholder farmers collected mainly from scattered farmland trees, the remainder being produced from seed orchards and seed stands owned or controlled by research organizations. Three organizations—namely the Land Resources Centre (LRC), National Tree Seed Centre (NTSC) of the Forestry Research Institute of Malawi (FRIM) and the World Agroforestry Centre (ICRAF)—were identified as major procurers of agroforestry tree seed produced by smallholder farmers. Agroforestry germplasm is distributed to farmers by non-governmental organizations (NGOs) and government agricultural and forestry extension departments. The procurement and distribution of germplasm to farmers is in general effective. The major challenge to sustainability of agroforestry tree germplasm distribution in Malawi is dependence on donor funding. The agroforestry tree seed system is, to some extent, sustainable with regards to production, although the genetic quality of the germplasm is low. Germplasm storage facilities at national level are available and possibly adequate, but knowledge and information on effective low-cost tree germplasm storage systems at household level are limited. Sustainability could be enhanced by strengthening of grass-root organizations involved in tree seed production to institutionalize the distribution through farmer–farmer exchange. There is also a need to support the development, promotion and adoption of low-cost tree germplasm storage facilities by smallholder farmers.

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

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

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi

BackgroundTwelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals.MethodsWe obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART) using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions.ResultsThere were 610 clinicians (396 clinical officers and 214 physicians), 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs) and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7–31.4% of all physicians and clinical officers, 66.5–199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of nurses, 118.1% to 354.2% of all the available pharmacists and pharmacy technicians and 27.9% to 55.7% of all clinical officers and physicians. The actual number of health professionals working in the delivery of HAART in the clinics represented 44% to 88.8% (for clinical officers and medical doctors) and 13.6% and 47.6% (for nurses), of what would have been needed based on the literature estimation.ConclusionHAART provision is a labour intensive exercise. Although these data are insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings. The impact of HAART scale-up on the overall delivery of health services should be assessed.

Estimated financial and human resources requirements for the treatment of malaria in Malawi

BackgroundMalaria fever is a common medical presentation and diagnosis in Malawi. The national malaria policy supports self-diagnosis and self-medication for uncomplicated malaria with first line anti-malaria drugs. While a qualitative appreciation of the burden of malaria on the health system is recognized, there is limited quantitative estimation of the burden malaria exacts on the health system, especially with regard to human resources and financial burden on Malawi.MethodsThe burden of malaria was assessed based on estimated incidence rates for a high endemic country of which Malawi is one. Data on the available human resources and financial resources committed towards malaria from official Malawi government documents and programme reports were obtained. The amount of human and financial resources that would be required to treat 65% or 85% of symptomatic malaria cases as per the Roll Back Malaria partnership and the US President's Malaria Initiative targets.ResultsBased on a malaria incidence rate of 1.4 episodes per year per person it was estimated that there would be 3.71 million symptomatic episodes of malaria among children <5 years of age based on mid-2007 census projections. At 0.59 episodes each year per person there would be 2.13 million episodes in the 5 to 14 year age group and 1.02 million episodes in. There would be 761,848 malaria cases when HIV is not factored in among those 15 years of age or above; this figure rose to 2.2 million when the impact of HIV in increasing malaria incidence was considered. The prevalence of HIV has resulted in 42.3% increase in symptomatic malaria cases. Treating 65% to 85% of cases would result in using 8.9% to 12.2% of the national health budget or 22.2% to 33.2% of the national drug budget. Furthermore, having 65% to 85% of cases treated at a health facility would consume 55.5% to 61.1% of full-time equivalents of all the clinicians registered in the country. While this study's estimated time of 5 and 10 minutes per consultation may differ in actual practice, due to time constraints patients may not be seen for longer consultation in resources limited settings.ConclusionMalaria exacts a heavy toll on the health system in Malawi. The national recommendation of self-medication with first-line drug for uncomplicated malaria is justified as there are not enough clinicians to provide clinical care for all cases. The Malawi Ministry of Health's promotion of malaria drug prescription including other lower cadre health workers may be justified.