Characteristics of high-intensity groundwater abstractions from weathered crystalline bedrock aquifers in East Africa

Weathered crystalline bedrock aquifers sustain water supplies across the tropics, including East Africa. Although well yields are commonly <1 L s−1, more intensive abstraction occurs and provides vital urban and agricultural water supplies. The hydrogeological conditions that sustain such high abstraction from crystalline bedrock aquifers remain, however, poorly characterised. Five sites of intensive groundwater abstraction (multiple boreholes yielding several L s−1 or more) were investigated in Uganda and Tanzania. Analysis of aquifer properties data indicates that the sites have transmissivities of 10–1,000 m2 day−1, which is higher than generally observed in deeply weathered crystalline bedrock aquifers. At four of the five sites, weathered bedrock (saprolite) is overlain by younger superficial sediments, which provide additional storage and raise the water table within the underlying aquifer. Residence-time indicators suggest that: (1) abstracted water derives, in part, from modern recharge (within the last 10–60 years); and (2) intensive abstraction is sustained by recharge occurring over several decades. This range of encountered residence times indicates a degree of resilience to contemporary climate variability (e.g. short-term droughts), although the long-term sustainability of intensive abstractions remains uncertain. Evidence from one site in Tanzania (Makutapora) highlights the value of multi-decadal groundwater-level records in establishing the long-term viability of intensive groundwater abstraction, and demonstrates the influence of intra-decadal climate variability in determining the magnitude and frequency of recharge

How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

Treatment partnering is an adherence intervention developed in sub-Saharan Africa. This paper describes the additional social functions that treatment partners serve and shows how these functions contribute to health and survival for patients with HIV/AIDS. Ninety-eight minimally structured interviews were conducted with twenty pairs of adult HIV/AIDS patients (N = 20) and treatment partners (N = 20) treated at a public HIV-care setting in Tanzania. Four social functions were identified using inductive, category construction and interpretive methods of analysis: (1) encouraging disclosure; (2) combating stigma; (3) restoring hope; and (4) reducing social difference. These functions work to restore social connections and reverse the isolating effects of HIV/AIDS, strengthening access to essential community safety nets. Besides encouraging ARV adherence, treatment partners contribute to the social health of patients. Social health as well as HIV treatment success is essential to survival for persons living with HIV/AIDS in sub-Saharan Africa

Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10–12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention

Socio-Ecological Associations of the Development of Sexual Behavior in Young Adolescent Girls in the Rural Southern Region of Malawi

Adolescent girls are more likely to experience early sexual debut than boys. However, the developmental context of their sexual behaviors is under-investigated. Using the socio-ecological model and Malawi Schooling and Adolescent Survey, we investigated factors crucial in determining the development of sexual behaviors of 416, 14-year-old girls in rural southern Malawi. We applied Bivariate Logistic Regression analysis to determine associations. Results showed that 353 (84.9%) experienced sexual intercourse, 60 (18.4%) had multiple sexual partners, and 32 (9.1%) used condoms or hormonal contraceptives. Participants’ educational background, desire for higher education, reproductive health knowledge, and being monitored by teachers in school were positively associated with healthy sexual behaviors. Having a boyfriend, lack of schooling support, and being invited to teachers’ homes were positively associated with risky sexual behaviors. Therefore, promoting adolescents’ formal education, sexual health literacy, and safety in schools should be essential components of research and biobehavioral interventions targeting young adolescents in Malawi

Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

Abstract Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT0371178