Planning and budgeting for primary health care in Zambia : a policy analysis

Despite policy intentions for a “bottom-up approach,” planning and budgeting for primary health care (PHC) in Zambia is still a top-down process. Through fieldwork activities it became clear that issues of power played a key role in implementation outcomes. With an equity focus in mind, this study took place in the four Equity Gauge districts: Chama (the poorest), Choma (semi rural, semi urban), Chingola (urban, light industrial and mining) and Lusaka (capital city). The study thereby examined how policy implementation had progressed across districts with vastly different socioeconomic characteristics and capacity to implement policy

Early Childhood Infection of Kaposi’s Sarcoma-associated Herpesvirus in Zambian Households: a Molecular Analysis

Sub-Saharan Africa is endemic for Kaposi’s sarcoma-associated herpesvirus (KSHV) and there is a high rate of early childhood infection; however, the transmission sources are not well characterized. We examined household members as potential KSHV transmission sources to young children in the KSHV-endemic country of Zambia. To this end, we enrolled and followed Zambian households with at least one KSHV-seropositive child and collected longitudinal buccal swab samples. KSHV burden was evaluated and K1 sequences from the children were determined and analyzed for differences to K1 sequences from household members. The K1 sequences were also analyzed for evolution over time. We generated K1 sequences from 31 individuals across 16 households. Nine households contained multiple KSHV-positive members, including at least one child. In 6 of 9 households, the child had 100% sequence identity to all household members. However, in two households the child and mother had distinct K1 sequences. In the remaining household, the children were the only KSHV-infected individuals. Furthermore, we report that 1 of 18 individuals had K1 sequence variation within the timespan analyzed. In the present study, we provide evidence that (1) early childhood KSHV transmission occurs from both within and outside the household, (2) intra-household transmission can occur via non-maternal sources, (3) viral shedding in the buccal cavity is highly variable, and (4) the dominant K1 sequence within an individual did not rapidly evolve over time. These results are important for developing KSHV intervention strategies

Lactobacillus-deficient vaginal microbiota dominate post-partum women in rural Malawi

The bacterial community found in the vagina is an important determinant of a woman's health and disease. A healthy vaginal microbiota is associated with a lower species richness and high proportions of one of a number of different Lactobacillus spp.. When disrupted the resulting abnormal vaginal microbiota is associated with a number of disease states and poor pregnancy outcomes. Studies up until now have concentrated on relatively small numbers of American and European populations which may not capture the full complexity of the community, nor adequately predict what constitutes a healthy microbiota in all populations. In this study we sampled and characterised the vaginal microbiota from a cohort of 1107 women in rural Malawi found on vaginal swabs taken post-partum. We found a population dominated by Gardnerella vaginalis and devoid of the most common vaginal Lactobacillus species, even if the vagina was sampled over a year post-partum. The Lactobacillus-deficient anaerobic community commonly labelled community state type (CST) 4 could be sub-divided into four further communities. A Lactobacillus iners dominated vaginal microbiota became more common the longer after delivery the vagina was sampled, but G. vaginalis remained the dominant organism. These results outline the difficulty in all-encompassing definitions of what a healthy or abnormal vaginal microbiota is post-partum. Previous identification of community state types and associations between bacterial species, bacterial vaginosis and adverse birth outcomes may not represent the complex heterogeneity of the microbiota present.ImportanceA bacterial community in the vaginal tract that is dominated by small number of bacterial Lactobacillus species and when they are not present, there is a greater incidence of inflammatory conditions and adverse birth outcomes. A switch to a vaginal bacterial community lacking in Lactobacillus species is common after pregnancy. In this study we characterised the vaginal microbiota after delivery of a large group of women from a resource poor, under-sampled population in rural Malawi. The majority of women were found to have a Lactobacillus-deficient community and even after a year after delivery the majority of women still did not have Lactobacillus present in their vaginal microbiota. The effect of becoming pregnant again for those who do not revert to a Lactobacillus dominant community is unknown and could suggest that not all Lactobacillus-deficient community structures are adverse. A better understanding is needed of this complex community state type

Impact of soil fertility management practices on the nutritional quality of Soybean (Glycine max (l.) Merr.) varieties grown in Eastern Zambia

Open Access Journal; Published online: 26 Sept 2019Zambia has three primary agro-ecological regions, with each region having specific ecological characteristics. Region II agro-ecological zone of Zambia has low nutrient reserves and poor water holding capacity due to moderately leached clayey to loamy soil; this has led to low soybean productivity. Soil fertility management (ISFM) strategies such as the use of inorganic fertilizers and the use of inoculants of rhizobia have been introduced and promoted among small-scale farmers in Eastern Province. Two soybean varieties (Lukanga and Kafue) were used for this study and 96 samples from on-farm soil fertility management trials in Chipata, and Petauke districts were collected for the determinations of nutritional and anti-nutritional properties. The proximate analysis of Chipata samples showed that the ash content 5.10‒6.23%, fat content 17.71‒25.57%, protein content 27.73‒37.11%, amylose content 1.26‒4.56 %, sugar content 6.75‒9.62%, and starch content 4.00‒18.57%, while anti-nutritional properties ranged between 3.07 and 8.21% for phytate and 1.42‒3.35% for tannin. With Petauke, the ash content 3.32‒6.8 %, fat content 19.16‒26.85%, protein content 27.68‒35.62%, amylose 2.00‒4.37%, sugar content 6.23‒9.76%, and starch content 5.70‒18.63%. Phytate and tannin contents were 3.37‒7.90% and 0.14‒3.32%, respectively. The highest protein content was found at the level of 37.11% in Kafue with 40kg P/ha and inoculant, and the least was 27.73% for Lukanga without inputs in Chipata while in Petauke, Lukanga with 40 P/ha and inoculant had the highest protein content of 35.62% and the least was 27.68% for Lukanga with inoculant. The co-application of rhizobia inoculant and P nutrient increased phytate, and tannin content significantly (P < 0.05)

A simple method of formulating least-cost diets for smallholder dairy production in subSaharan Africa,”

Smallholder dairy farmers in sub-Saharan Africa are constrained by inadequate supply of good quality protein sources particularly during the dry season. Commercial protein concentrates are expensive and not readily accessible. Multipurpose forage legumes and other non-conventional protein sources available on-farm have been promoted as alternative cheaper protein sources. The major problem faced by smallholder dairy farmers however is the formulation of diets balanced for the key nutrients and also being cost-efficient. This paper presents a step by step spreadsheet based procedure of diet formulation for smallholder dairy production. The procedure ensures that the diet is balanced for all the key nutrients, is low-cost and the user has significant control over the formulation process. An example using this formulation method incorporating the fodder legumes Leucaena diversifolia, Leucaena pallida, Leucaena esculenta, Acacia angustissima and Calliandra calothyrsus indicate a cost reduction from 10% on C. calothyrsus to 30% on L. diversifolia inclusion when compared to the conventional dairy meal concentrate (US$ 0.34/kg). This ration formulation method is recommended for use by livestock extension advisors and smallholder dairy farmers to quickly formulate low-cost diets using locally available feed sources so as to optimise the feeding of dairy animals at the farm level

Ex-ante Assessment of Adoption of Small-scale Post-harvest Mechanization: The Case of Groundnut Producers in Malawi, Series Paper Number 44

The study combines household-level demand function analysis and community-level benefit cost analysis to conduct ex-ante assessment of the adoption of small-scale post-harvest mechanization with a case of groundnut producers in Malawi. Based on the needs assessment conducted in 2010, Compatible Technology International (CTI) designed three pieces of labor-saving equipment for post-harvest operations for smallholder groundnut production, namely, lifter (harvester), stripper (thresher), and sheller (dehuller) in partnership with ICRISAT, Department of Agricultural Research Services (DARS), and C-to-C Engineering. The paper attempts to assess the viability of adoption and dissemination of each of these technologies which are technically categorized as “club goods” or “artificially scarce goods” through examining two steps: (1) smallholders' level of willingness-to-pay (WTP) for use of the equipment after seeing the demonstration, and (2) community leaders' preferences for methods of acquisition. The data collection leverages farmer research network (FRN) established in collaboration with farmer organizations, complemented by gender disaggregated household interviews. The analytical output suggests that the WTP for smallholders to use the equipment for their entire volume of groundnut harvest was approximately 2,000 Malawian kwachas (MWK) per acre, MWK 50 per pail, and MWK 35 per pail for the lifter, stripper, and sheller, respectively and that lead farmers’ investment in acquiring these technologies can be recovered in a single post-harvest season. The critical values for farmer group size to achieve breakeven points were 75, 22, and 129 for the lifter, stripper, and sheller, respectively under the base scenario and 127, 37, and 218 under the conservative scenario. Lead farmers’ return on investment (ROI) for one season was 2.3, 10.5, and 0.9 for the lifter, stripper, and sheller, respectively under the base scenario and 1.0, 5.8, and 0.1 under the conservative scenario, which will further increase as multiple seasons are considered. The sensitivity analysis indicated that the result was largely robust to altering the assumptions on group size and fees for using the equipment. The findings suggest that the business of lead farmers acquiring the equipment and renting it out to member farmers is indeed profitable, meeting the necessary condition for sustainable adoption. Other conditions to ensure successful adoption are also discussed

Access to menstrual hygiene products through incentivised, community-based, peer-led sexual and reproductive health services before and during the COVID-19 pandemic: findings from the Yathu Yathu trial.

BACKGROUND: Access to affordable and effective menstrual hygiene products (MHP) is critical to the menstrual health of adolescent girls and young women (AGYW). In this mixed-methods analysis, we use data from a programme delivering comprehensive sexual and reproductive health (SRH) services to describe access to MHP and how COVID-19-related closures affected access to MHP; we use qualitative data to understand AGYW's experience accessing products during the study. METHODS: Between September 2019-January 2021, we used data routinely collected from ten Yathu Yathu hubs offering community-based, peer-led SRH services to adolescents and young people aged 15-24. Hubs offered free MHP (primarily disposable pads) as a service. To incentivise service access, a "loyalty" card system was embedded within Yathu Yathu, allowing individuals to gain points for services accessed and redeem rewards using these points. Branded pads, tampons and reusable pads were among available rewards. We describe access to service pads and to reward MHP, and use logistic regression to investigate factors associated with accessing pads and reward products before (Sept 2019-March 2020) and after (July 2020-Jan 2021) COVID-19-related closures. Focus group discussions explored accessibility of offering MHP through hubs. RESULTS: Between September 2019-January 2021, 6374 AGYW made 34,116 hub visits to access an SRH service and/or redeem a reward. At 30% of these visits, AGYW accessed any MHP. Before COVID19-closures, an average of 17% of monthly visits were for freely-available disposable pads compared to 34% after hubs reopened (p < 0.001). Results were similar for reward visits. Overall, 63% of 6374 AGYW collected pads as a service at least once. Prior to COVID19-closures, AGYW aged 18-24 were more likely to access service pads than adolescents (15-17-years). After reopening, access was lower among older AGYW. Prior to hub closures, uptake of reward MHP was higher among AGYW with some secondary education but not after reopening. Discussions revealed that, for adolescents aged 15-19, COVID-19-related hub closures required reverting to using ineffective materials to manage menstruation. CONCLUSION: Availability of MHP through Yathu Yathu provided a large number of AGYW with access to these products. Hubs seemed particularly important for adolescent girls. Community-based, peer-led hubs should be considered as spaces to provide AGYW access to affordable and effective MHP

Acquisition of a Unique Onshore/Offshore Geophysical and Geochemical Dataset in the Northern Malawi (Nyasa) Rift

The Study of Extension and maGmatism in Malawi aNd Tanzania (SEGMeNT) project acquired a comprehensive suite of geophysical and geochemical datasets across the northern Malawi (Nyasa) rift in the East Africa rift system. Onshore/offshore active and passive seismic data, long‐period and wideband magnetotelluric data, continuous Global Positioning System data, and geochemical samples were acquired between 2012 and 2016. This combination of data is intended to elucidate the sedimentary, crustal, and upper‐mantle architecture of the rift, patterns of active deformation, and the origin and age of rift‐related magmatism. A unique component of our program was the acquisition of seismic data in Lake Malawi, including seismic reflection, onshore/offshore wide‐angle seismic reflection/refraction, and broadband seismic data from lake‐bottom seismometers, a towed streamer, and a large towed air‐gun source

Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study [version 1; peer review: awaiting peer review]

BACKGROUND: Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. METHODS: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. RESULTS: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p <0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl vs. 76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). CONCLUSIONS: Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies. TRIAL REGISTRATION: ISRCTN (ISRCTN45035509) 19/06/2012