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

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

Background: Point-of-care ultrasound is increasingly being used as a diagnostic tool in resource-limited settings. The majority of existing ultrasound protocols have been developed and implemented in high-resource settings. In sub-Saharan Africa (SSA), patients with heart failure of various etiologies commonly present late in the disease process, with a similar syndrome of dyspnea, edema and cardiomegaly on chest X-ray. The causes of heart failure in SSA differ from those in high-resource settings. Point-of-care ultrasound has the potential to identify the underlying etiology of heart failure, and lead to targeted therapy. Based on a literature review and weighted score of disease prevalence, diagnostic impact and difficulty in performing the ultrasound, we propose a context-specific cardiac ultrasound protocol to help differentiate patients presenting with heart failure in SSA. Results: Pericardial effusion, dilated cardiomyopathy, cor pulmonale, mitral valve disease, and left ventricular hypertrophy were identified as target conditions for a focused ultrasound protocol in patients with cardiac failure and cardiomegaly in SSA. By utilizing a simplified 5-question approach with all images obtained from the subxiphoid view, the protocol is suitable for use by health care professionals with limited ultrasound experience. Conclusions: The “Cardiac ultrasound for resource-limited settings (CURLS)” protocol is a context-specific algorithm designed to aid the clinician in diagnosing the five most clinically relevant etiologies of heart failure and cardiomegaly in SSA. The protocol has the potential to influence treatment decisi