Socio-economic causes of food insecurity in Malawi

The food crisis that Malawi experienced in 2002 led to hundreds – maybe thousands – of hunger-related deaths, which is more than any famine in living memory. During this famine, maize production fell by over 30% and maize prices rose by over 300% (Devereux, 2002). At the peak of the crisis, nearly a third of the population were dependent on food aid (USAID/Malawi, 2004)

Income-generating activities for young people in southern Africa: Exploring AIDS and other constraints

Copyright @ 2010 The Authors. The Geographical Journal © 2010 Royal Geographical Society (with the Institute of British Geographers). The published version of the article can be accessed via the link below.This paper reports on a study with rural young people (aged 10–24 years) in Malawi and Lesotho, focusing on their opportunities to learn skills and access capital and assets to engage in incomegenerating activities (IGAs). Participatory group exercises and individual interviews provide many examples of how young people learn skills and start small businesses, as well as an insight into their strategic thinking about engaging in these livelihood options. Various factors, including the effects of AIDS, are shown to affect young people’s prospects of succeeding in their ventures.Young people are very keen on starting IGAs, and are supported by adult members of their communities in asking for interventions to help them. We argue that expanded vocational and business training, focusing on locally appropriate types and scale of businesses, coupled with help to raise start-up capital has the potential to improve the chances of young people who are poor and/or AIDS-affected securing sustainable rural livelihoods in their futures. Since AIDS is intertwined with many other issues affecting young people’s livelihoods, it is problematic to single out and target only AIDS-affected young people with interventions on skills building and IGAs. Policymakers’ attitudes to vocational skills training and support for IGAs in Malawi and Lesotho are also explored, and policy recommendations made to support vulnerable rural young people in their attempts to build sustainable livelihoods.ESRC/DFI

Contraceptive Knowledge, Beliefs and Attitudes in Rural Malawi: Misinformation, Misbeliefs and Misperceptions

IntroductionThe objective of the study was to find out factors that affect the intentions of men and women to use family planning methods.MethodsThe study was conducted in Mangochi district, the southern regionof Malawi in 2006. About 60 Focus group discussions were conducted to identify the attitudes and beliefs of 30 male and 30 female participantsregarding family planning methods. The data was then transcribed and analyzed manually identifying central themes and relationships across the cases and narratives.ResultsMost of the respondents knew the different types of family planning methods and reported that health facilities had adequate stock of family planning supplies. However, it was found that most of the women and men were not using any modern family planning methods. Reasons included: family planning methods were perceived side effects, such as prolonged menstruation, men’s concerns about impotence and genital sores, weight gain or loss, and subsequent infertility. Traditional family planning methods were mostly used for infertility problems.ConclusionDespite knowing about the different types of family planning methods, and awareness of their ready availability in health facilities, use of these methods is low because considerable misinformation still prevails regarding contraceptive methods’ side effects

How do women prepare for pregnancy in a low-income setting? Prevalence and associated factors

Background Despite growing evidence of pregnancy preparation benefits, there is little knowledge on how women in developing countries prepare for pregnancy and factors influencing their preparedness for pregnancy. Here, we determine how women in Malawi prepare for pregnancy and factors associated with pregnancy preparation. Methods We used data from a previous cohort study comprising 4,244 pregnant mothers, recruited between March and December 2013 in Mchinji district, Malawi. Associations of pregnancy preparation with socio-demographic and obstetric factors were tested for using mixed effects ordinal regression, with the likelihood ratio and Wald's tests used for variable selection and independently testing the associations. Results Most mothers (63.9%) did not take any action to prepare for their pregnancies. For those who did (36.1%), eating more healthily (71.9%) and saving money (42.8%) were the most common forms of preparation. Mothers who were married (adjusted odds-ratio (AOR 7.77 (95% CI [5.31, 11.25]) or with no or fewer living children were more likely to prepare for pregnancy (AOR 4.71, 95% CI [2.89,7.61]. Mothers with a period of two to three years (AOR 2.51, 95% CI [1.47, 4.22]) or at least three years (AOR 3.67, 95%CI [2.18, 6.23]) between pregnancies were more likely to prepare for pregnancy than women with first pregnancy or shorter intervals. On the other hand, teenage and older (≥ 35 years old) mothers were less likely to prepare for pregnancy (AOR 0.61, 95%CI [0.47, 0.80]) and AOR 0.49 95%CI [0.33, 0.73], respectively). Conclusion While preconception care may not be formally available in Malawi, our study has revealed that over a third of mothers took some action to prepare for pregnancy before conception. Although this leaves around two thirds of women who did not make any form of pregnancy preparation, our findings form a basis for future research and development of a preconception care package that suits the Malawian context

Designing local solutions for emptying pit latrines in low-income urban settlements (Malawi)

A lack of effective options in local technology poses challenges when onsite household sanitation facilities are eventually filled to capacity in unplanned settlement areas within Mzuzu City, located in northern Malawi. Vacuum trucks currently dominate the market but focus on emptying septic tanks in the more easily accessible planned settlement areas, rather than servicing the pit latrines common in unplanned settlement areas. As a result, households in the unplanned settlement areas within Mzuzu rely primarily on manual pit emptying (i.e., shoveling by hand) or digging a new pit latrine. These practices have associated health risks and are limited by space constraints. This research focused on filling the technological gap through the design, development, and testing of a pedal powered modified Gulper pump using locally available materials and fabrication. A modified pedal powered Gulper technology was developed and demonstrated to be capable of lifting fecal sludge from a depth of 1.5 m with a mean flow rate of 0.00058 m3/s. If the trash content was low, a typical pit latrine with a volume of 1–4 m3 could be emptied within 1–2 h. Based on the findings in our research Phase IV, the pedal powered Gulper modification is promising as a potential emptying technology for lined pit latrines in unplanned settlement areas. The success rate of the technology is about 17% (5 out 30 sampled lined pit latrines were successful) and reflects the difficulty in finding a single technology that can work well in all types of pit latrines with varying contents. We note that cost should not be the only design criteria and acknowledge the challenge of handling trash in pit latrines

Trash removal methods for improved mechanical emptying of pit latrines using a screw auger

Trash in pit latrines is one of the largest challenges facing pit emptying technologies, including the powered auger (the Excrevator), developed for improved emptying in lower- and lower-middle income countries. This study focused on two trash removal methods in conjunction with pit emptying by the Excrevator: (1) simultaneous removal of trash with sludge and (2) manual trash removal prior to sludge removal. Simultaneous removal was tested by adding to the inlet of the Excrevator system two cutting heads designed to reduce the size of trash particles before entering the pipe and auger. Laboratory testing indicated that the auger will not provide the rotational speeds necessary for proper maceration of fibrous materials such as clothing, indicating that a separate maceration unit with higher rotational methods may be more appropriate. Four manual trash removal mechanisms were designed to improve on existing manual trash ‘fishing’ tools such as iron rods with fixed hooks. Two of these tools (the ‘claw’ and the ‘hook’) showed promising laboratory results and were subsequently field tested in Mzuzu, Malawi. Both tools proved more efficient than the current tools used in the field and have potential for use in Malawi

TEN Team

There is a growing realisation that to better understand and intervene in the interconnected political, cultural and psycho-social dynamics that constitute the contexts for these current global challenges requires transdisciplinary and intersectoral approaches; approaches that include and value diverse perspectives and pay particular attention to the perspectives and experiences of those who are the most vulnerable and those who are currently excluded from the knowledge creation processes. This article discusses the learning gained from an inter-disciplinary and inter-institutional project entitled Transformative Engagement Network (TEN). &nbsp

Beyond Prejudice as Simple Antipathy: Hostile and Benevolent Sexism Across Cultures

The authors argue that complementary hostile and benevolent componen:s of sexism exist ac ro.ss cultures. Male dominance creates hostile sexism (HS). but men's dependence on women fosters benevolent sexism (BS)-subjectively positive attitudes that put women on a pedestal but reinforce their subordination. Research with 15,000 men and women in 19 nations showed that (a) HS and BS are coherenl constructs th at correlate positively across nations, but (b) HS predicts the ascription of negative and BS the ascription of positive traits to women, (c) relative to men, women are more likely to reject HS than BS. especially when overall levels of sexism in a culture are high, and (d) national averages on BS and HS predict gender inequal ity across nations. These results challenge prevailing notions of prejudice as an antipathy in that BS (an affectionate, patronizing ideology) reflects inequality and is a cross-culturally pervasive complement to HS

T-cell subpopulations αβ and γδ in cord blood of very preterm infants : The influence of intrauterine infection

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are creditedPreterm infants are very susceptible to infections. Immune response mechanisms in this group of patients and factors that influence cord blood mononuclear cell populations remain poorly understood and are considered insufficient. However, competent immune functions of the cord blood mononuclear cells are also described. The aim of this work was to evaluate the T-cell population (CD3+) with its subpopulations bearing T-cell receptor (TCR) αβ or TCR γδ in the cord blood of preterm infants born before 32 weeks of gestation by mothers with or without an intrauterine infection. Being a pilot study, it also aimed at feasibility check and assessment of an expected effect size. The cord blood samples of 46 infants age were subjected to direct immunofluorescent staining with monoclonal antibodies and then analyzed by flow cytometry. The percentage of CD3+ cells in neonates born by mothers with diagnosis of intrauterine infection was significantly lower than in neonates born by mothers without infection (p = 0.005; Mann-Whitney U test). The number of cells did not differ between groups. Infection present in the mother did not have an influence on the TCR αβ or TCR γδ subpopulations. Our study contributes to a better understanding of preterm infants' immune mechanisms, and sets the stage for further investigations.Peer reviewedFinal Published versio

Prevention of cervical cancer through two HPV-based screen-and-treat implementation models in Malawi: protocol for a cluster randomized feasibility trial

Background: Cervical cancer is the leading cause of cancer incidence and mortality among Malawian women, despite being a largely preventable disease. Implementing a cervical cancer screening and preventive treatment (CCSPT) program that utilizes rapid human papillomavirus (HPV) testing on self-collected cervicovaginal samples for screening and thermal ablation for treatment may achieve greater coverage than current programs that use visual inspection with acetic acid (VIA) for screening and cryotherapy for treatment. Furthermore, self-sampling creates the opportunity for community-based screening to increase uptake in populations with low screening rates. Malawi’s public health system utilizes regularly scheduled outreach and village-based clinics to provide routine health services like family planning. Cancer screening is not yet included in these community services. Incorporating self-sampled HPV testing into national policy could address cervical cancer screening barriers in Malawi, though at present the effectiveness, acceptability, appropriateness, feasibility, and cost-effectiveness still need to be demonstrated. Methods: We designed a cluster randomized feasibility trial to determine the effectiveness, acceptability, appropriateness, feasibility, and budget impact of two models for integrating a HPV-based CCSPT program into family planning (FP) services in Malawi: model 1 involves only clinic-based self-sampled HPV testing, whereas model 2 includes both clinic-based and community-based self-sampled HPV testing. Our algorithm involves self-collection of samples for HPV GeneXpert® testing, visual inspection with acetic acid for HPV-positive women to determine ablative treatment eligibility, and same-day thermal ablation for treatment-eligible women. Interventions will be implemented at 14 selected facilities. Our primary outcome will be the uptake of cervical cancer screening and family planning services during the 18 months of implementation, which will be measured through an Endline Household Survey. We will also conduct mixed methods assessments to understand the acceptability, appropriateness, and feasibility of the interventions, and a cost analysis to assess budget impact. Discussion: Our trial will provide in-depth information on the implementation of clinic-only and clinic-and-community models for integrating self-sampled HPV testing CCSPT with FP services in Malawi. Findings will provide valuable insight for policymakers and implementers in Malawi and other resource-limited settings with high cervical cancer burden. Trial registration: ClinicalTrials.gov identifier: NCT04286243. Registered on February 26, 2020