Is transcription of data on antiretroviral treatment from electronic to paper-based registers reliable in Malawi?

SETTING: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. OBJECTIVE: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. DESIGN: Retrospective analysis of routine programme data. RESULTS: A total of 31 763 registrations and 2922 deaths in the EMR were compared with those in the paper registers. In one hospital, up to 24% of overall case registrations were missing from the paper registers. At other sites, the differences were minor and included duplicate patients who should have been classified as ‘transfer in’ patients in the paper register. There were major differences in the number of registered deaths in two of the five facilities. CONCLUSION: There are varying degrees of agreement between the EMR and paper registers which compromise the use of the latter as a backup solution in case of EMR failure. The reasons for this unreliability and ways forward to address the problem are discussed

Recent advances in understanding hypertension development in sub-Saharan Africa

Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the Human Immunodeficiency Virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions, as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies, and (c) policymakers and health advocates to collectively contribute in creating health-promoting environments in Africa

How to Reduce Aflatoxin Contamination in Groundnuts and Maize A Guide for Extension Workers

Many agricultural commodities are susceptible to several diseases caused by fungi, viruses and insect pests. These diseases may also contaminate the crops with deadly toxins. Fungi are of particular concern. Many fungi are free-living organisms capable of surviving in the environment (soil, air and water) and can easily find their way into crop products especially when the weather conditions are suitable. Many of these fungi are free-living organisms and can survive in the environment even without the crops we grow. The toxins produced by fungi are called mycotoxins (Myco=fungus; toxin=poison)..

Genotype-by-environment interactions for grain yield of Valencia groundnut genotypes in East and Southern Africa

Grain yield is a quantitatively inherited trait in groundnut (Arachis hypogea L.) and subject to genotype by environment interactions. Groundnut varieties show wide variation in grain yield across different agro-ecologies. The objectives of this study were to evaluate Valencia groundnut genotypes for yield stability and classify environments to devise appropriate breeding strategies. Seventeen multi-location trials were conducted in six countries, viz., Malawi, Tanzania, Uganda, Zimbabwe, Mozambique and Zambia, from 2013 to 2016. The experiments were laid out following a resolvable incomplete block design, with two replications at each location (hereafter referred to as ‘environments’) using 14 test lines and two standard checks. The additive main effects and multiplicative interaction (AMMI) analysis was conducted. Variation attributable to environments, genotypes and genotype × environment interaction for grain yield was highly significant (P<0.001). Genotype, environment and genotype × environment interactions accounted for 7%, 53 % and 40% of the total sum of squares respectively. Superior-performing genotypes possessing high to moderate adaptability and stability levels included ICGV-SM 0154, ICGV-SM 07539, ICGV-SM 07536, ICGV-SM 7501, ICGV-SM 99568 and ICGV SM 07520. Nachingwea 2013 in Tanzania, Nakabango 2014 in Uganda and Chitedze 2015 in Malawi were the most representative and discriminative environments. Considering the implications of interactions for Valencia groundnut breeding in East and Southern Africa we propose that different varieties should be targeted for production in different environments and at the same time used for breeding in specific environments

Socio-Demographic Factors Influencing the Use of Assistive Technology among Children with Disabilities in Malawi

Abstract: This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targete

Supporting Children with Disabilities in Low- and Middle- Income Countries: Promoting Inclusive Practice within Community-Based Childcare Centres in Malawi through a Bioecological Systems Perspective

RLOsGiven the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer ‘caregiver’ in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.ESRC-DFI

Youth, mobility and mobile phones in Africa: findings from a three-country study

he penetration of mobile phones into sub-Saharan Africa has occurred with amazing rapidity: for many young people, they now represent a very significant element of their daily life. This paper explores usage and perceived impacts among young people aged c. 9–18 years in three countries: Ghana, Malawi and South Africa. Our evidence comes from intensive qualitative research with young people, their parents, teachers and other key informants (in-depth interviews, focus groups and school essays) and a follow-up questionnaire survey administered to nearly 3000 young people in 24 study sites. The study was conducted in eight different sites in each country (i.e. urban, peri-urban, rural and remote rural sites in each of two agro-ecological zones), enabling comparison of experiences in diverse spatial contexts. The evidence, collected within a broader research study of child mobility, allows us to examine current patterns of usage among young people with particular attention to the way these are emerging in different locational contexts and to explore connections between young people's phone usage, virtual and physical mobilities and broader implications for social change. The issues of gender and inter-generational relations are important elements in this account

‘Where we stayed was very bad …’: migrant children’s perspectives on life in informal rented accommodation in two southern African cities

Most research and initiatives relating to children's experiences of urban space have focused on the physical environment. Housing policies in Third World countries have also emphas- ised the provision of physical infrastructure and buildings, and urban aesthetics. In this paper the authors draw on the voices of young informants from Maseru (Lesotho), and Blantyre (Malawi), who, in discussions concerning moving house, chose to talk about social and economic aspects of life in the informal sector rented accommodation that is increasingly characteristic of these and many other African cities. The children offer insight into the peopling of urban space, mapping unruly environments characterised by disorder, gossip, and social contestation, far removed from the hard technocratic spaces imagined by planners. Their observations are important not only because children represent a very large and relatively neglected proportion of African urban dwellers but also because they offer a unique insight into the dynamic character of urban environments. As close observers of adult decisionmaking processes, children are informed commentators on motivations for moving house as well as the impacts of urban environments on their own lives. Not only do the children highlight the inadequacies of the informal private rental sector but they also offer a window onto why it is inadequate