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.</div

Optimal (Control of) Intervention Strategies for Malaria Epidemic in Karonga District, Malawi

Malaria is a public health problem for more than 2 billion people globally. About 219 million cases of malaria occur worldwide and 660,000 people die, mostly (91%) in the African Region despite decades of efforts to control the disease. Although the disease is preventable, it is life-threatening and parasitically transmitted by the bite of the female Anopheles mosquito. A deterministic mathematical model with intervention strategies is developed in order to investigate the effectiveness and optimal control strategies of indoor residual spraying (IRS), insecticide treated nets (ITNs) and treatment on the transmission dynamics of malaria in Karonga District, Malawi. The effective reproduction number is analytically computed, and the existence and stability conditions of the equilibria are explored. The model does not exhibit backward bifurcation. Pontryagin’s Maximum Principle which uses both the Lagrangian and Hamiltonian principles with respect to a time dependent constant is used to derive the necessary conditions for the optimal control of the disease. Numerical simulations indicate that the prevention strategies lead to the reduction of both the mosquito population and infected human individuals. Effective treatment consolidates the prevention strategies. Thus, malaria can be eradicated in Karonga District by concurrently applying vector control via ITNs and IRS complemented with timely treatment of infected people

Assessment of implementation of the health management information system at the district level in southern Malawi

Background Despite Malawi’s introduction of a health management information system (HMIS) in 1999, the country’s health sector still lacks accurate, reliable, complete, consistent and timely health data to inform effective planning and resource management.Methods A cross-sectional survey was conducted wherein qualitative and quantitative data were collected through in-depth interviews, document review, and focus group discussions. Study participants comprised 10 HMIS officers and 10 district health managers from 10 districts in the Southern Region of Malawi. The study was conducted from March to April 2012. Quantitative data were analysed using Microsoft Excel and qualitative data were summarised and analysed using thematic analysis.Results The study established that, based on the Ministry of Health’s minimum requirements, 1 out of 10 HMIS officers was qualified for the post. The HMIS officers stated that HMIS data collectors from the district hospital, health facilities, and the community included medical assistants, nurse–midwives, statistical clerks, and health surveillance assistants. Challenges with the system included inadequate resources, knowledge gaps, inadequacy of staff, and lack of training and refresher courses, which collectively contribute to unreliable information and therefore poorly informed decision-making, according to the respondents. The HMIS officers further commented that missing values arose from incomplete registers and data gaps. Furthermore, improper comprehension of some terms by health surveillance assistants (HSAs) and statistical clerks led to incorrectly recorded data.Conclusions The inadequate qualifications among the diverse group of data collectors, along with the varying availability and utilisation different data collection tools, contributed to data inaccuracies. Nevertheless, HMIS was useful for the development of District Implementation Plans (DIPs) and planning for other projects. To reduce data inconsistencies, HMIS indicators should be revised and data collection tools should be harmonised

Health data consistency and management, case study of maternal health data in Malawi

Date of award is 2017, not 2016 as stated in thesis.Good quality data is vital. It informs decision making in a wide range of sectors, at all levels. Accuracy, completeness, consistency, timeliness and standard-based are the properties of good quality data. Data which satisfies these properties is deemed fit and appropriate for its intended use. Data lacking these qualities poses challenges in operations, decision making and planning.The Millennium Development Goals (MDG), specifically MDG number 5- the reduction of maternal mortality by two-thirds between 1990 and 2015- now succeeded by Sustainable Development Goal (SDG) number 3 - has led to a significant need for reliable maternal health data. Accurate data is needed on the levels of (and trends in) maternal death in developing countries in order to address and improve maternal health and survival. The health care system in Malawi lacks vital registration systems which are rich and valuable sources of health data, including maternal health. Malawi had a health information system that did not produce reliable data, and therefore could not be used for decision making in terms of planning and management with respect to maternal health. In 1999, after reviewing the Health Management Information System (HMIS), Malawi developed a new system based on the strengths of the old system while addressing its weaknesses.This study aimed to use maternal health data to investigate management processes and procedures within the HMIS from data collection by different entities, transitioning through the hierarchy from the community to the point of use at district level. The study also assessed the consistency of the data itself as it transitioned through this hierarchy. Transitions of data were explored, and difficulties in maternal health data collection were assessed among stakeholders including community members, government health staff and non-governmental organisations (NGOs). Monthly and annual data collected and compiled by various personnel over one year, was also tested for consistency using chi-square test.The study was carried out in three phases. The first was done in the Southern Region of Malawi (Phase 1). The second one was done in three health facilities which had interventions (Phase 2) in terms of training, infrastructure and provision of resources in maternal and neonatal health. The third one was conducted in six health facilities (three with (as in Phase 2) and three without intervention (Phase 3);Ten HMIS officers and 10 data users (programme coordinators at the District Health Office (DHO)) were selected for Phase One since they were involved in data management and decision making processes respectively given the data. For Phase Two participants included 14 Secret Women, 16 Health Surveillance Assistants (HSAs), Three Village Health Committees (VHCs) and two Health Personnel. Phase Three participants included 17 Secret Women, 42 Chiefs, 40 Health Surveillance Assistants (HSAs), six Health Personnel and also one Safe Motherhood Coordinator, one Community Based Maternal and Neonatal Health Coordinator, one NGO and one HMIS Officer chosen from the District Health Office, all of whom are involved in the data management process until the data is sent to the users.Cross-tabulations, frequency tables and graphs were used to assess data management processes, procedures and problems among the personnel. Testing data uniformity was achieved using the Chi-square test of homogeneity to compare monthly data and annual data aggregates for the groups of personnel to check for data quality.The results showed that data management was compromised by problems faced by data collection personnel such as lack of transportation affecting timeliness of data submission, lack of basic needs (e.g. proper housing and low salaries for HSAs and Health Personnel) which affected their motivation to work, and lack of reporting forms and writing materials which led to data gaps and missing information. Discrepancies arose in compilation and transfer of information since some information was forgotten or not recorded during the process. Furthermore, lack of supervision coupled with lack transportation and stationary led to inconsistent, incomplete, inaccurate and unreliable data.The quantitative analysis showed that there were significant differences, thus no consistency, in the monthly and annual data for the selected variables i.e. new pregnancies, births, live births among the groups of personnel. Monthly data for maternal and neonatal deaths also showed differences among the personnel, with annual aggregates also showing differences.;Important resources such as stationary and reporting forms should be provided in good time (and in adequate numbers) to ensure that there are no data gaps. In addition, the study strongly recommends the use of eHealth/mHealth in rural communities to reduce errors and data gaps during entry, so as to increase accuracy, reliability, consistency,completeness and timeliness. It also recommends training for new officers, and refresher courses for those already in the system to instil procedures and for the purpose of review (supervision) of work that has been completed.Key words: Accuracy, Consistency, Maternal Health, Data Management, HMISGood quality data is vital. It informs decision making in a wide range of sectors, at all levels. Accuracy, completeness, consistency, timeliness and standard-based are the properties of good quality data. Data which satisfies these properties is deemed fit and appropriate for its intended use. Data lacking these qualities poses challenges in operations, decision making and planning.The Millennium Development Goals (MDG), specifically MDG number 5- the reduction of maternal mortality by two-thirds between 1990 and 2015- now succeeded by Sustainable Development Goal (SDG) number 3 - has led to a significant need for reliable maternal health data. Accurate data is needed on the levels of (and trends in) maternal death in developing countries in order to address and improve maternal health and survival. The health care system in Malawi lacks vital registration systems which are rich and valuable sources of health data, including maternal health. Malawi had a health information system that did not produce reliable data, and therefore could not be used for decision making in terms of planning and management with respect to maternal health. In 1999, after reviewing the Health Management Information System (HMIS), Malawi developed a new system based on the strengths of the old system while addressing its weaknesses.This study aimed to use maternal health data to investigate management processes and procedures within the HMIS from data collection by different entities, transitioning through the hierarchy from the community to the point of use at district level. The study also assessed the consistency of the data itself as it transitioned through this hierarchy. Transitions of data were explored, and difficulties in maternal health data collection were assessed among stakeholders including community members, government health staff and non-governmental organisations (NGOs). Monthly and annual data collected and compiled by various personnel over one year, was also tested for consistency using chi-square test.The study was carried out in three phases. The first was done in the Southern Region of Malawi (Phase 1). The second one was done in three health facilities which had interventions (Phase 2) in terms of training, infrastructure and provision of resources in maternal and neonatal health. The third one was conducted in six health facilities (three with (as in Phase 2) and three without intervention (Phase 3);Ten HMIS officers and 10 data users (programme coordinators at the District Health Office (DHO)) were selected for Phase One since they were involved in data management and decision making processes respectively given the data. For Phase Two participants included 14 Secret Women, 16 Health Surveillance Assistants (HSAs), Three Village Health Committees (VHCs) and two Health Personnel. Phase Three participants included 17 Secret Women, 42 Chiefs, 40 Health Surveillance Assistants (HSAs), six Health Personnel and also one Safe Motherhood Coordinator, one Community Based Maternal and Neonatal Health Coordinator, one NGO and one HMIS Officer chosen from the District Health Office, all of whom are involved in the data management process until the data is sent to the users.Cross-tabulations, frequency tables and graphs were used to assess data management processes, procedures and problems among the personnel. Testing data uniformity was achieved using the Chi-square test of homogeneity to compare monthly data and annual data aggregates for the groups of personnel to check for data quality.The results showed that data management was compromised by problems faced by data collection personnel such as lack of transportation affecting timeliness of data submission, lack of basic needs (e.g. proper housing and low salaries for HSAs and Health Personnel) which affected their motivation to work, and lack of reporting forms and writing materials which led to data gaps and missing information. Discrepancies arose in compilation and transfer of information since some information was forgotten or not recorded during the process. Furthermore, lack of supervision coupled with lack transportation and stationary led to inconsistent, incomplete, inaccurate and unreliable data.The quantitative analysis showed that there were significant differences, thus no consistency, in the monthly and annual data for the selected variables i.e. new pregnancies, births, live births among the groups of personnel. Monthly data for maternal and neonatal deaths also showed differences among the personnel, with annual aggregates also showing differences.;Important resources such as stationary and reporting forms should be provided in good time (and in adequate numbers) to ensure that there are no data gaps. In addition, the study strongly recommends the use of eHealth/mHealth in rural communities to reduce errors and data gaps during entry, so as to increase accuracy, reliability, consistency,completeness and timeliness. It also recommends training for new officers, and refresher courses for those already in the system to instil procedures and for the purpose of review (supervision) of work that has been completed.Key words: Accuracy, Consistency, Maternal Health, Data Management, HMI

Problems associated with the health management information system at district level in southern Malawi

Introduction: Malawi implemented a Health Management Information System (HMIS) in 1999 whose aim was to improve health data management. However, there still exists a deficiency of accurate, reliable and timely health data to inform effective planning and resource management. Methods: A cross sectional survey was conducted where qualitative and quantitative data was collected through in-depth interviews, documentation review and focus group discussions. Study participants comprised of 10 HMIS Officers and 10 District Health Managers, from 10 districts in the southern region of Malawi. The study was conducted from March to April 2012 and the data collected was transcribed to identify theme and key points. Results: The study established that 1 out of 10 HMIS Officers was qualified for the post using Ministry of Health HMIS minimum requirements. The HMIS Officers stated that data collectors for HMIS from the district hospital, health facilities and the community included Medical Assistants, Nurses/Midwives, Statistical Clerks and Health Surveillance Assistants. Challenges with the system included inadequate resources, knowledge gaps, inadequacy of staff and lack of training and refresher courses which lead to information provided not being reliable. The HMIS Officers further commented that missing values arose from incomplete registers and data gaps. Furthermore, improper comprehension of some terms by Health Surveillance Assistants (HSAs) and Statistical Clerks led to incorrectly recorded data. The study suggests that collection of data by a wide range of health workers and use of different tools leads to inaccuracy of the data being reported. Nevertheless, data users reported that they find the system useful for development of District Implementation Plans (DIPs). Conclusion: There is need for the review of HMIS indicators and harmonization of data collection tools feeding into the HMIS to reduce data inconsistencies. We suggest that Ministry of Health should consider employing HMIS Officers with suitable qualification as stated under the job requirement, and quarterly refresher courses should be organized to increase the competence of staff involved in data management at all levels

Non-communicable diseases and HIV/AIDS burden by socio-demographic characteristics in Malawi

# Background The co-existence of non-communicable diseases (NCDs) and HIV/AIDS is a health concern that needs to be promptly addressed in Sub-Saharan Africa. However, with limited data, responding to this problem may be difficult. This paper aims to describe the burden of NCDs and HIV/AIDS within patients’ socio-demographic and health facility characteristics across the cities and districts in Malawi. # Methods We analysed health facility-based data extracted from NCD patient mastercards from 2019 to 2022 from 70 health facilities in 11 cities and districts in Malawi. Data analysis was done in R using mean, proportions, frequency distributions and charts. Hybrid k-means clustering was used to determine health facilities with similar cases. # Results A total of 29,196 patients had at least one non-communicable disease, with 7.9% having NCDs comorbid with HIV/AIDS. The southern part of Malawi (54.2%), inland locations (69.9%) and health centres (55.3%) recorded large numbers of cases in their respective categories. The health facilities’ case clustering indicated that Neno and Salima district hospitals had similar cases. About 16.1% of the young adults (19 - 39 years) had either a non-communicable disease or NCD-HIV/AIDS comorbidity. The most prominent NCD was hypertension (63.2%), followed by asthma (9.2%). The most commonly employed intervention was medication for NCD (51.6%) and NCD-HIV/AIDS comorbidity (43.4%). Only 13% of all the health facilities in the selected cities/districts used NCD mastercards from which data for this study was extracted. # Conclusions NCDs and NCD-HIV/AIDS comorbidity among young adults pose a major concern since the ailment would lead to days off during the peak of their productivity. The NCD and NCD-HIV/AIDS comorbidity is a major public health problem that needs more attention than realised since the cases reported in this study could be under-reported

Optimal (Control of) Intervention Strategies for Malaria Epidemic in Karonga District, Malawi

Malaria is a public health problem for more than 2 billion people globally. About 219 million cases of malaria occur worldwide and 660,000 people die, mostly (91%) in the African Region despite decades of efforts to control the disease. Although the disease is preventable, it is life-threatening and parasitically transmitted by the bite of the female Anopheles mosquito. A deterministic mathematical model with intervention strategies is developed in order to investigate the effectiveness and optimal control strategies of indoor residual spraying (IRS), insecticide treated nets (ITNs) and treatment on the transmission dynamics of malaria in Karonga District, Malawi. The effective reproduction number is analytically computed, and the existence and stability conditions of the equilibria are explored. The model does not exhibit backward bifurcation. Pontryagin&apos;s Maximum Principle which uses both the Lagrangian and Hamiltonian principles with respect to a time dependent constant is used to derive the necessary conditions for the optimal control of the disease. Numerical simulations indicate that the prevention strategies lead to the reduction of both the mosquito population and infected human individuals. Effective treatment consolidates the prevention strategies. Thus, malaria can be eradicated in Karonga District by concurrently applying vector control via ITNs and IRS complemented with timely treatment of infected people