Institutional Change and Discontinuities in Farmers' Use of Hybrid Maize Seed and Fertilizer in Malawi: Findings from the 1996-97 CIMMYT/ MoALD Survey

This study records the use of hybrid maize seed and fertilizer by small-scale farmers in Malawi, as well as their opinions about these inputs, from 1989-90 through 1996-97. Its main purpose is to determine whether the principal constraint to smallholders� use of maize hybrids is the acceptability of the hybrid maize germplasm or the institutional reforms and policies affecting its use. The study also provides information about a practice that has implications for the impact of seed technologies and seed industries � the recycling of nonconventional hybrids (i.e., saving seed of an F1 hybrid to plant in subsequent seasons). Findings of the most recent farmer survey in 1996-97 demonstrate that the grain quality or yield characteristics of maize hybrids no longer constrain smallholders� use of F1 hybrid seed. Farmers stated almost unanimously that they wanted to grow F1 hybrid seed, but most could not purchase as much seed as they wished. A large number of farmers recycle hybrid seed, which is not surprising, given the early stages of diffusion of hybrid maize in Malawi, the start-stop nature of policies affecting input use, and free seed distributed by the government and NGOs. It may be worthwhile for researchers to investigate prospects for producing hybrids whose characteristics resist deterioration from recycling. Aside from this plant breeding issue, pressing concerns of national maize production, food security, and the welfare of smallholders remain to be addressed. Farmers with the resources to use credit, purchase inputs, grow cash crops, or produce maize surpluses represent a smaller and smaller percentage of farmers. It is doubtful whether complete reliance on private initiatives can transform the smallholder maize sector in a country that relies on agriculture as much as Malawi, but where infrastructure is inadequate, nonfarm employment opportunities are few, and incentives are insufficient to mobilize trade and generate cash in rural areas.Crop Production/Industries,

Determinants of Moral hazard in Microfinance: Empirical Evidence from Joint Liability Lending Schemes in Malawi

Moral hazard is widely reported as a problem in credit and insurance markets, mainly arising from information asymmetry. Although theorists have attempted to explain the success of Joint Liability Lending (JLL) schemes in mitigating moral hazard, empirical studies are rare. This paper investigates the determinants of moral hazard among JLL schemes from Malawi, using group level data from 99 farm and non-farm credit groups. Results reveal that peer selection, peer monitoring, peer pressure, dynamic incentives and variables capturing the extent of matching problems explain most of the variation in the incidence of moral hazard among credit groups. The implications are that Joint Liability Lending institutions will continue to rely on social cohesion and dynamic incentives as a means to enhancing their performance which has a direct implication on their outreach, impact and sustainability.moral hazard, joint liability, dynamic incentives, group lending, Malawi, Financial Economics,

Vulnerability and social protection in Malawi

Vulnerability appears to be rising for many Malawians, whose exposure to livelihood shocks is increasing while their ability to cope is decreasing. The first part of this report draws on recently published studies and analysis of the 2004/05 Integrated Household Survey dataset to explore the nature of vulnerability in Malawi. Most livelihoods in Malawi depend on agriculture, but agricultural vulnerability is extremely high due to erratic rainfall, inequality in landholdings, constrained access to inputs, limited diversification and weak markets. Noneconomic factors that compound economic risks include demographic and health risks, gendered vulnerabilities, social change and governance failures. Economic vulnerability, defined as the risk of future monetary poverty, is high because of the heavy concentration of Malawians clustered close to the poverty line, and because of the frequency and severity of covariant shocks such as droughts, floods and food price fluctuations, as well as idiosyncratic shocks such as accidents, illness and death of family members. The economic, demographic and social impacts of HIV/AIDS are especially devastating. Monetary and subjective indicators of vulnerability are related to demographic characteristics (female- and older-headed households, orphans), lack of assets, geographic location (with a north-south gradient of rising vulnerability) and multiple shocks. Policy priorities derived from this analysis include: stabilise food prices, enhance access to agricultural inputs, and identify labour-saving technologies for labour-constrained households. More generally, social protection and livelihood promotion measures, together with an enabling environment, are central to addressing vulnerability in Malawi. The second part of this report reviews a range of ongoing and discontinued social protection mechanisms in Malawi. Free inputs distribution (‘Starter Packs’) followed the abolition of fertiliser subsidies in the 1990s, and had positive impacts on food production and prices. Public works programmes (food-, cash- or inputs-for-work), social funds (the Malawi Social Action Fund) and food transfers (food aid, school feeding) also have long histories in Malawi, but have demonstrated limited impacts. Finally, unconditional cash transfers are increasingly popular, which this review endorses with the qualification that ongoing pilot projects need to be institutionalised within a comprehensive, government owned, national social protection strategy. Keywords: Malawi, poverty, social protection, vulnerability

Integration of Sugar Markets between Swaziland and its Major Trading Partners

The study was designed to examine the extent of market integration between Swaziland sugar markets and its major trading partners (i.e., South Africa, EU and USA) using monthly export sugar price data from January 2001 to December 2013. Price series were tested for stationarity with the Augmented Dickey-Fuller (ADF) test and it was found that all prices were integrated of order one I (1). Zivot and Andrews test was used to determine the structural break in the price series and it revealed that the Swaziland and USA price break was in August, 2009 while for the EU price break was in October, 2008. Price relationships were examined in one period (entire period) and two sub-periods (before structural break and after structural break). The Johansen’s cointegration test revealed long-run integration for almost all the pairs of sugar markets, except for the USA in the full sample period. The integrations between the markets shows a significant improvement after the structural break. The Vector Error Correction model (VECM) estimates showed that the Swaziland’s  export market prices adjust significantly to the short-run shocks that appeared in the South African’s and EU’s sugar market for the entire period while when the structural breaks period was allowed it adjusts significantly before the break for the South African’s market. Swaziland’s market only adjusts significantly to the EU and USA market shocks after the structural break. The overall coefficient of the adjustment parameter has been very low due to high government interventions in the sugar sector by the Swaziland trading partners which is an impediment to the efficient market functioning. It is therefore suggested that interventions of the respective governments should be reduced for efficient functioning of the markets Keywords: sugar, trading partners, cointegration, stationarity, structural brea

Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study

Background: Nurses have an increased risk for non-communicable diseases (NCDs), along with a high prevalence of obesity, poor eating habits and insufficient physical activity. The aim of this study was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. Methods: Participants were purposively sampled (n = 103), and included management personnel (n = 9), night shift (n = 57) and day-shift nurses (n = 36). Twelve focus groups (FGDs) were conducted with nursing staff to obtain insight into nurses’ health concerns, lifestyle behaviours and worksite health promotion programmes (WHPPs). Seven key informant interviews (KII) were conducted with management personnel, to gain their perspective on health promotion in the worksite. Thematic analysis was used to analyse the data with the assistance of Atlas.ti Qualitative Data Analysis Software. Results: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. Being overweight was perceived to have a negative impact on work performance. All nurses identified backache and exposure to tuberculosis (TB) as occupation-related health concerns, and both management and nurses frequently reported a stressful working environment. Nurses frequently mentioned lack of time to prepare healthy meals due to long working hours and being overtired from work. The hospital environment was perceived to have a negative influence on the nurses’ lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling services, an online employee wellness programme offered by the Department of Health and wellness days in which clinical measures, such as blood glucose were measured. Nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Conclusions: Public hospitals are a stressful work environment and shift work places an additional strain on nurses. The risk of NCDs and exposure to infectious disease remains a concern in this working population. Our findings highlight the need for WHPPs that support nurses in managing stress and transforming the work environment to facilitate healthy lifestyles

Fistula awareness among sisters of women with fistula

ObjectiveTo determine whether sisters of women with obstetric fistula (OF) were aware of their sisters’ condition, in order to inform the development of survey questions that adapt the sister‐based method to fistula rate estimation.MethodsTwelve women with OF and 20 of their sisters were interviewed using semi‐structured questionnaires in rural Uganda in 2007. Topics included fistula awareness and perceptions of causality.ResultsEleven women had vesicovaginal fistula and 1 had rectovaginal fistula. Three were primiparous at time of fistula occurrence; 6 had a parity of 6 or more. Nineteen sisters were aware their sister had OF; 12 became aware at the time of occurrence. The majority of participants (fistula patients and their sisters) associated OF with mistakes made by hospital personnel or problems during procedures.ConclusionSisters were generally aware of OF within their family. Larger studies are needed to assess the validity and reliability of the sister‐based method in capturing fistula through household surveys. In the present study, there was a widespread perception among fistula patients and their sisters that fistula is caused by medical procedures. More research is needed to understand this perception, and program development efforts are required to improve patient perceptions of hospital care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135323/1/ijgo232.pd

Feasibility and acceptability of oral cholera vaccine mass vaccination campaign in response to an outbreak and floods in Malawi

Introduction: Despite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015. Methods: This was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak. Results: During the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign. Conclusion: This documentation has demonstrated that it was feasible, acceptable by the community to conduct a largescale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi.Pan African Medical Journal 2016; 2

Impact of foot-and-mouth disease on mastitis and culling on a large-scale dairy farm in Kenya

Foot and mouth disease (FMD) is a highly transmissible viral infection of cloven hooved animals associated with severe economic losses when introduced into FMD-free countries. Information on the impact of the disease in FMDV-endemic countries is poorly characterised yet essential for the prioritisation of scarce resources for disease control programmes. A FMD (virus serotype SAT2) outbreak on a large-scale dairy farm in Nakuru County, Kenya provided an opportunity to evaluate the impact of FMD on clinical mastitis and culling rate. A cohort approach followed animals over a 12-month period after the commencement of the outbreak. For culling, all animals were included; for mastitis, those over 18 months of age. FMD was recorded in 400/644 cattle over a 29-day period. During the follow-up period 76 animals were culled or died whilst in the over 18 month old cohort 63 developed clinical mastitis. Hazard ratios (HR) were generated using Cox regression accounting for non-proportional hazards by inclusion of time-varying effects. Univariable analysis showed FMD cases were culled sooner but there was no effect on clinical mastitis. After adjusting for possible confounders and inclusion of time-varying effects there was weak evidence to support an effect of FMD on culling (HR = 1.7, 95% confidence intervals [CI] 0.88-3.1, P = 0.12). For mastitis, there was stronger evidence of an increased rate in the first month after the onset of the outbreak (HR = 2.9, 95%CI 0.97-8.9, P = 0.057)

Understanding antimicrobial resistance through the lens of antibiotic vulnerabilities in primary health care in rural Malawi

The diminishing effectiveness of antimicrobials raises serious concerns for human health. While policy makers grapple to reduce the overuse of antimicrobial medicines to stem the rise of antimicrobial resistance, insufficient attention has been paid to how this applies to low-resource contexts. We provide an in-depth portrayal of antimicrobial prescribing at primary health care level in rural Chikwawa District, Malawi. Ethnographic fieldwork took place over 18 months (2018–2020). We surveyed 22 health facilities in the district, observed 1348 health worker-patient consultations, and carried out 49 in-depth interviews with staff and patients. Care was centred around provision of an antimicrobial. Amid chronic lack of essential medicines and other resources, clinic interactions were tightly scripted, providing patients little time to question or negotiate their treatment. We develop the concept of ‘antibiotic vulnerabilities’ to reveal multiple ways in which provision of antimicrobials in rural Malawi impacts care in conditions of extreme scarcity. Antibiotics are central and essential to primary care. As targets for optimal antimicrobial prescribing take a more central role in global policy, close attention is required of the ramifications for the delivery of care to ensure that efforts to stem resistance do not undermine the goal of improved health for all