Pattern of Maternal Knowledge and Its Implications for Diarrhoea Control in Southern Malawi: Multilevel Thresholds of Change Analysis

A survey was conducted in Southern Malawi to examine the pattern of mothers’ knowledge on diarrhoea. Diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average at 17%. Using hierarchically built data from a survey, a multilevel threshold of change analysis was used to determine predictors of knowledge about diarrhoeal aetiology, clinical features, and prevention. The results show a strong hierarchical structured pattern in overall maternal knowledge revealing differences between communities. Responsible mothers with primary or secondary school education were more likely to give more correct answers on diarrhoea knowledge than those without any formal education. Responsible mothers from communities without a health surveillance assistant were less likely to give more correct answers. The results show that differences in diarrhoeal knowledge do exist between communities and demonstrate that basic formal education is important in responsible mother’s understanding of diseases. The results also reveal the positive impact health surveillance assistants have in rural communities

BREATHER Plus clinical trial design: A randomised non-inferiority trial evaluating the efficacy, safety and acceptability of short cycle (five days on, two days off) dolutegravir/tenofovir-based triple antiretroviral therapy (ART) compared to daily ART in virologically suppressed adolescents living with HIV aged 12 to <20 years in sub-Saharan Africa

Background: Novel strategies to improve ART adherence, retention in care and quality of life among adolescents living with HIV (ALHIV) are needed. Short-Cycle Therapy (SCT) with 4/5 sequential days on ART, 2/3 days off ART per week has shown non-inferior virological outcomes and high acceptability, but most data are in adults and are very limited for dolutegravir (DTG)-based SCT. Methods: BREATHER Plus is an ongoing 96-week non-inferiority randomised trial evaluating efficacy, safety and acceptability of SCT (5 sequential days on, 2 days off at the weekend) with DTG/tenofovir (TNV)-based triple ART versus continuous (daily) therapy (CT) in ALHIV. Participants are aged 12 to <20 years in Kenya/South Africa/Uganda/Zimbabwe, virologically suppressed (Viral Load (VL) <50copies/mL) for ≥12 months at enrollment, with no prior treatment failure. Randomisation is 1:1 to SCT versus CT. VL monitoring for clinical management is 6–12 monthly aligning with standard-of-care. The primary outcome is confirmed virological rebound ≥50 copies/mL by 96 weeks. The trial employs the Smooth Away From Expected (SAFE) non-inferiority frontier, where the non-inferiority margin depends on the observed event risk in the CT arm. Secondary outcomes include HIV resistance, toxicities, patient-reported outcomes and cost-effectiveness. Enrolment of 470 participants completed in June 2023. Discussion: BREATHER Plus is the first randomised trial specifically evaluating DTG/TNV-triple based SCT. Rapid roll-out of DTG and a pragmatic approach to VL monitoring mean results will be generalisable to ALHIV across sub-Saharan Africa. If SCT provides non-inferior virological suppression to CT, it may offer choice for ALHIV on how they take their ART

Classification and quality of groundwater supplies in the Lower Shire Valley, Malawi – Part 1 : physico-chemical quality of borehole water supplies in Chikhwawa, Malawi

This paper presents data on the physico-chemical quality of groundwater supplies in Chikhwawa, Malawi. Eighty-four water samples were collected and analysed for a range of chemical constituents (Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, Mg, Mn, Ni, Pb, Se, V, Zn, K, Na,Cl-, F-, NO3-, SO42-), pH, temperature, electrical conductivity and turbidity, from 28 boreholes located in 25 remote, rural villages (n=3 per village) distributed along the east (n=15) and west (n=10) banks of the Shire River. Samples were collected every 2 months during the wet season, over a period of 5 months (December to April). Results were compared with national (Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL)) and international (World Health Organization Guideline Values (WHO GV)) drinking-water standards. In general, most parameters complied with the Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL) for borehole water supplies. The MBS MPL standards for iron, sodium and nitrate were slightly exceed at a few boreholes, technically rendering the water supply unwholesome but not necessarily unfit for human consumption. In contrast, significantly high nitrate (< 200 mg/ℓ) and fluoride (< 5 mg/ℓ) concentrations at levels which constitute a significant risk to the health of the consumer were detected in borehole samples in a number of villages and warrant further investigation. Water committee members complained of problems associated with taste (saltiness or bitterness) and appearance (discoloured water) primarily on the west bank, presumably as a result of the high sodium and chloride levels, and precipitation of soluble iron and manganese, respectively. This resulted in some water collectors reverting to the use of surface water sources to obtain drinking-water, a practice which should be dissuaded through the education of water and village health committees

Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi

A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children's hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools

Past, present and future developments in environmental health education and professional practice in Malawi

Since the mid 70’s Environmental Health Officers (EHOs) in the UK have been educated to honours degree level with the curricula periodically reviewed and accredited by the appropriate professional body i.e. The Royal Environmental Health Institute of Scotland (REHIS) and the Chartered Institute of Environmental Health (CIEH) for England, Wales and Northern Ireland. Prior to then, the preliminary qualification for Public Health Officers was a three-year Diploma in Public Health. Upon graduation and after approximately one year of practical training, working often with a local authority, graduates take a professional exam leading to full qualification. Thereafter, practising officers are expected to ensure that their knowledge and skills are updated through participation in various schemes of continuous professional development. This is a compulsory requirement for EHOs to remain registered as a member of the professional bodies. The development and practice of Environmental Health in UK since the Victorian age has resulted in significant improvement to the environment and health of the population. People today can expect to live a relatively healthy lifestyle with a life expectancy, on average, of more than 80 years