Hydrological and Water Quality Characteristics of Rivers Feeding into Small Earth Dams for Rural Water Supply: A Case Study of Traditional Authority Kalolo in Lilongwe District

The obligation to ensure adequate and clean water supply to everyone, has necessitated the development of small earth dams for rural water supply in developing countries. In Malawi, there are approximately 750 small and medium dams most of which are used multiple purposes. However, in most cases, the sustainability of these dams is challenged by gross catchment mismanagement and improper designs and set up. In this study, FDC analysis, in conjunction with water quality assessment, was used to evaluate the reliability of rivers flows that supply small earth dams designed for rural water supply in Malawi, using Kalolo area in Lilongwe district as a case study. FDC analysis showed that over 80% of the time, all rivers in the study area would not meet the target community’s water demand, without the dams in place. Water quality assessments show biological contamination as the major water quality problem. Significant seasonal variation in water quality is evident, with the dry season having generally better biological water quality. Further, the study categorized the catchments areas as moderately to largely modified using rapid ecological assessment method. Therefore, the low biological water quality may be attributed to uncontrolled anthropogenic activities in the catchment, arising from lack of proper catchment management. It is then recommended that construction of such small earth dams should be preceded by thorough scientific design through appropriate engineering and environmental studies, encompassing hydrological, geological, ecological and socio-economic factors, if the small earth dams are to result into long term outputs.Keywords: River flow; small earth dams; flow duration curve; water quality; rural water supply

Forest management through community participation in Sri Lanka (with reference to Kurunegala district)

A forest is an area with a high density of trees (or, historically, an area set aside for hunting). Plantcommunities covering large areas of the globe provide carbon-sink, oxygen-release, habitat, and soilretentionfunctions. Therefore, Earth's forests constitute one of the most important aspects of ourbiosphere.In response to escalating concerns about the degradation of State-managed forests, developing countriesaround the world are increasingly promoting decentral ization of natural resource management. Fromthe State-centric policies that were promoted in different parts of the world in the mid-Zf)" century,the trend has shifted toward encouraging participatory systems of management by local communities.This shift has been prompted by recognition of the numerous problems associated with consolidatingall power in the hands of the State, and of the crucial, hitherto unrecognized, positive role played bylocal communities-albeit nudged by international shifts in policy.Isolated islands of forests in Sri Lanka have received the attention of both the state and the peoplebecause of their economic importance. Responsibility for forest management has been placed ontechnically trained officers in the public sector, the objective being to promote state regulation in theefficient management of forest resources. Sri Lanka's natural forest cover is now around 31% of theisland's 65,610 sq km, and natural closed canopy forests have dwindled to 22.5 % of the total landarea from 44 % in 1956. It is significant that tropical humid forests, which form the natural vegetationtype of the island's ever-wet southwestern quarter, have shrunk to about 9.5% of this region. Theseforests are also heavily fragmented and few are more than 10,000 ha in extent. Although much of theendemic species among both fauna and flora are concentrated in the wet zone, lowland rain forests ofthis region comprise about 1.9% of the island's land area.This research follows the manner in which State-driven, upwardly accountable, forest decentralizationprograms play out on the ground, and evaluates their impact on forests and local institutions, a topic ofmuch current concern and debate. In-depth field interviews with the communities provide us withinformation about the impact of these initiatives on local institutions. Non-wood forest products areimportant to people for a number of reasons. First, NWFPs are integral to the lifestyle of forestdependentcommunities. They fulfill basic requirements, provide gainful employment during lean periodsand supplement incomes from agriculture and wage labor. Medicinal plants have an important role inrural health.The objective of this paper is to explores forest management through community participation toprotect the forest in Sri Lanka. Up to now there is no local communities currently function under asituation of constraint, where they have not been delegated responsibilities. It has been collectedopinion from hundred families who lives around forest cover in Kurunegala district and 95% of peoplesaid that community participation is the best way to manage the forest in Sri Lanka. It can be takenexperience from India and Nepal for this program.

Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.

OBJECTIVES: To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. SETTING: Households in Lusaka District, Zambia, 2004-2011. PARTICIPANTS: 43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years. PRIMARY OUTCOME: Premature adult mortality. RESULTS: The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. CONCLUSIONS: To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services

Language policy and orthographic harmonization across linguistic, ethnic and national boundaries in Southern Africa

Drawing on online and daily newspapers, speakers' language and writing practices, official government documents and prescribed spelling systems in Southern Africa, the paper explores the challenges and possibilities of orthographic reforms allowing for mobility across language clusters, ethnicity, regional and national borders. I argue that this entails a different theorisation of language, and for orthographies that account for the translocations and diasporic nature of late modern African identities and lifestyles. I suggest an ideological shift from prescriptivism to practice-orientated approaches to harmonisation in which orthographies are based on descriptions of observable writing practices in the mobile linguistic universe. The argument for orthographic reforms is counterbalanced with an expose on current language policies which appear designed for an increasing rare monoglot 'standard' speaker, who speaks only a 'tribal' language. The implications of the philosophical challenges this poses for linguists, language planners and policy makers are thereafter discussed.IS

Participatory learning and action cycles with women s groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability.

WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range:$61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from$135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations

A nurse‐led intervention improves detection and management of AKI in Malawi

BACKGROUND: Acute kidney injury is common and has significant impact on mortality and morbidity. There is a global drive to improve the lack of knowledge and understanding surrounding the recognition, diagnosis and management of patients with AKI in resource poor healthcare systems. OBJECTIVES: We propose a nurse‐led education programme to medical and nursing staff of the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, will improve the overall care and understanding of patients with AKI that will still be effective 3 months later. METHODS: This was a three phase, prospective interventional pilot study which evaluated base line knowledge and clinical practice amongst healthcare workers, provided a comprehensive combination nurse‐led class room and ward based teaching programme and evaluated the change in knowledge and clinical management of patients in the high dependency areas of the hospital immediately, and 3 months, after the teaching intervention. RESULTS: The nurse‐led intervention significantly improved the healthcare workers attitudes towards detecting or managing patients with suspected AKI (p < 0.0001). There were also significant improvements in the completion of fluid charts and recording of urine output (p < 0.0001), corner stones of AKI management. Knowledge and clinical intervention was still present three months later. There was however little change in the understanding that AKI could be a significant clinical problem in QECH and that it may have a major impact on mortality and working practice and this needs to be addressed in future teaching programmes. CONCLUSIONS: A low cost, nurse‐led AKI educational intervention improved the knowledge and management of AKI at QECH, which was still evident 3 months later

A compact fluorescence sensor for low-cost non-invasive monitoring of gut permeability in undernutrition

Undernutrition is associated with approximately 45% of deaths among children under the age of 5. Furthermore, in 2020, around 149 million children suffered impaired physical/cognitive development due to lack of adequate nutrition. Environmental enteropathy (EE) is associated with undernutrition and is characterized by a multifaceted breakdown in gut function, including an increase in intestinal permeability that can lead to inflammatory responses. However, the role and mechanisms associated with EE (particularly gut permeability) are not well understood. This is partly because current techniques to assess changes in gut permeability, such as endoscopic biopsies, histopathology and chemical tests such as Lactulose:Mannitol assays, are either highly invasive, unreliable or difficult to perform on specific groups of patients (such as infants and patients with urine retention problems). Therefore, low-cost, non-invasive and reliable diagnostic tools are urgently needed for better evaluation of intestinal permeability. Here, we present a compact transcutaneous fluorescence spectroscopy sensor for non-invasive evaluation of gut permeability and report the first in vivo data collected from volunteers in an undernutrition trial. Using this technique and device, fluorescence signals are detected transcutaneously after oral ingestion of a fluorescent solution. Preliminary results demonstrate the potential use of the presented sensor for clinical assessment of gut permeability in low-income settings

A qualitative evaluation of hospital versus community-based management of patients on injectable treatments for tuberculosis

Abstract Background Patients being treated for recurrent or multidrug-resistant tuberculosis (TB) require long courses of injectable anti-tuberculous agents. In order to maintain strong TB control programmes, it is vital that the experiences of people who receive long-term injectables for TB are well understood. To investigate the feasibility of a novel model of care delivery, a clinical trial (The TB-RROC Study) was conducted at two central hospitals in Malawi. Hospital-based care was compared to a community-based approach for patients on TB retreatment in which ‘guardians’ (patient-nominated lay people) were trained to deliver injections to patients at home. This study is the qualitative evaluation of the TB-RROC trial. It examines the experiences of people receiving injectables as part of TB treatment delivered in hospital and community-based settings. Methods A qualitative evaluation of the TB-RROC intervention was conducted using phenomenographic methods. Trial participants were purposively sampled, and in-depth interviews were conducted with patients and guardians in both arms of the trial. Key informant interviews and observations in the wards and community were performed. Thematic content analysis was used to derive analytical themes. Results Fourteen patients, 12 guardians and 9 key informants were interviewed. Three key themes relating to TB retreatment emerged: medical experiences (including symptoms, treatment, and HIV); the effects of the physical environment (conditions on the ward, disruption to daily routines and livelihoods); and trust (in other people, the community and in the health system). Experiences were affected by the nature of a person’s prior role in their community and resulted in a range of emotional responses. Patients and guardians in the community benefited from better environment, social interactions and financial stability. Concerns were expressed about the potential for patients’ health or relationships to be adversely affected in the community. These potential concerns were rarely realised. Conclusions Guardian administered intramuscular injections were safe and well received. Community-based care offered many advantages over hospital-based care for patients receiving long-term injectable treatment for TB and their families

Expanding CWD Disease Surveillance Options Using Environmental Contamination at Deer Signposts

1. Environmental surveillance can allow early detection of diseases, which increases management options and can improve disease trajectories. Chronic wasting disease (CWD) in cervids is a significant prion disease that has been spreading across North America since the 1960s, leading to cervid population declines and concern from hunters and state wildlife agencies. White-tailed deer have a unique breeding season behavior called scraping, where they deposit urine and saliva at shared sites. Since both these fluids can contain CWD prions, scrape sites have the potential to serve as sentinel sites for environmental surveillance of CWD.2. To examine this potential, we used camera traps to monitor deer behavior and collected environmental samples from 105 scrape sites. The 48 km2 study site was located at the center of the CWD zone in southwestern Tennessee (United States), where CWD prevalence is ~50%. We also sampled scrapes in northern Mississippi at the leading edge of the same CWD distribution to test the potential for early CWD detection using scrape sampling.3. From camera data, we identified 218 unique bucks visiting 105 scrapes, with a mean of 12.2 ± 7.5 bucks per scrape (mean ± SD, range 1–39) and individual bucks visiting a mean of 5.9 ± 4.6 monitored scrapes each (range 1–23).4. Using real-time quaking-induced conversion (RT-QuIC), we detected prion seeding activity in 20% of the soil and 41% of the licking branches of the scrape sites within the CWD study area, and in 25% of the soil and 11% of the licking branches of scrape sites sampled at the edge of the known CWD distribution.5. Our data show there is environmental prion contamination at scrape sites. This supports the idea that scrapes could serve as early warning sentinel sites for CWD surveillance through testing soil and licking branches for prion seeding ac-tivity, especially in areas with limited access to harvested deer samples

The Magnitude, Clinical Presentation and Consequences of Patients with Burn Injuries Admitted to Tertiary Care Hospital, Kurunegala, Sri Lanka: A Prospective Analysis

This prospective analysis is based on clinical forensic examinations and clinical case records of the victims who sustained burns and were admitted during a one-year period since 2017. Of the 90 patients (34 children and 56 adults), 54 % were male with ages ranging from 1 month to 80 years. Males below the age of 20 years (48 %) were highly vulnerable. Education status revealed that most of the patients have an education level below O/L representing 52 % (Ordinary Level/ O/L is similar to the General Certificate of Secondary Education/ GCSE in Cambridge Education System in United Kingdom) and the majority were married (52%). Scalds were seen in 52 %, while flame burns in 28 % cases. Most of the incidents had taken place at home (92%). Burn injuries were most frequently observed on upper extremities (47 %) and the majority were of first degree in nature. Furthermore, this study revealed that 57 % recovered without any complications, while 34 % resulted in scarring or disfigurement. It was highlighted that children are the most vulnerable to in sustaining burns, especially with hot water in domestic settings. The study recommends increasing awareness among parents/guardians regarding safe handling of hot water to minimize such incidents