Rural Areas Of Malawi Research Articles

What Have We Learned about the Prevention of NMSC from Albino Patients from Malawi? Secondary Prevention Maintained over Time.

We have conducted cooperative campaigns focusing on albino patients in a rural area of Malawi. What have we learned? Three surgical campaigns were performed in Nkhotakota district (2019-2023). Albino clinical and tumor characteristics were collected. Between 22 and 75 albinos were evaluated in each campaign (mean age < 28 years old). Most patients did not use sunscreen in a way that provided optimal photoprotection. Regarding tumors, the proportion of basal and squamous cell carcinomas ranged from 1:1 to almost 2:1. Of 156 albino patients, 34 attended more than once. However, of the 19 patients with 30 tumors operated on in 2021, only seven were assessed the following year (12 were lost to follow-up). At least 14 albinos with locally advanced tumors were evaluated. Distributing photoprotective clothing could be more efficient or perhaps an earlier measure of sunscreen in rural Africa as it does not require permanent repositioning. Very-high-risk patients (previous interventions with positive margins or high-risk tumors, intense actinic damage, and new tumors constantly appearing, especially those presenting SCCs) require close follow-up and treatment and represent our main target. Secondary prevention with Malawian collaboration and the use of teledermatology is essential for patient tracking, as they are able to offer curative treatments.

Information sources and factors influencing the use of herbal medicine among women during pregnancy and childbirth in rural Lilongwe, Malawi: A qualitative study

Existing literature shows increased use of herbal medicine during pregnancy, childbirth, and when tackling associated problems among Malawian women. Beyond Malawi, herbal medicine use is also common among women during pregnancy and childbirth in other parts of the world. However, little is known about the precise information sources and factors that affect women&amp;rsquo;s use of herbal medicine in Malawi, especially in rural areas where it is commonly practiced. This study aimed at exploring information sources and understanding factors that influence herbal medicine use during pregnancy and childbirth among women living in the rural Lilongwe, Malawi. This is a qualitative descriptive study on 28 female participants purposively identified from four villages (Kagona, Champsinja, Mthupi, and Manja) of Traditional Authority Malili in rural Lilongwe, Malawi. Data were collected from four focus group discussions, with each group consisting of 6 &amp;ndash; 8 women, and their discussions were transcribed and analyzed using content analysis method. The findings indicated that previous obstetric experiences (negative and positive), quick relief from labor pain, hastened delivery process, fear of abandonment by guardian during childbirth, and encouragement from peers (friends) are key factors influencing herbal medicine use in rural Lilongwe. We also found that peers (friends), parents, and traditional birth attendants are major sources of information regarding herbal medicine use in Malawi. This study concludes that herbal medicine use during pregnancy and childbirth in rural Malawi is largely influenced by previous labor experiences and fears of being abandoned during labor and childbirth, and that information on herbal medicine use is often sourced from peers, parents, and traditional birth attendants. Thus, this study sheds light on how the community-led pathways can be exploited to influence the decisions to use herbal medicine among women in the rural areas of Malawi.

Combating coronavirus disease (COVID-19) in rural areas of Malawi: Factors affecting the fight.

Owing to their detachment from urban areas, people living in rural areas of Malawi are on the receiving end of health services and socio-economic benefits. The study therefore explored how Malawians living in these areas are adhering to coronavirus disease 2019 (COVID-19) containment measures and the factors that affect the COVID-19 fight amongst this population. The study investigated how the rural population in Malawi adheres to COVID-19 containment measures. The study was conducted in two districts in Northern Malawi. Data were collected from 263 participants. The chi-square (χ2) test was performed to determine the association between demographic variables and COVID-19 prevention practices and factors affecting the COVID-19 fight. Education was significantly associated with wearing of masks (p = 0.01), use of sanitisers (p 0.01) and practising social distancing (p = 0.07). Monthly income was associated with the use of sanitisers (p 0.01). Women were more exposed to fake news about COVID-19 (p = 0.09); older people were more likely to disregard COVID-19 containment measures for cultural reasons (p = 0.07); and monthly income was associated with a lack of resources for following COVID-19 containment measures (p 0.01). Findings show that factors affecting the COVID-19 fight are influenced by various socio-economic factors which should therefore be taken into account in policy planning aiming at controlling the pandemic.Contribution: The study provides health stakeholders with a policy direction that enhances better coordination, implementation and monitoring of COVID-19 response and recovery activities in rural areas in Malawi. The findings have implications on controlling current and future communicable diseases; the proposed strategies might be employed in fighting similar current and future pandemics.

Identifying Plasmodium falciparum transmission patterns through parasite prevalence and entomological inoculation rate

Monitoring malaria transmission is a critical component of efforts to achieve targets for elimination and eradication. Two commonly monitored metrics of transmission intensity are parasite prevalence (PR) and the entomological inoculation rate (EIR). Comparing the spatial and temporal variations in the PR and EIR of a given geographical region and modelling the relationship between the two metrics may provide a fuller picture of the malaria epidemiology of the region to inform control activities. Using geostatistical methods, we compare the spatial and temporal patterns of Plasmodium falciparum EIR and PR using data collected over 38 months in a rural area of Malawi. We then quantify the relationship between EIR and PR by using empirical and mechanistic statistical models. Hotspots identified through the EIR and PR partly overlapped during high transmission seasons but not during low transmission seasons. The estimated relationship showed a 1-month delayed effect of EIR on PR such that at lower levels of EIR, increases in EIR are associated with rapid rise in PR, whereas at higher levels of EIR, changes in EIR do not translate into notable changes in PR. Our study emphasises the need for integrated malaria control strategies that combine vector and human host managements monitored by both entomological and parasitaemia indices. This work was supported by Stichting Dioraphte grant number 13050800.

Isotopic measurement of iron requirements in sub-Saharan African children

Prevention of iron deficiency in African children is a public health priority. Current WHO/FAO estimations of iron requirements are derived from factorial estimates based on healthy, iron-sufficient "model" children using data derived mainly from adults. In this study, we aimed to quantify iron absorption, loss, and balance in apparently healthy 5- to 7-y-old children living in rural Africa. We directly measured long-term iron absorption and iron loss in a 2-y observational study in Malawian children (n=48) using a novel stable iron isotope method. Of the 36 children with height-for-age and weight-for-age z scores ≥-2, 13 (36%) were iron deficient (soluble transferrin receptor >8.3 mg/L) and 23 were iron sufficient. Iron-deficient children weighed more than iron-sufficient children [mean difference (95% CI): +2.1 (1.4, 2.7) kg; P=0.01]. Mean iron losses did not differ significantly between iron-deficient and iron-sufficient children and were comparable to WHO/FAO median estimates of 19 µg/(d×kg). In iron-sufficient children, median (95% CI) dietary iron absorption was 32 (28, 34) µg/(d×kg), comparable to WHO/FAO-estimated median requirements of 32 µg/(d×kg). In iron-deficient children, absorption of 28 (25, 30) µg/(d×kg) was not increased to correct their iron deficit, likely because of a lack of bioavailable dietary iron. Twelve children (25%) were undernourished (underweight, stunted, or both). Our results suggest that WHO/FAO iron requirements are adequate for healthy iron-sufficient children in this rural area of Malawi, but iron-deficient children require additional bioavailable iron to correct their iron deficit.

Energy and Water Needs Analysis: Towards Solar Photovoltaic Water Pumping in Rural Areas of Malawi

Water and energy are both major challenges in rural areas of developing countries, including in the sub-Saharan Africa Region. This study assessed water and energy needs, challenges, and costs in order to produce a body of knowledge and further explore ways in which the water-energy synergies could be utilised. A mixed-mode survey method consisting of questionnaires, semi-structured interviews, observations and focus group discussions involving participants in the rural areas of Chiradzulu District in Malawi was employed. The study findings show that water access is generally inadequate, caused by high population, low yield, disparity in the distribution of water sources, and non-functionality. Using the contingent valuation method, logistic regression showed the only predictor of willingness to pay for drinking water was income and the predictors to pay for irrigation water were occupation, age and household size. Sustainable energy access was also found lacking for cooking and basic energy services such as for lighting, mobile charging and for radios. Biomass remains the main source of cooking energy, whereas battery powered torches have replaced paraffin for lighting. Overall, the household survey results imply that there is need for more sustainable water and energy provision. To address both challenges, the study recommends solar PV water pumping systems which can be designed in such a way that they can be simultaneously used for providing basic energy services. Further research is needed to address cooking energy choices.

Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi - A cross-sectional patient survey.

BackgroundHaving to pay out-of-pocket for health care can be prohibitive and even cause financial catastrophe for patients, especially those with low and irregular incomes. Health services at Government-owned hospitals in Malawi are provided free of charge but patients do incur costs when they access facilities and some of them forego income. This research paper presents findings on the direct and indirect expenditure incurred by patients who underwent hernia surgery at district and central hospitals in Malawi. It reports the main cost drivers, how costs relate to patients’ household incomes, the financial burden of undergoing surgery and the extent to which hernia patients had recovered and restored their capacity to work and earn an income.Materials and methodsUsing a cross-sectional study design, surveys were held with patients who had undergone hernia surgery in four district and two central hospitals in Malawi. Interviews were conducted by surgically trained clinical officers, trained in survey administration, and included, inter alia, questions about patients’ hospital stay, the direct and indirect cost they incurred in accessing surgery, and how they financed the expenditure. Follow-up interviews by telephone were held 8–10 weeks after discharge.ResultsThe sample included 137 patients from district and 86 patients from central hospitals. The main direct cost drivers were transport and food & groceries. More than three quarters of patients who had their surgery at a district hospital incurred indirect costs, because of income lost due to hospital admission, compared with just over a third among central hospital patients. Median reported income losses were US$ 90 and US$ 71, respectively. Catastrophic expenditure for surgery occurred in 94% of district and 87% of central hospital patients. When indirect costs are added to the out-of-pocket expenditure, it constituted more than 10% of the monthly per capita income for 97% and 90% of the district and central hospital patients, respectively.ConclusionOut-of-pocket household expenditure associated with essential surgery in Malawi is high and in many instances catastrophic, putting households, especially those who are already poor, at risk of further impoverishment. The much needed scaling-up of surgical services in rural areas of Malawi needs to be accompanied by financial risk protection measures.

Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants.

To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors' perceptions regarding the implementation of this policy and the related affects that arose from its implementation. The results revealed the complexity of decision-making and delivery care-seeking behaviours in rural areas of Malawi in the context of this policy. Although women and other actors seemed to agree that institutional deliveries were safer when complications occurred, this did not necessarily ensure their compliance. Furthermore, implementation of the 2007 Community Policy aggravated some of the barriers women already faced. This innovative bottom-up analysis of policy implementation showed that the policy had further ruptured linkages between community and health facilities, which were ultimately detrimental to the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation in Low and middle income countries (LMICs), by focusing on the perceptions of those at the receiving end of policy change. It highlights the need for globally promoted policies and strategies to take better account of local realities.

Ability to understand and correctly follow HIV self-test kit instructions for use: applying the cognitive interview technique in Malawi and Zambia.

IntroductionThe ability to achieve an accurate test result and interpret it correctly is critical to the impact and effectiveness of HIV self‐testing (HIVST). Simple and easy‐to‐use devices, instructions for use (IFU) and other support tools have been shown to be key to good performance in sub‐Saharan Africa and may be highly contextual. The objective of this study was to explore the utility of cognitive interviewing in optimizing the local understanding of manufacturers’ IFUs to achieve an accurate HIVST result.MethodsFunctionally literate and antiretroviral therapy‐naive participants were purposefully selected between May 2016 and June 2017 to represent intended users of HIV self‐tests from urban and rural areas in Malawi and Zambia. Participants were asked to follow IFUs for HIVST. We then conducted cognitive interviews and observed participants while they attempted to complete the HIVST steps using a structured guide, which mirrored the steps in the IFU. Qualitative data were analysed using a thematic approach.ResultsOf a total of 61 participants, many successfully performed most steps in the IFU. Some had difficulties in understanding these and made errors, which could have led to incorrect test results, such as incorrect use of buffer and reading the results prematurely. Participants with lower levels of literacy and inexperience with standard pictorial images were more likely to struggle with IFUs. Difficulties tended to be more pronounced among those in rural settings. Ambiguous terms and translations in the IFU, unfamiliar images and symbols, and unclear order of the steps to be followed were most commonly linked to errors and lower comprehension among participants. Feedback was provided to the manufacturer on the findings, which resulted in further optimization of IFUs.ConclusionsCognitive interviewing identifies local difficulties in conducting HIVST from manufacturer‐translated IFUs. It is a useful and practical methodology to optimize IFUs and make them more understandable.

Intensive physiotherapy with subsequent community-based rehabilitation: two cases of cerebral malaria in rural areas of Malawi

[Purpose] This study aimed to elucidate the effect of intensive physiotherapy and community-based rehabilitation on motor function for patients with cerebral malaria in the rural areas of Malawi. [Participants and Methods] The participants were 10- and 9-year-old children with cerebral malaria. At ages 8 and 6 years, they contracted malaria, and their motor function decreased to Gross Motor Function Classification System level III. They underwent intensive physiotherapy for 2 weeks administered by their mothers and volunteers, who were taught rehabilitation exercises. The improvements in the participants’ motor functions were assessed after completion of therapy and 2 months later. [Results] In case 1, no improvement was observed in the 88-item Gross Motor Function Measure (GMFM-88) score after intensive physiotherapy. However, after 2 months of intensive physiotherapy, the total score improved by 6% from 61% to 67%, and the scores for the target areas improved from 12% to 20%. In case 2, the total GMFM-88 score improved from 66% to 68% during physiotherapy and further improved from 68% to 78% after 2 months. The score for the target areas improved from 25% to 26% and further improved from 26% to 49% after 2 months. [Conclusion] The participants in this study achieved improvements in GMFM-88 score after receiving intensive rehabilitation by community members. The effect was more pronounced after 2 months than immediately after intensive physiotherapy.

Reducing the burden of rural water supply through greywater reuse: a case study from northern Malawi

Greywater reuse has potential for non-potable applications that conserve freshwater resources in water-stressed areas especially in sub-Saharan Africa. The feasibility of reusing greywater for domestic activities in a rural area of Malawi, Africa, was evaluated from microbiological and public acceptance perspectives. Median Escherichia coli concentrations for eight domestic greywater sources (handwashing, laundry, runoff from a tap apron, bathing, cleaning a home/kitchen, cleaning a water collection container, washing plates and soaking vegetables) ranged from 100 to &amp;gt;20,000 colony forming units (cfu)/100 ml. Twenty-four of 47 greywater samples tested (51%) met the World Health Organization guideline for unrestricted use of greywater for irrigation. Pertinently, 80% (4/5) and 60% (3/5) of greywater samples from handwashing stations and bathing had E. coli less than the WHO guideline. Users reported greatest acceptance of reusing greywater for growing food and washing clothes, especially when the greywater source was bathing. Acceptance was closely tied to a household's economic standing, geographic location, and first-hand knowledge of reusing greywater. Greywater reuse practices in rural areas, especially targeting bathing water as suitable from bacteriological and user perception criteria, can help mitigate the impacts of water stress in sub-Saharan Africa.

Applying a Reading Program Based on Cognitive Science in Rural Areas of Malawi: Preliminary Results

Reading fluency is a skill foundational to academic performance, and acquiring this skill in early grades is crucial. Throughout sub-Saharan Africa, reading levels of students are far below grade level, and Malawi is no exception. Research suggests that students, particularly in consistently spelled languages, acquire automaticity most easily by starting from individual letters, combining them in increasingly larger chunks, and getting plenty of practice in decoding them. Due to working memory capacity limits, students must attain a minimum reading speed in order to understand text. These concepts were tested in a rural district in Malawi. The study helps to explain the components of this science-based “learning package” needed for reading fluency. Volunteers held the classes in communities as an after school program for children from grades 1 to 5. The goal behind this innovative six-month program is students’ recognition of all letters used in Chichewa language and progress in text decoding. This study helps to explain the various components of the learning intervention and the results show that there has been improvement in knowledge of letter sounds. This study uses an already tried and tested cognitive neuroscience model, which was contextualized and implemented in the Malawi setting.

Evaluation of groundwater quality in rural-areas of northern Malawi: Case of Zombwe Extension Planning Area in Mzimba

Many people in in the Sub-Saharan region rely on groundwater for drinking and other household uses. Despite this significance, information on the chemical composition of the water in the boreholes and emperical data on groundwater quality is limited in some rural areas of Malawi. This study was conducted to evaluate the physico-chemical quality of water from boreholes (n = 20) in Zombwe Extension Planning Area (EPA), Mzimba in Northern Malawi to ascertain their safety. Desktop studies and participatory approaches were employed to assess the socio–economic activities and water supply regime in the study areas. The water samples were analysed for pH, conductivity (EC), turbidity, water temperature, nitrate (NO3−), magnesium (Mg), calcium (Ca), zinc (Zn), fluoride (F−), and sulphate (SO42−). In-situ and laboratory analyses were carried out using portable meters and standard procedures. The results were compared with national (Malawi Bureau of Standards – MBS) and international standards (World Health Organization – WHO) for drinking water. The following ranges were obtained: pH (6.00–7.80), EC (437–3128 μS/cm), turbidity (0.10–5.80 NTU), water temperature (27.0–30.60 °C), NO3− (0.30–30.00 mg/L), F− (0.10–8.10 mg/L), Mg (31.00–91.00 mg/L), Ca (20.00–197.10 mg/L), SO42− (10.20–190 mg/L), Fe (0.10–3.60 mg/L) and Zn (0.00–5.10 mg/L). Generally, some parameters tested at several sites (>80%, n = 20) complied with both MBS and WHO limits. No significant differences (p > 0.05) was observed for most parameters (>65%, n = 11). Groundwater contamination was not significant in the area despite some parameters like F−, Ca and SO42− showing higher levels at other sites. Some sites registered very hard water (244.60–757.80 mg/L CaCO3) probably due to mineralization influenced by underground rock material. Further studies are needed to ascertain the groundwater quality of other parameters (like F−, and SO42−) which registered higher levels at some sites. Routine monitoring of the groundwater in the study area and entire Malawi is needed for spatio-temporal variation assessment and to ensure good public health.

English

Integrated rural development under the Malawi Growth and Development Strategy is a key operational framework for achieving sustainable economic growth where rural industrialisation is earmarked as a strategy for achieving production diversity, creation of employment, reduction of poverty and curbing rural-urban migration. Entrepreneurship development has been central to this process. Existing models offer three key components for entrepreneurship development; the supportive and cooperative environments and entrepreneurial orientation. Efforts to create the supportive and cooperative environments for entrepreneurship development in Malawi have existed since the 1970s. However, lack of significant entrepreneurship development raises questions on the entrepreneurial orientation of the rural communities targeted with supporting efforts. The research investigated entrepreneurial orientation of 162 participants in two rural areas of Malawi. The results first confirm that practice of entrepreneurship is predominantly at income generating activities level. Entrepreneurship is affected by poverty, low levels of education and lack of technical and enterprise management skills. The practice of entrepreneurship is driven by push factors as such as lack of employment and no alternative sources of income to earn a living. These results do support previous empirical studies. The research however found positive mind sets and orientation towards entrepreneurship. There are positive entrepreneurial attitudes and intentions in the rural areas in Malawi. The intentions are influences by the respondents’ perceived desirability of entrepreneurship, their perceived feasibility that informs positive attitude towards entrepreneurship. These results support the theory of planned behaviour that attitude, perceived feasibility and perceived desirability are the antecedents of entrepreneurial intentions. The research further found that education and training significantly affected entrepreneurship practice but availability of finance does not affect entrepreneurial intentions. The results of this research therefore call for a review of entrepreneurship development strategies and models because despite proving the existence of entrepreneurial orientation in particular rural contexts where supportive and cooperative environments do exist, entrepreneurship has not developed to contribute to economic growth. That demonstrates the inadequacy of the existing models to guide entrepreneurship development in practice. Practical models are required that can offer guidance for entrepreneurship development in rural economies to help achieve economic growth and development. Key words: Entrepreneurship, entrepreneurial attitudes and intentions, entrepreneurial orientation.

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India

ObjectiveUnderstanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of...

Dynamics of community participation, student achievement and school management: the case of primary schools in a rural area of Malawi

School management in many sub-Saharan African countries has been enhanced through community participation in an attempt to improve education quality. This study uses field research in a rural district of Malawi to assess how community and parent participation differs between schools, the intentions of communities and parents when carrying out activities in schools, and the mechanism promoting active participation in schools. In high-achieving schools, but not in low-achieving schools, communities and parents were actively involved in events aimed at improving student achievement. Communities and parents considered most highly prioritised activities that directly influenced student achievement, including hiring volunteer teachers, arranging extra classes and holding mock examinations. Community participation did not directly improve student achievement. Instead, when communities and parents actively participated in a school, school management improved, ensuring better student achievement. The implications of this finding are discussed in relation to community participation.

Do local land institutions make a dime's worth of a difference in rural land markets? Evidence from Malawi

Purpose – It has been argued that traditional land transfer systems provide disincentives for farmers to trade their land, thus reducing land availability and depressing productivity. The purpose of this paper is to investigate the determinants of land rentals under customary land ownership in matrilineal and patrilineal traditions and under formal land registration in the rural areas of Malawi. Design/methodology/approach – Using new data collected from around 100 households farming around 200 parcels in three regions of Malawi, a number of models are estimated with ordinary least squares. Findings – The paper finds some evidence that some variables within the traditional system of land holding are crucial for land rentals. However, when land titles are used as a proxy for security of tenure, none of the relationships commonly hypothesized between land ownership security and land lease are corroborated. Land registration is found to have no significant effects on land and rentals. Social implications – These results put into question the potency of sole land registration as a means of enhancing land market activities for rural masses in Malawi. Originality/value – The uniqueness of this paper rests in it its use of context-specific constructs of land ownership security. Moreover the tested hypotheses emerge from a theoretical model that is unique to the literature on rural land markets and land tenure.

Endogenous African Governance Systems: what roles do women play in rural Malawi?

Endogenous African governance systems are criticised for excluding women. This critique ignores several realities that women have played roles different from those of men. This article examines the roles that women play in endogenous governance structures of patrilineal and matrilineal ethnic groups in rural areas in Malawi on leadership, violent conflict prevention, and transformation. It argues that these endogenous governance systems inherently contain features that enable women to actively participate and play powerful leadership roles, though men dominate in terms of numbers and authority. These gender patterns do not seem to change much despite the changing political, social, and economic environment.

Identification of the potential opportunities, barriers, and threats within the sector in taking up sanitation as a business: rural sanitation in Nkhata Bay District (Malawi)

Private sector participation in sanitation marketing provides a great opportunity to improve rural sanitation access. Although a number of opportunities for private sector participation within the sanitation sector exist, there are numerous barriers and threats to taking up sanitation as a business. This Note from the Field identifies these opportunities, barriers, and threats in Nkhata Bay District, a rural area of Malawi. These insights emerge from a wider research project entitled ‘Private sector participation in the delivery of sanitation and hygiene services’. This note provides background information on the research project on private sector participation and the project location. It goes on to describe the data collection process and present two examples of business activities in the district sanitation sector, before listing the opportunities, barriers, and threats identified and the recommendations that emerge from them.

From Early Childhood Development Policy to Sustainability: The Fragility of Community-Based Childcare Services in Malawi

Over the past 20 years, more than 6,000 community-based childcare centers (CBCCs) have been created in mostly rural areas of Malawi. Although the original purpose of these CBCCs was to meet the care needs of orphans and vulnerable children affected by the HIV/AIDS pandemic, the services have since expanded their mandate to provide early development and learning opportunities as well as part-time childcare for working parents. The Malawi national policy is to expand this network of CBCCs to improve early childhood development outcomes, however, sustainability of these services has been an ongoing challenge. This article discusses the roots and extent of this sustainability challenge, drawing on lessons learned from recent fieldwork conducted as part of a baseline study.