Delayed acquisition of Plasmodium falciparum antigen-specific CD4+ T cell responses in HIV-exposed uninfected Malawian children receiving daily cotrimoxazole prophylaxis

BACKGROUND: Cotrimoxazole (CTX) prophylaxis, recommended in HIV-exposed uninfected (HEU) children primarily against HIV-related opportunistic infections, has been shown to have some efficacy against Plasmodium falciparum malaria. The effects of CTX prophylaxis on the acquisition of P. falciparum antigen specific CD4(+) T cells-mediated immunity in HEU children is still not fully understood. METHODS: Peripheral blood was collected from HEU and HIV-unexposed uninfected (HUU) children at 6, 12 and 18 months of age. Proportion of CD4(+) T cells subsets were determined by immunophenotyping. P. falciparum antigen-specific CD4(+) T cells responses were measured by intracellular cytokine staining assay. RESULTS: There were no differences in the proportions of naïve, effector and memory CD4(+) T cell subsets between HEU and HUU children at all ages. There was a trend showing acquisition of P. falciparum-specific IFN-γ and TNF-producing CD4(+) T cells with age in both HUU and HEU children. There was, however, lower frequency of P. falciparum-specific IFN-γ-producing CD4(+) T cells in HEU compared to HUU at 6 and 12 months, which normalized 6 months after stopping CTX prophylaxis. CONCLUSION: The results demonstrate that there is delayed acquisition of P. falciparum-specific IFN-γ-producing CD4(+) T cells in HEU children on daily cotrimoxazole prophylaxis, which is evident at 6 and 12 months of age in comparison to HUU age-matched controls. However, whether this delayed acquisition of P. falciparum-specific IFN-γ-producing CD4(+) T cells leads to higher risk to malaria disease remains unknown and warrants further investigation

Lymphocyte subsets in healthy Malawians: Implications for immunologic assessment of HIV infection in Africa

BackgroundCD4+T lymphocyte measurements are the most important indicator of mortality in HIV-infected individuals in resource-limited settings. There is currently a lack of comprehensive immunophenotyping data from African populations to guide the immunologic assessment of HIV infection.ObjectiveTo quantify variation in absolute and relative lymphocyte subsets with age in healthy Malawians.MethodsLymphocyte subsets in peripheral blood of 539 healthy HIV-uninfected Malawians stratified by age were enumerated by flow cytometry.ResultsB and T–lymphocyte and T-lymphocyte subset absolute concentrations peaked in early childhood then decreased to adult levels, whereas lymphocyte subset proportions demonstrated much less variation with age. Adult lymphocyte subsets were similar to those in developed countries. In contrast, high B-lymphocyte and CD8+T-lymphocyte levels among children under 2 years, relative to those in developed countries, resulted in low CD4+T-lymphocyte percentages that varied little between 0 and 5 years (35% to 39%). The CD4+T-lymphocyte percentages in 35% of healthy children under 1 year and 18% of children age 1 to 3 years were below the World Health Organization threshold defining immunodeficiency in HIV-infected children in resource-limited settings. Thirteen percent of healthy children under 18 months old had a CD4:CD8T-lymphocyte ratio <1.0, which is commonly associated with HIV infection. All immunologic parameters except absolute natural killer lymphocyte concentration varied significantly with age, and percentage and overall absolute CD4+T-lymphocyte counts were higher in females than males.ConclusionAlthough lymphocyte subsets in Malawian adults are similar to those from developed countries, CD4+T-lymphocyte percentages in young children are comparatively low. These findings need to be considered when assessing the severity of HIV-related immunodeficiency in African children under 3 years

Energy supply in Malawi: Options and issues

Inadequate energy supply is one of the major problems confronting Malawi and limiting its social, economic and industrial development. This paper reviews the current status of energy supply and demand in Malawi; examines the major sources of energy, current exploitation status and their potential contribution to the electricity supply of the country; discusses key issues facing the energy sector; and identifies broad strategies to be implemented to tackle the energy supply challenges. Using secondary data for its critical analysis, the paper also presents modelling of long-term energy demand forecast in the economic sectors of Malawi using the Model for Analysis of Energy Demand (MAED) for a study period from 2008-2030. Three scenarios namely reference (REF), moderate growth (MGS) and accelerated growth (AGS) were formulated to simulate possible future long-term energy demand based on socio-economic and technological development with the base year of 2008. Results from all scenarios suggest an increased energy demand in consuming sectors with biomass being a dominant energy form in household and industry sectors in the study period. Forecast results reveal that energy demand will increase at an annual growth rate of 1.2% and reach 5160 ktoe in 2030 under REF scenario. The growth rates for MGS and AGS are projected at 1.5% each reaching 4639 ktoe and 5974 ktoe in 2030, respectively. The final electricity demand of about 105 ktoe in the base year will grow annually at average rates of 13.8%, 15.3% and 12.6% for REF, AGS and MGS, respectively. Over the study period 2008-2030 the annual electricity per capita will increase from about 111 kWh to 1062, 1418 and 844 kWh for the REF, AGS and MGS, respectively. The final energy intensity will decrease continuously from about 13.71 kWh/US$in the base year to 3.88 kWh/US$, 2.98 kWh/US$and 5.27 kWh/US$ for the REF, AGS and MGS, respectively in the year 2030. In conclusion, the paper outlines strategies that could be utilized to ensure adequate supply of modern energy which is a key ingredient for achieving sustainable social and economic growth

Energy supply in Malawi: Options and issues

Inadequate energy supply is one of the major problems confronting Malawi and limiting its social, economic and industrial development. This paper reviews the current status of energy supply and demand in Malawi; examines the major sources of energy, current exploitation status and their potential contribution to the electricity supply of the country; discusses key issues facing the energy sector; and identifies broad strategies to be implemented to tackle the energy supply challenges. Using secondary data for its critical analysis, the paper also presents modelling of long-term energy demand forecast in the economic sectors of Malawi using the Model for Analysis of Energy Demand (MAED) for a study period from 2008-2030. Three scenarios namely reference (REF), moderate growth (MGS) and accelerated growth (AGS) were formulated to simulate possible future long-term energy demand based on socio-economic and technological development with the base year of 2008. Results from all scenarios suggest an increased energy demand in consuming sectors with biomass being a dominant energy form in household and industry sectors in the study period. Forecast results reveal that energy demand will increase at an annual growth rate of 1.2% and reach 5160 ktoe in 2030 under REF scenario. The growth rates for MGS and AGS are projected at 1.5% each reaching 4639 ktoe and 5974 ktoe in 2030, respectively. The final electricity demand of about 105 ktoe in the base year will grow annually at average rates of 13.8%, 15.3% and 12.6% for REF, AGS and MGS, respectively. Over the study period 2008-2030 the annual electricity per capita will increase from about 111 kWh to 1062, 1418 and 844 kWh for the REF, AGS and MGS, respectively. The final energy intensity will decrease continuously from about 13.71 kWh/US$in the base year to 3.88 kWh/US$, 2.98 kWh/US$and 5.27 kWh/US$ for the REF, AGS and MGS, respectively in the year 2030. In conclusion, the paper outlines strategies that could be utilized to ensure adequate supply of modern energy which is a key ingredient for achieving sustainable social and economic growth

Overview of the Malawi energy situation and A PESTLE analysis for sustainable development of renewable energy

This paper presents an overview of the Malawi energy situation and the potential of renewable energy resources including solar, wind, biomass, hydro and geothermal. Despite a range of efforts by local and international stakeholders to increase access to modern energy sources in the country, 89 per cent of Malawi׳s energy is still sourced from traditional biomass mainly fuel wood. Only 8 per cent of the population in Malawi have access to electricity but installed capacity of electricity generation is lower than demand. This leads to load shedding by the electricity supplier; consequently electricity supply in Malawi is unreliable and micro and macroeconomic activities are significantly affected. Solar, non-traditional biomass (crop residues and forest residues not burnt on three stone fireplaces, and biogas), hydro, wind and geothermal are potential energy resources that could enhance Malawi׳s energy security. However, unreliable financing mechanisms for large scale energy projects; shortage of trained human resource; lack of coordination among local institutions; unclear regulation enforcement; and sometimes political governance impede sustainable delivery of energy projects. The Malawi energy policy targets and drivers are also discussed in the paper. Based on the prevailing energy situation, a PESTLE analysis is provided in this paper outlining a novel thinking for addressing the political (P), economic (E), social (S), technological (T), legal (L), and environmental (E) challenges that constrain the development of renewable energy technologies in Malawi

Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform

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Dietary change, noncommunicable disease and local knowledge: results of a small-scale study of the views of older Malawians

Interviews were conducted with a small group of Malawians over the age of 60 in rural Karonga district and in Area 25 of the capital, Lilongwe. We asked their views on the changes in diet that had taken place over their lifetimes and also on the causes of 'noncommunicable' diseases, such as Type 2 diabetes and hypertension in their communities. Their answers generally confirmed research showing that dietary diversity is decreasing in Malawi, but many of our interviewees also recalled that hunger was more frequently experienced in the past. Our interviews revealed that though the essential rural diet based on either maize or cassava appears superficially largely unchanged, there have been significant changes in the varieties of crops grown, methods of production and food processing. Many of our interviewees were concerned that the application of chemical fertiliser and pesticides was harming their health

Assessing the post-harvest constraints in smallholders’ groundnut production: A Survey in central Malawi

An in-depth scoping survey was conducted on 248 smallholder farmers producing groundnut in Malawi to delineate the constraints in production, especially on-farm post-harvest operations, while revealing various aspects in the status of production and consumption practices. The insightful outcomes included the farmers’ perception of the post-harvest operations as highly labor demanding, being the major obstacle to production expansion for the lucrative and nutritious crop. In particular, shelling, lifting, and stripping were the top three processes of remarkable labor intensity. The respondents expressed the intention for scale-up as long as the labor constraints were mitigated, with expected welfare gain through increased income, improved nutrition, and reduced aflatoxin contamination, as well as mitigated drudgery for women