The Likoma Network Study: Context, data collection and initial results

The extent and structure of sexual networks have important consequences for the spread of sexually transmitted diseases such as HIV. However, very few datasets currently exist that allow a detailed investigation of sexual networks in sub-Saharan African settings where HIV epidemics have become generalized. In this paper, we describe the context and methods of the Likoma Network Study (LNS), one of the few studies that have collected extensive information on sexual networks in sub-Saharan Africa. We start by reviewing theoretical arguments and empirical studies emphasizing the importance of network structures in the epidemiology of HIV and other sexually transmitted infections (STI). The island setting of this study is described, and we argue that the choice of an island as a research site limited potential biases that may make the collection of sexual network data difficult. We then document our empirical strategy for the collection of sexual network data and the subsequent identification of sexual network partners. A description of the protocol for the collection of biomarker data (HIV infection) is provided. Finally, we present initial results relating to the socioeconomic context of the island, the size and composition of sexual networks, the quality of the sexual network data, the determinants of successful contact tracing during the LNS, and the prevalence of HIV in the study population.HIV risk factors, HIV transmission, Malawi, sexual behavior, sexual networks

The Likoma Network Study: Context, Data Collection and Initial Results

The sexual networks connecting members of a population have important consequences for the spread of sexually transmitted diseases including HIV. However, very few datasets currently exist that allow an investigation of the structure of sexual networks, particularly in sub-Saharan Africa where HIV epidemics have become generalized. In this paper, we describe the context and methods of the Likoma Network Study (LNS), a survey of complete sexual networks we conducted in Likoma island (Malawi) between October 2005 and March 2006. We start by reviewing theoretical arguments and empirical studies emphasizing the importance of network structures for the epidemiology of sexually and transmitted diseases. We describe the island setting of this study, and argue that the choice of an island as research site addresses the possible sources of bias in the collection of complete network data. We then describe in detail our empirical strategy for the identification of sexual networks, as well as for the collection of biomarker data (HIV infection). Finally, we provide initial results relating to the socioeconomic context of the island, the size and composition of sexual networks, the prevalence of HIV in the study population, the quality of the sexual network data, the determinants of successful contact tracing during the LNS, and basic measures of network connectivity

Research Article (Human Resources for Health) Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to  non-doctors.Methods: During a three month period, data from 2131 consecutive obstetric  surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.Results: During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.Conclusions: Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians

Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

<p>Abstract</p> <p>Background</p> <p>Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.</p> <p>Methods</p> <p>During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.</p> <p>Results</p> <p>During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.</p> <p>Conclusion</p> <p>Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.</p

Women’s empowerment, spousal communication and reproductive decision-making in Malawi

This study is focused on the relationship between women’s power, spousal interactions and reproductive decision-making. It examines the nature of Reproductive Decision-Making Processes (RDMP) and the effect of spousal interactions and power relations on women’s capacity to make autonomous reproductive decisions or to negotiate desired reproductive outcomes. The study questions whether or not women’s empowerment and spousal communication really matters for the spread of family planning in Malawi? The major findings of the study show that social dynamics at the national, the community, the lineage and the family levels affect the nature of RDMP and their outcomes. A number of indices are identified as having a significant impact on women’s power to participate in RDMP and influence their outcomes. These factors include non-egalitarian lineage or marriage system, women’s perceived autonomy, spousal communication about family planning and exposure to modern ideas and lifestyles. This study demonstrates that changes in the social context, particularly in the lineage power structures and relationships, influence women’s capacity to participate in deciding to space births, stop child bearing and use family planning methods. For example, the social change that has been taking place in Malawian societies has had an impact on family dynamics and structures. Urbanisation has continuously attracted men and women to migrate to cities leading to the fragmentation of lineages. De facto female-headed households have been on the increase. This has allowed married women to consider making autonomous reproductive decisions to space births using modern contraceptive methods. The reproductive decision-making power of lineage heads has been weakened. Nevertheless, married women are still not able to make autonomous decisions or convince their husbands to use modern contraceptive methods for the purpose of limiting family sizes. The empirical findings of the study provide a paradox for research and public policies. Contrary to theoretical beliefs and the ‘Cairo Model’, less gender egalitarian lineage and marriage systems permit married women to make autonomous reproductive decisions, whereas more gender egalitarian lineage and marriage systems enable married women to negotiate desired reproductive behaviours and outcomes. In order to meet the needs of these categories of married women, public policies will require analyses that would provide in-depth understanding of the relationship between social change, spousal power relations, reproductive decision-making and family planning. The few reproductive decision-making power variables identified in this study: lineage, type of union, perceived autonomy, perceived negotiating power, spousal communication and exposure to modern ideas, have only measured the degree of women’s reproductive decision-making power. A more in-depth understanding of why most married women do not have the capacity to make autonomous decisions or to influence their husbands to use modem family planning methods for limiting family sizes is essential. This thesis has partially brought about that understanding. But more in-depth analyses of the impact of men’s power, women’s power, couple power, higher levels of spousal communication and levels of socio-economic development on the nature and outcomes of reproductive decision-making processes is called for. There is need to develop more cultural and socio-economic-based women’s power measures that would allow for more gender and cultural-sensitive research, analyses and policy planning and implementation

The Likoma network study: study context, data collection and survey instruments

The extent and structure of sexual networks have important consequences for the spread of sexually transmitted diseases such as HIV. However, very few datasets currently exist that allow a detailed investigation of sexual networks in sub-Saharan African settings where HIV epidemics have become generalized. In this paper, we describe the context and methods of the Likoma Network Study (LNS), one of the few studies that have collected extensive information on sexual networks in sub-Saharan Africa. We start by reviewing theoretical arguments and empirical studies emphasizing the importance of network structures in the epidemiology of HIV and other sexually transmitted infections (STI). The island setting of this study is described, and we argue that the choice of an island as a research site limited potential biases that may make the collection of sexual network data difficult. We then document our empirical strategy for the collection of sexual network data and the subsequent identification of sexual network partners. A description of the protocol for the collection of biomarker data (HIV infection) is provided. Finally, we present initial results relating to the socioeconomic context of the island, the size and composition of sexual networks, the quality of the sexual network data, the determinants of successful contact tracing during the LNS, and the prevalence of HIV in the study population