Market liberalization and food security in Malawi

A conference paper on market liberalization to avert food insecurity in Malawi.Since independence, Malawi has emphasised the smallholder and estate sectors. They differ in terms of land tenure, type of crops grown, credit institutions, market access, and availability of extension service rather than in farm size. Farmers under communal land tenure cannot grow burley tobacco, are serviced by the Agricultural Development and Marketing Corporation (ADMARC), and have access to government extension services. On the other hand, estate farmers under freehold or leasehold can obtain commercial bank credit. Hence, the smallholder sector produces food and a limited number of export crops while the estate sector has concentrated on tobacco, tea, and sugar. During the 1960s and 1970s, estate production grew much faster than smallholder output. Exports from estates expanded at an annual rate of 15% while smallholder exports recorded very little growth. The estate’s share of exports increased from 32% in 1967 to 65% in 1979 and reached 80% in 1981- 82.The research supporting the preparation the proceedings papers was financed by the U.S. Agency for International Development, Bureau of Science and Technology; Bureau for Africa; and the Southern Africa Regional Programme

Mosquito Net Coverage and Utilisation for Malaria\ud Control in Tanzania\ud

\ud In recent years malaria parasites have developed resistance to the most commonly used antimalarial drugs in Tanzania, posing a major challenge for its control. This has led to frequent changes of malaria treatment guidelines, more recently to expensive, yet more effective arthemether/lumefantrine. The use of insecticide treated mosquito nets (ITNs) and long lasting nets (LLINs) in Tanzania has increased slowly over the past few years. Despite the introduction of a voucher scheme to the vulnerable groups, the proportion of households with at least an ITN/LLIN in the country has not been able to achieve the Abuja Declaration of 60% net coverage. Statistics available on the utilisation of nets do not provide a good estimate of the coverage, because of the different study design used to collect the information. This survey was carried out in 21 districts of Tanzania to determine the coverage and utilisation of insecticide treated nets to provide baseline information of the net requirement to cover every sleeping bed in the country. Specifically, this study aimed to (i) determine the ITN coverage by and its distribution in the country; and (ii) determine knowledge, attitudes and practice of the householders as regards to malaria prevention and control Twenty one districts (one from each region) of Mainland Tanzania were selected for the survey. Selection of the district was random. In each district, two wards were selected, one urban (within the district capital) and one rural or sub‐urban. Households were selected randomly using a table of random numbers. At household level, the head or any adult who represented the head of household was interviewed. A structured pre‐tested questionnaire was used to collect information on knowledge, attitude and practices in malaria control, with emphasis on mosquito net ownership and utilisation. Of the 9549 targeted households, 9166 (96%) participated in the survey. Majority of the respondents (76.8%) were from rural district.The mean household size was 3.9 persons. On average, children <5 years old accounted for 39.3% of the members of the households. Respondents with no formal education accounted for 15.8‐37.4% of the interviewees. Most of them were from Mkuranga (55%), Kigoma‐Ujiji (44.2%) and Newala (37.9%). High literate rates were observed in Arumeru and Moshi districts. The majority of the respondents knew that the mosquito is the vector of the malaria parasite (92.6‐99.4%) and infection is through a mosquito bite (92.7‐99.8%). The knowledge of respondents on malaria transmission was generally high (94.0‐99.0%). The majority of the respondents (95.2%) considered the use of mosquito nets as the most effective way of malaria prevention. However, of these, only 66.7% said to have actually used nets in their life time. Knowledge on the use of mosquito nets in the control of malaria was highest and lowest in Eastern and Central zones, respectively.\ud Seventy‐seven percent (4457/8933) agreed to have the investigator entry into their houses and verify the\ud number of nets owned. On average, 62.9% (5,785/8933) of the households had at least a mosquito net. Majority of the respondents in Northern (76.5%) and Southern (76.5%) zones owned at least a mosquito net. The lowest mosquito net ownership was observed among respondents in Western Zone (39.6%). District‐wise, net ownership was highest in Lindi (94.5%), Kyela (91.3%) Arumeru (86.1%), Ilala (83.1%)\ud and Nyamagana (80.0%). Ownership of net was very low in Kilolo (34.8%), Kigoma (36.5%) and Musoma Rural (41.3%). Of the households with nets, 74.4% were using nets all year round. A larger proportion of respondents in Kilolo (68.5%), Mpwapwa (51.9%), Songea Rural (49.2%) and Shinyanga Rural (46.3%) were only using the nets during the rainy season. Out of 9,166 households visited, 3,610 (39.3%) had at least one under five child. Of these, in 1,939 (53.7%) of the households the child slept under a mosquito net during the previous night. Use of nets in children <5 years was most common in northern zone (74%); followed by eastern (66.9%) and southern zone (61.1%). Districts with the largest proportion of <5 year children sleeping under a mosquito nets were Lindi (90.0%), Kyela (85.2%), Ilala (83.2%) and Arumeru (78.2%). Only about a quarter (27%) of the children <5% in western zone were sleeping under a mosquito net. Lowest net coverage for <5 year was in Kigoma (22.7%), Kilolo (25%) and Bukoba Rural (31.2%). A total of 5,785 (62.9%) owned at least a mosquito net. Of these, 4,219 and 1,566 were from the rural and urban districts, respectively. More households in the urban districts (73.4%) than rural districts (59.7%) owned at least a mosquito net. Likewise, there were more households (64.9%) in the urban districts with <5years children sleeping under mosquito nets than in the rural districts (50.4%). More households in urban (32.8%) than in rural districts (25.1%) had at least one insecticide treated net. The number of households with mosquito nets enough for all members of the households ranged from 18.9% (in Urambo) to 37.4% (in Hanang). Households with at least 50% or more occupants using mosquito nets ranged from 16.4% (in Urambo) to 42.8% (in Arumeru). Districts with the largest proportion of ≥50% of the household members sleeping under mosquito nets were Arumeru (46.9%) and Lindi (46.7%). In Manyoni and Lindi, 3.1% and 5% of the households were found to have more nets than the number of household occupants. Only 9% (801/9196) of the households had all occupants sleeping under a mosquito net. Kyela district had about a quarter (23.9%) of the households with all occupants sleeping under nets. Only 29% of the households had at least one insecticide treated mosquito nets. All nets in 51.4% of the households surveyed were ITNs. The largest proportion of households with ITN was observed in northern zone (40.2%), with Arumeru (46%) and Hanang (44.1%) districts having the highest ITN coverage. The lowest proportion (15.5%) of households with ITN was found in the Western Zone. Districts which had the lowest ITN coverage were Musoma Rural (12.6%), Kigoma‐Ujiji (13.2%), and Shinyanga Rural (14.4%). On average, 90.7% (8,123/8,953) of the respondents would prefer using ITN than having their house sprayed with long lasting residual insecticide. More households in urban (32.8%) than in rural districts (25.1%) had at least an ITN> A total of 1939 children underfives were sleeping under mosquito net (any type). Of these, 1140 (58.8%) were using insecticide treated nets (ITN). Overall, 31.6% of the underfives slept under an insecticide treated net during the previous night. Highest coverage was reported in Kyela (47.7%), Nyamagana (47.7%) and Arumeru (46.4%). Lowest ITN in underfives was reported in Kigoma‐Ujiji (16.0%), Musoma (17.2%) and Urambo (17.7%). In Songea more underfives children were sleeping under ITN (43.6%) than in untreated nets (40.9%). Control of bedbugs, lice, fleas, mites and cockroaches was the major added advantage of using insecticide treated nets. On average, 30.8% and 19.6% of the respondents mentioned cockroach and bedbug control as the main advantage of using ITN, respectively. The majority (52.9%) preferred blue coloured net (Northern=45.6%; Central=59.2%; Eastern=56.4%; Lake= 54.4%; Southern= 60.3%, Western= 58.5%) and Southern Highlands= 49.1%). Other colour preferences were white (29.6%), green (14.1%), black (2.1%) and pink (1.2%). A strong preference for blue mosquito nets was observed among respondents in Musoma (77.3%) and Newala (75.5%) districts. On the other hand, the weakest preference (24.7%) for blue nets was observed among respondents in Arumeru district. The majority of the respondents (82%) preferred rectangular shaped net. A larger percent (61.8%) the respondents preferred to have the map of Tanzania as a national logo to identify nets distributed in the country. On average, 62.7% and 28.8% of the households in Tanzania own at least one mosquito net (any type) and insecticide treated net, respectively. Tanzania expects that ITN coverage of under fives in 2009, after the Under Five Catch‐up Campaign is complete, to be at least 80%. If this is to be achieved, there is a need for concerted effort in scaling up the distribution and demand for long lasting nets throughout the country. Moreover, the planned use of IRS in malaria control, currently considered unpopular should be accompanied by rigorous community health education to avoid resistance from household members.\u

Preferential Targeting of Conserved Gag Regions after Vaccination with a Heterologous DNA prime - Modified Vaccinia Ankara (MVA) boost HIV-1 vaccine regimen

Prime-boost vaccination strategies against HIV-1 often include multiple variants for a given immunogen for better coverage of the extensive viral diversity. To study the immunologic effects of this approach, we characterized breadth, phenotype, function and specificity of Gag-specific T cells induced by a DNA-prime Modified Vaccinia Ankara (MVA)-boost vaccination strategy, which uses mismatched Gag immunogens in the TamoVac 01 phase IIa trial. Healthy Tanzanian volunteers received three injections of the DNA-SMI vaccine encoding for a subtype B and AB-recombinant Gagp37 and two vaccinations with MVA-CMDR encoding subtype A Gagp55 Gag-specific T-cell responses were studied in 42 vaccinees using fresh peripheral blood mononuclear cells. After the first MVA-CMDR boost, vaccine-induced IFN-γ(+) Gag-specific T cell responses were dominated by CD4(+) T cells (compared to CD8(+) T cells, p<0.001) that co-expressed IL-2 (66.4%) and/or TNFα (63.7%). A median of 3 antigenic regions were targeted with a higher median response magnitude to Gagp24 regions - more conserved between prime and boost - as compared to regions within Gagp15 (not primed) and Gagp17 (less conserved, both p<0.0001). Four regions within Gagp24 were each targeted by 45% to 74% of vaccinees upon restimulation with DNA-SMI-Gag matched peptides. The response rate to individual antigenic regions correlated with the sequence homology between the MVA and DNA Gag encoded immunogens (p=0.04, r(2)=0.47). In summary, after the first MVA-CMDR boost, the sequence-mismatched DNA-prime MVA-boost vaccine strategy induced a Gag-specific T cell response that was dominated by polyfunctional CD4(+) T cells and that targeted multiple antigenic regions within the conserved Gagp24 Protein.IMPORTANCE Genetic diversity is a major challenge for the design of vaccines against variable viruses. While including multiple variants for a given immunogen in prime-boost vaccination strategies is one approach that aims to improve coverage for global virus variants, the immunologic consequences of this strategy have been poorly defined so far. It is unclear whether inclusion of multiple variants in prime-boost vaccination strategies improves recognition of variant viruses by T cells and by which mechanisms this would be achieved; either by improved cross-recogniton of multiple variants for a given antigenic region or rather through preferential targeting of antigenic regions more conserved between prime and boost. Engineering vaccines to induce adaptive immune responses that preferentially target conserved antigenic regions of viral vulnerability might facilitate better immune control after preventive and therapeutic vaccination for HIV and for other variable viruses

Seven Malawian parastatals An appraisal of performance and policy

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