Efficacy of Bacillus thuringiensis var israelinsis (Bti) on Culex and Anopheline mosquito larvae in Zomba

Laboratory based experiments were conducted using Bacillus thuringiensis var israelinsis (Bti) to establish the efficacy of Bti on Anopheles and Culex mosquito larvae from Zomba. The study evaluated two formulations of Bti namely VectoBac® WG and VectobaBac® 12AS against selected species of mosquito larvae. During this study, six different concentrations of Bti were set and 360 mosquito larvae were exposed to these different concentrations and results were observed hourly for 10 hours, then 24 hours and 48 hours. The experiment was replicated three times. Results show that the lower effective dosage that can be used to control Culex mosquito larvae in Zomba after 48hours of exposure is 47.73g/ha. The LT50 and LT90 being 7.5hrs and 24.3 hrs respectively. On the other hand, Anopheles mosquito larvae require 103.41g/ha of Bti which is almost double as much as that required by Culex. Anopheles LT50 is 6.2 hrs and LT90 is 18.5 hrs. In addition, it was observed that when Culex and Anopheles mosquito larvae were exposed to the same dosage of liquid formulation of Bti (0.001ml/L) there was no significant difference in their mortalities. Following the successful results of Bti in controlling mosquito larvae at laboratory level it is our recommendation to ask the Government of Malawi to come up with a policy to allow the use of Bti in controlling mosquito larvae in Malaw

Gentamicin for treatment of gonococcal urethritis in Malawi

No Abstrac

The Impact of Bacillus Thuringiensis Israelensis (Bti) on Adult and Larvae Black Fly Populations

In the year 2007, the Ministry of Health (MoH) initiated a larviciding program using Bacillus thuringiensis israelensis (Bti) to mitigate the effects of black fly bites. This study was aimed at assessing the impact of Bti on adult and larvae black fly populations. Baseline data was collected prior to Bti application and after application Larva monitoring was done using four different substrates: nylon strips, rocks, and debri. Adult monitoring was carried out by human landing catches. Data analysis included descriptive summaries, t-tests, regression and Analysis of Variance (ANOVA). The analysis also included the assessment of the effect of Bti on adult flies and Larva density on substrates. All the statistical analysis were done at 5% significance level. The results showed statistically significant differences (p <0.001) in populations of black fly before and after Bti application. Larva density was higher before Bti application and adult numbers were also high in that period. After Bti application a decrease in larva density was recorded and this associated with a gradual decrease in adult numbers. Bti had an impact on the larval population in that a decrease in larva population due to larviciding resulted in the decrease of adult population

Maternal mortality in Malawi, 1977-2012.

Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality

The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality : a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project

Background: Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design: This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion: Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training. Trial registration: ISRCTN6329415

A legal-realist assessment of human rights, right to health and standards of healthcare in the Malawian prison system during COVID-19 state disaster measures.

Purpose: The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19 outbreaks and deaths in the prison system, due to the poor infrastructure, lack of health care and adequate COVID-19 mitigation measures, existing co-morbidities (tuberculosis, HIV, hepatitis C), malnutrition and poor health of many prisoners. Design/methodology/approach: We conducted a legal-realist assessment of the Malawian prison system response to COVID-19 during state disaster measures, with a specific focus on the right to health and standards of health care as mandated in international, African and domestic law. Findings: The Malawi prison system was relatively successful in preventing serious COVID-19 outbreaks in its prisons, despite the lack of resources and the ad hoc reactive approach adopted. Whilst the Malawi national COVID plan was aligned to international and regional protocols, the combination of infrastructural deficits (clinical staff, medical provisions) and poor conditions of detention (congestion, lack of ventilation, hygiene and sanitation) were conducive to poor health and the spread of communicable disease. The state of disaster declared by the Malawi government and visitation restrictions at prisons worsened prison conditions for those working and living there. Originality: In sub-Saharan Africa, there is limited capacity of prisons to adequately respond to COVID-19. This is the first legal-realist assessment of the Malawian prison system approach to tackling COVID-19, and it contributes to a growing evidence of human rights-based investigations into COVID19 responses in African prisons (Ethiopia, South Africa, Zimbabwe)

The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system

OBJECTIVES: This prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi. SETTING: Data were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre. PARTICIPANTS: Children under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients. RESULTS: Total costs in 2014 US$for rural inpatient, rural outpatient, urban inpatient and urban outpatient were$65.33, $8.89,$60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%. CONCLUSION: This study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness

Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient-Level Costing Data.

Background. Rotavirus vaccination reduces childhood hospitalization in Africa, but cost-effectiveness has not been determined using real-world effectiveness and costing data. We sought to determine monovalent rotavirus vaccine cost-effectiveness in Malawi, one of Africa's poorest countries and the first Gavi-eligible country to report disease reduction following introduction in 2012. Methods. This was a prospective cohort study of children with acute gastroenteritis at a rural primary health center, a rural first referral–level hospital and an urban regional referral hospital in Malawi. For each participant we itemized household costs of illness and direct medical expenditures incurred. We also collected Ministry of Health vaccine implementation costs. Using a standard tool (TRIVAC), we derived cost-effectiveness. Results. Between 1 January 2013 and 21 November 2014, we recruited 530 children aged <5 years with gastroenteritis. Costs did not differ by rotavirus test result, but were significantly higher for admitted children and those with increased severity on Vesikari scale. Adding rotavirus vaccine to the national schedule costs Malawi $0.42 per dose in system costs. Vaccine copayment is an additional$0.20. Over 20 years, the vaccine program will avert 1 026 000 cases of rotavirus gastroenteritis, 78 000 inpatient admissions, 4300 deaths, and 136 000 disability-adjusted-life-years (DALYs). For this year's birth cohort, it will avert 54 000 cases of rotavirus and 281 deaths in children aged <5 years. The program will cost $10.5 million and save$8.0 million in averted healthcare costs. Societal cost per DALY averted was $10, and the cost per rotavirus case averted was$1. Conclusions. Gastroenteritis causes substantial economic burden to Malawi. The rotavirus vaccine program is highly cost-effective. Together with the demonstrated impact of rotavirus vaccine in reducing population hospitalization burden, its cost-effectiveness makes a strong argument for widespread utilization in other low-income, high-burden settings