Evidence, Analysis and Advocacy for Equity- The Perspective of the Malawi Health Equity Network

This paper presents a synopsis of experiences of Malawi Health Equity Network, in its work to deepen the evidence and strengthen the platform for civic participation in the promotion of equitable health services in Malawi. The Malawi Health Equity Network (MHEN) is a non-profit independent alliance of Civil Society Organizations and other interested parties promoting equity and quality in health for all people in Malawi, by influencing policy and practice, through research, monitoring, information dissemination, advocacy and civic education. MHEN's vision is for “All people in Malawi to have access to equitable, quality and responsive essential health care services by the year 2020 with Malawi Health Equity Network as the ‘Health Equity Watch'.” MHEN was formed in 2000 when the Health Advocacy Network and Malawi EQUINET merged, since both organizations had similar goals and objectives. The Network is legally registered under the laws of Malawi. MHEN seeks to address health inequalities that are avoidable and unfair. In line with this, the Network activities are geared towards influencing redistribution of social resources, which include skilled human resources within the Public Health Sector, and the power and ability of people at the grassroots level to make choices over health inputs, thus building their capacity to use these choices to improve their health status. Malawi Medical Journal Vol. 18 (2) 2006: pp. 53-5

Risk, knowledge and preventive measures of smallholder dairy farmers in northern Malawi with regard to zoonotic brucellosis and bovine tuberculosis

Milk production using local cattle breed-types is an age-old practice in Malawi. Although dairy farming is becoming more common as a result of the increasing population and demand for milk and milk products, there is limited knowledge of the farmers’ awareness of zoonotic disease risks, their preventative practices and the disease burden in animals. This study determined dairy farmers’ general knowledge of zoonoses, assessed their risks for infection with zoonotic bovine tuberculosis (bTB) and brucellosis, and evaluated farm practices to prevent disease transmission. A questionnaire was drawn up and administered by the authors. It was used to collect information about the knowledge and preventive practices of 140 out of 684 registered dairy farmers at Mzuzu Agricultural Development Division, northern Malawi. During a second visit to 60 out of the 140 farms, a total of 156 and 95 cattle were tested for brucellosis and tuberculosis, respectively. Most farmers (77.1%) knew or had heard of zoonotic diseases, whilst 75.0% correctly named at least one zoonotic disease. More survey participants named tuberculosis as a zoonotic disease compared to brucellosis (74.3% versus 2.9%). The most commonly named means of transmission were milk (67.0%) and meat (56.0%). Almost all survey participants (96.4%) practised at least one farm activity that could lead to potential transmission of brucellosis or bTB, including sale (67.0%) and consumption (34.0%) of unpasteurised milk. Antibodies against brucellosis were found in 12 cattle (7.7%), whilst one animal (1.1%) reacted to the tuberculin skin test. General knowledge about possible transmission of diseases between humans and animals was high, although most farmers practised risk behaviours that could potentially expose the public to milk-borne zoonotic diseases such as brucellosis and bTB. Furthermore, some animals had positive results for brucellosis and tuberculosis tests. Therefore, improvement of zoonotic disease prevention programmes, as well as further investigation into the prevalence and risk factors for zoonoses, is recommended

Do support groups members disclose less to their partners? The dynamics of HIV disclosure in four African countries

BACKGROUND: Recent efforts to curtail the HIV epidemic in Africa have emphasised preventing sexual transmission to partners through antiretroviral therapy. A component of current strategies is disclosure to partners, thus understanding its motivations will help maximise results. This study examines the rates, dynamics and consequences of partner disclosure in Burkina Faso, Kenya, Malawi and Uganda, with special attention to the role of support groups and stigma in disclosure. METHODS: The study employs mixed methods, including a cross-sectional client survey of counselling and testing services, focus groups, and in-depth interviews with HIV-positive individuals in stable partnerships in Burkina Faso, Kenya, Malawi and Uganda, recruited at healthcare facilities offering HIV testing. RESULTS: Rates of disclosure to partners varied between countries (32.7% - 92.7%). The lowest rate was reported in Malawi. Reasons for disclosure included preventing the transmission of HIV, the need for care, and upholding the integrity of the relationship. Fear of stigma was an important reason for non-disclosure. Women reported experiencing more negative reactions when disclosing to partners. Disclosure was positively associated with living in urban areas, higher education levels, and being male, while being negatively associated with membership to support groups. CONCLUSIONS: Understanding of reasons for disclosure and recognition of the role of support groups in the process can help improve current prevention efforts, that increasingly focus on treatment as prevention as a way to halt new infections. Support groups can help spread secondary prevention messages, by explaining to their members that antiretroviral treatment has benefits for HIV positive individuals and their partners. Home-based testing can further facilitate partner disclosure, as couples can test together and be counselled jointly.Funding: National Institutie of Health (NIH) and World Health Organization (WHO).</p