The Brain Drain of Health Care Professionals from sub-Saharan Africa

This policy brief explores the mass emigration of Africa's highest trained health professional who seek a better life elsewhere in richer parts of Africa and the world, including the United Kingdom and the United States, how this exodus is affecting Africa's economies, labor pools, and quality of health.Title VI Grant for National Resource Centers through the U.S. Department of Educationpublished or submitted for publicationnot peer reviewe

Determinants of infant mortality in Malawi: A spatial perspective

This paper examines the spatial variation of infant mortality in Malawi between 1977 and 1987. Data from the 1977 and 1987 censuses are used in simple correlation and forward stepwise regression analysis to explain and/or predict the variation and change of infant mortality at district (county) level. The results indicate that, at the macro-level, the variation of infant mortality is strongly associated with a number of demographic and socioeconomic variables. Region in which a district finds itself also matters as far as levels of infant mortality are concerned. With a rapidly expanding population, the study concludes that the reduction of infant mortality throughout the country should be vigorously pursued by the government of Malawi. Fertility will continue to be high if infant and childhood mortality persist at current levels.infant mortality spatial variation forward stepwise regression analysis female occupations female education

Health and disease in southern Africa: a comparative and vulnerability perspective

Using a vulnerability and comparative perspective, this paper examines the status of health in southern Africa highlighting the disease complex and some of the factors for the deteriorating health conditions. It is argued that aggregate social and health care indicators for the region such as life expectancy and infant mortality rates often mask regional variations and intra-country inequalities. Furthermore, the optimistic projections of a decade ago about dramatic increases in life expectancy and declines in infant mortality rates seem to have been completely out of line given the current and anticipated devastating effects of the HIV/AIDS pandemic in southern Africa. The central argument is that countries experiencing political and/or economic instability have been more vulnerable to the spread of diseases such HIV/AIDS and the collapse of their health care systems. Similarly, vulnerable social groups such as commercial sex workers and women have been hit hardest by the deteriorating health care conditions and the spread of HIV/AIDS. The paper offers a detailed discussion of several interrelated themes which, through the lense of vulnerability theory, examine the deteriorating health care conditions, disease and mortality, the AIDS/HIV situation and the role of structural adjustment in the provision of health care. The paper concludes by noting that the key to a more equitable and healthy future seems to lie squarely with increased levels of gender empowerment.Infectious disease HIV Vulnerability theory Southern Africa

Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS

Malawi, a very poor country located in southern Africa, is no exception to the growing trend and severity in HIV prevalence. By the end of 2003 there were 900 000 adults and children in Malawi living with HIV/AIDS. Adult prevalence was estimated to be 15%, which is higher than the 7.1% average rate for sub-Saharan Africa. In order to understand the spread of HIV/AIDS it is imperative to address the economic, social, cultural, and political issues that impact on women's contraction and spread of the virus.We do so in this paper by critically examining the gendered context of HIV/AIDS with reference to Malawi.The theoretical framework for this research focuses on poverty, gender relations, regional migration patterns, and global economic changes which place women in highly vulnerable situations.The study was conducted in a low-income area in Lilongwe, the capital city of Malawi. In 2003 and 2004, 60 randomly selected women who lived in a low socioeconomic residential area completed a structured interview on issues concerning individual economic situations, marriage history, fertility, family planning and social networks, gender, sexual partnerships, and HIV/AIDS. Focus group interviews were also conducted with an additional 20 women.The results of our study indicate that the rising epidemic among women in Malawi is firstly driven by poverty which limits their options. Secondly, gender inequality and asymmetrical sexual relations are basic to spreading HIV/AIDS among women. Thirdly, in spite of their awareness through media and health care professionals, women are unable to protect themselves, which further increases their vulnerability. Keywords: Lilongwe, Malawi, HIV/AIDS, womenRésumé Le Malawi, un pays très pauvre situé en Afrique Australe, n'est pas exclut de la tendance croissante et la sévérité de la prédominance du VIH.A la fin de 2003, il y avait 900 000 adultes et enfants vivant avec le virus au Malawi. Le taux de prédominance chez les adultes fut prévu d'être à 15%, ce qui est supérieur à la moyenne de 7.1% du taux de l'Afrique sudsaharienne. Pour comprendre la propagation du VIH/SIDA, il faut absolument aborder les sujets économiques, sociaux, culturels et politiques qui ont l'impact sur la contamination des femmes et la propagation du virus. Dans cette présente, nous examinons, de façon critique, le contexte de sexes vis-à-vis le VIH/SIDA dans le cas du Malawi. Le cadre théorique de cette recherche met au point la pauvreté, les relations de sexes, la tendance de la migration régionale et les changements économiques mondiaux qui disposent les femmes à des situations de vulnérabilité élevée. Cet article présente les résultats d'une étude faite dans une partie moins aisée à Lilongwe, la capitale du Malawi. En 2003 et 2004, nous avons sélectionné, au hasard, 60 femmes qui vivaient dans un quartier socio-économiquement en bas d'échelle. Elles étaient sélectionnées selon les situations économiques personnelles, l'histoire du mariage, la fertilité, la limitation de naissances et les réseaux sociaux, les sexes, les relations sexuelles et le VIH/SIDA. En plus de ces entretiens bien structurés, des entretiens en groupe de foyer ont eu lieu avec 20 femmes de plus. Les résultats de cette étude montrent que l'accroissement de l'épidémie chez les femmes du Malawi est premièrement dû à la pauvreté qui restreint leurs options. Deuxièmement, l'inégalité de sexes et des relations sexuelles asymétriques sont à la base de la propagation du VIH/SIDA parmi les femmes. Troisièmement, en dépit de leur prise de conscience à travers les médias et le personnel de services de soin, les femmes sont incapables de se protéger. Ceci augment davantage leur vulnérabilité. Mots clés: Lilongwe, Malawi,VIH/SIDA, femmes SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) Vol. 2(3) 2005: 320-33

Applications of geospatial analysis to surveillance data: a spatial examination of HIV/AIDS prevalence in Zambia

Techniques of spatial statistics and GIS are applied to socio-economic, demographic and HIV sentinel data to characterize the geographical distribution of HIV prevalence in Zambia and to estimate current prevalence rates. Maps of the 4 years under study (i.e. 1994, 1998, 2002 and 2004) reveal a spatial variation in HIV prevalence with urban and provincial districts having higher prevalence than rural areas. However, there was an overall trend of decrease in HIV prevalence across the country. The year 2004 exhibited the most reduction, coinciding with protective sexual behavior campaigns operating in the country. Risk factors for HIV prevalence included literacy rates, unemployment, poverty and urban residency. Analysis of regression residual maps indicated high spatial autocorrelation: Moran’s I value was 0.28 (z = 4.12 and p < 0.000) and a highly significant Robust LM (lag; p < 0.00000) suggestive of contagious and hierarchic spatial diffusion processes. High HIV prevalence rates among interdependent districts and locational similarity patterns suggest that HIV control programs in the country would require an integrated approach combining HIV prevention messages as well as an understanding of social and cultural interactions between interdependent districts that produce behavioral diffusion of HIV prevalence rates

Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS

Malawi, a very poor country located in southern Africa, is no exception to the growing trend and severity in HIV prevalence. By the end of 2003 there were 900 000 adults and children in Malawi living with HIV/AIDS. Adult prevalence was estimated to be 15%, which is higher than the 7.1% average rate for sub-Saharan Africa. In order to understand the spread of HIV/AIDS it is imperative to address the economic, social, cultural, and political issues that impact on women\u27s contraction and spread of the virus. We do so in this paper by critically examining the gendered context of HIV/AIDS with reference to Malawi. The theoretical framework for this research focuses on poverty, gender relations, regional migration patterns, and global economic changes which place women in highly vulnerable situations. The study was conducted in a low-income area in Lilongwe, the capital city of Malawi. In 2003 and 2004, 60 randomly selected women who lived in a low socioeconomic residential area completed a structured interview on issues concerning individual economic situations, marriage history, fertility, family planning and social networks, gender, sexual partnerships, and HIV/AIDS. Focus group interviews were also conducted with an additional 20 women. The results of our study indicate that the rising epidemic among women in Malawi is firstly driven by poverty which limits their options. Secondly, gender inequality and asymmetrical sexual relations are basic to spreading HIV/AIDS among women. Thirdly, in spite of their awareness through media and health care professionals, women are unable to protect themselves, which further increases their vulnerability. Le Malawi, un pays très pauvre situé en Afrique Australe, n\u27est pas exclut de la tendance croissante et la sévérité de la prédominance du VIH. A la fin de 2003, il y avait 900 000 adultes et enfants vivant avec le virus au Malawi. Le taux de prédominance chez les adultes fut prévu d\u27être à 15%, ce qui est supérieur à la moyenne de 7.1% du taux de l\u27Afrique sudsaharienne. Pour comprendre la propagation du VIH/SIDA, il faut absolument aborder les sujets économiques, sociaux, culturels et politiques qui ont l\u27impact sur la contamination des femmes et la propagation du virus. Dans cette présente, nous examinons, de façon critique, le contexte de sexes vis-à-vis le VIH/SIDA dans le cas du Malawi. Le cadre théorique de cette recherche met au point la pauvreté, les relations de sexes, la tendance de la migration régionale et les changements économiques mondiaux qui disposent les femmes à des situations de vulnérabilité élevée. Cet article présente les résultats d\u27une étude faite dans une partie moins aisée à Lilongwe, la capitale du Malawi. En 2003 et 2004, nous avons sélectionné, au hasard, 60 femmes qui vivaient dans un quartier socio-économiquement en bas d\u27échelle. Elles étaient sélectionnées selon les situations économiques personnelles, l\u27histoire du mariage, la fertilité, la limitation de naissances et les réseaux sociaux, les sexes, les relations sexuelles et le VIH/SIDA. En plus de ces entretiens bien structurés, des entretiens en groupe de foyer ont eu lieu avec 20 femmes de plus. Les résultats de cette étude montrent que l\u27accroissement de l\u27épidémie chez les femmes du Malawi est premièrement dû à la pauvreté qui restreint leurs options. Deuxièmement, l\u27inégalité de sexes et des relations sexuelles asymétriques sont à la base de la propagation du VIH/SIDA parmi les femmes. Troisièmement, en dépit de leur prise de conscience à travers les médias et le personnel de services de soin, les femmes sont incapables de se protéger. Ceci augment davantage leur vulnérabilité

The refugee crisis in Africa and implications for health and disease: a political ecology approach

Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis; the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.refugee crisis political ecology health and disease Africa

Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi

This study explores sociocultural and other risk factors associated with unplanned teenage pregnancy in Zomba district of Malawi. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews held at five antenatal clinics. The data were analysed using descriptive statistics, frequency tables and chi-square analysis which allowed comparative understanding of the sociocultural risk factors for planned and unplanned teenage pregnancy in Zomba district. The findings revealed that teenage pregnancy is a major health and social problem. Over 76% of the teenage respondents in the study had experienced unplanned pregnancy. Among the prominent factors that stood out in the analysis for this high rate of teenage pregnancy were early sex and marriage, low contraceptive use, low educational levels, low socio-economic status, lack of knowledge of reproductive and sexual health, gender inequity, and physical/sexual violence. The consequences on teenage mothers of unplanned pregnancy have been tragic and have compromised their physical, psychological and socioeconomic wellbeing, not just on them but also their families and society at large. The findings point to the need for a multi-sectoral approach to tackle the problem on teenage pregnancy in this district, and likely throughout Malawi