Women’s groups’ perceptions of neonatal and infant health problems in rural Malawi

AimsTo present the perceptions of women in rural Malawi regarding the health problems affecting neonates and infants and to explore the relevance of these perceptions for child health policy and strategy in Malawi.MethodsWomen’s groups in Mchinji district identified newborn and infant health problems (204 groups, 3484 women), prioritised problems they considered most important (204 groups, 3338 women) and recorded these problems on monitoring forms. Qualitative data was obtained through 6 focus-groupdiscussions with the women’s groups and 22 interviews with individuals living in women’s group communities but not attending groups.ResultsWomen in Malawi do not define the neonatal period accordingto any epidemiological definition. In order of importance they identified and prioritised the following problems for newborns and infants: diarrhoea, infection, preterm birth, tetanus, malaria, asphyxia, respiratory tract infection, hypothermia, jaundice, convulsions and malnutrition.ConclusionThis study suggests that women in rural Malawi collectively have a developed understanding of neonatal and infant health problems. This makes a strong argument for the involvement of lay people in policy and strategy development and also suggests that this capacity, harnessed and strengthened through community mobilisation approaches, has thepotential to improve neonatal and infant health and reduce mortality

Prevalence and associated factors of physical fighting among school-going adolescents in Namibia

<p>Abstract</p> <p>Background</p> <p>Interpersonal physical violence is an important global public health concern that has received limited attention in the developing world. There is in particular a paucity of data regarding physical violence and its socio-demographic correlates among in-school adolescents in Namibia.</p> <p>Methods</p> <p>We analysed cross-sectional data from the Namibia Global School-Based Health Survey (GSHS) conducted in 2004. We aimed to estimate the prevalence and socio-demographic correlates of physical fighting within the last 12 months. We obtained frequencies of socio-demographic attributes. We also assessed the association between self-reported history of having engaging in a physical fight and a selected list of independent variables using logistic regression analysis.</p> <p>Results</p> <p>Of the 6283 respondents, 50.6% (55.2% males and 46.2% females) reported having been in a physical fight in the past 12 months. Males were more likely to have been in a physical fight than females (OR = 1.71, 95% CI (1.44, 2.05)). Smoking, drinking alcohol, using drugs and bullying victimization were positively associated with fighting (OR = 1.91, 95% CI (1.49, 2.45); OR = 1.48, 95% CI (1.21, 1.81); OR = 1.55, 95% CI (1.22, 1.81); and OR = 3.12, 95% CI (2.62, 3.72), respectively). Parental supervision was negatively associated with physical fighting (OR = 0.82, 95% CI (0.69, 0.98)). Both male and female substance users (cigarette smoking, alcohol and drug use) were more likely to engage in physical fighting than non-substance users (OR = 3.53, 95% CI (2.60, 4.81) for males and OR = 11.01, 95% CI (7.25, 16.73) for females). Parental supervision was negatively associated with physical fighting (OR = 0.85, 95% CI (0.72, 0.99)).</p> <p>Conclusion</p> <p>Prevalence of physical fighting within the last 12 months was comparable to estimates obtained in European countries. We also found clustering of problem behaviours or experiences among adolescents who reported having engaged in physical violence in the past 12 months. There is a need to bring adolescent violent behaviour to the fore of the public health agenda in Namibia.</p

Modelling the effect of malaria endemicity on spatial variations in childhood fever, diarrhoea and pneumonia in Malawi

BACKGROUND: Co-morbidity with conditions such as fever, diarrhoea and pneumonia is a common phenomenon in tropical Africa. However, little is known about geographical overlaps in these illnesses. Spatial modelling may improve our understanding of the epidemiology of the diseases for efficient and cost-effective control. METHODS: This study assessed subdistrict-specific spatial associations of the three conditions (fever, diarrhoea and pneumonia) in relation to malaria endemicity. We used data from the 2000 Malawi demographic and health survey which captured the history of childhood morbidities 2 weeks prior to the survey date. The disease status of each child in each area was the outcome of interest and was modelled using a trivariate logistic regression model, and incorporated random effects to measure spatial correlation. RESULTS: The risk of fever was positively associated with high and medium malaria endemicity levels relative to low endemicity level, while for diarrhoea and pneumonia we observed marginal positive association at high endemicity level relative to low endemicity level, controlling for confounding covariates and heterogeneity. A positive spatial correlation was found between fever and diarrhoea (r = 0.29); while weak associations were estimated between fever and pneumonia (r = 0.01); and between diarrhoea and pneumonia (r = 0.05). The proportion of structured spatial variation compared to unstructured variation was 0.67 (95% credible interval (CI): 0.31-0.91) for fever, 0.67 (95 % CI: 0.27-0.93) for diarrhoea, and 0.87 (95% CI: 0.62-0.96) for pneumonia. CONCLUSION: The analysis suggests some similarities in subdistrict-specific spatial variation of childhood morbidities of fever, diarrhoea and pneumonia, and might be a result of shared and overlapping risk factors, one of which is malaria endemicity

The Impact of Bacillus Thuringiensis Israelensis (Bti) on Adult and Larvae Black Fly Populations

In the year 2007, the Ministry of Health (MoH) initiated a larviciding program using Bacillus thuringiensis israelensis (Bti) to mitigate the effects of black fly bites. This study was aimed at assessing the impact of Bti on adult and larvae black fly populations. Baseline data was collected prior to Bti application and after application Larva monitoring was done using four different substrates: nylon strips, rocks, and debri. Adult monitoring was carried out by human landing catches. Data analysis included descriptive summaries, t-tests, regression and Analysis of Variance (ANOVA). The analysis also included the assessment of the effect of Bti on adult flies and Larva density on substrates. All the statistical analysis were done at 5% significance level. The results showed statistically significant differences (p &lt;0.001) in populations of black fly before and after Bti application. Larva density was higher before Bti application and adult numbers were also high in that period. After Bti application a decrease in larva density was recorded and this associated with a gradual decrease in adult numbers. Bti had an impact on the larval population in that a decrease in larva population due to larviciding resulted in the decrease of adult population

MaiMwana women’s groups: a community mobilisation intervention to improve mother and child health and reduce mortality in rural Malawi

This article presents a detailed description of a community mobilization intervention involving women’s groups in Mchinji District, Malawi. The intervention was implemented between 2005 and 2010.The intervention aims to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it comprises trained local female facilitators establishing groups and using a manual, participatory rural appraisal tools and picture cards to guide them through a community action cycle to identify and implement solutions to mother and child health problems. Significant resource inputs include salaries for facilitators and supervisors, and training, equipment and materials to support their work with groups.It is hypothesized that the groups will catalyse community collective action to address mother and child health issues and improve the health and reduce the mortality of mothers and children. Their impact, implementation and cost-effectiveness have been rigorously evaluated through a randomizedcontrolled trial design. The results of these evaluations will be reported in 2011

Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi

The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi.The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator.It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012

Wild and indigenous foods (wif) and urban food security in northern Namibia

Rapid urbanisation and food system transformation in Africa have been accompanied by growing food insecurity, reduced dietary diversity, and an epidemic of non-communicable disease. While the contribution of wild and indigenous foods (WIF) to the quality of rural household diets has been the subject of longstanding attention, research on their consumption and role among urban households is more recent. This paper provides a case study of the consumption of WIF in the urban corridor of northern Namibia with close ties to the surrounding rural agricultural areas. The research methodology involved a representative household food security sur vey of 851 urban households using tablets and ODK Collect. The key methods for data analysis included descriptive statistics and ordinal logistic regression. The main findings of the analysis included the fact that WIFs are consumed by most households, but with markedly different frequencies. Frequent consumers of WIF are most likely to be female-centred households, in the lowest income quintiles, and with the highest lived poverty. Frequent consumption is not related to food security, but is higher in households with low dietary diversity. Infrequent or occasional consumers tend to be higher-income households with low lived poverty and higher levels of food security. We conclude that frequent consumers use WIF to diversify their diets and that occasional consumers eat WIF more for reasons of cultural preference and taste than necessity. Recommendations for future research include the nature of the supply chains that bring WIF to urban consumers, intra-household consumption of WIF, and in-depth interviews about the reasons for household consumption of WIF and preferences for certain types of wild food

Association of CD4 Cell Depletion and Elevated Blood and Seminal Plasma Human Immunodeficiency Virus Type 1 (HIV-1) RNA Concentrations with Genital Ulcer Disease in HIV-1-Infected Men in Malawi

CD4 cell counts and blood plasma and seminal plasma human immunodeficiency virus type 1 (HIV-1) concentrations were compared in HIV-1 RNA-seropositive men with urethritis and with or without genital ulcer disease (GUD). GUD was associated with lower CD4 cell counts (median, 258 vs. 348/μL) and increased blood plasma HIV-1 RNA (median, 240 × 103 vs. 79.4 × 103 copies/ mL). Men with nongonococcal urethritis and GUD shed significantly greater quantities of HIV-1 in semen (median, 195 × 103 vs. 4.0 × 103 copies/mL) than men with nongonococcal urethritis without GUD. These levels decreased ∽4-fold following antibiotic therapy. The results indicate an association between GUD and increased blood HIV-1 RNA levels. Increased HIV-1 in semen was demonstrated in some men with GUD; such an increase could lead to increased transmission, thus complicating interpretation of the role of the genital ulcer itself in the infectiousness of HIV. Reasons for increased HIV RNA in semen in men with GUD remain to be determine

An assessment of a light-attraction fishery in southern Lake Malawi

This study provides the first quantitative assessment of the light-attraction component of a small-scale purse seine, locally known as a chilimira net, fishery in two areas of southern Lake Malawi. For monitoring purposes the shoreline of Lake Malawi is divided into a number of statistical strata. Two strata (‘2.1’ in the southeast arm and ‘3.1’ in the southwest arm of the lake) were selected for this study. Catch per unit effort in stratum 2.1 was generally lower than that recorded in stratum 3.1 but nets in stratum 2.1 fished more frequently, leading to similar annual catches in the two strata. Annual catch was estimated as 19.4 (CI = 15.9–23.5) tons net–1 year–1 in stratum 2.1 and 23.5 (CI = 19.5–28.1) tons net–1 year–1 in stratum 3.1 respectively. A total of 62 species from 28 cichlid genera, and 13 species from nine non-cichlid genera, were identified from the samples. Of the 37 genera identified, only five; Copadichromis, Dimidiochromis, Engraulicypris, Oreochromis and Rhamphochromis, contributed more than 5% to the total annual catch in either stratum. Their combined contribution to the annual catch was in excess of 85% in both strata. Comparisons showed that catch-composition was dependent on area. Length-frequency distributions of major target species in the catch showed that the fishery targeted juveniles in stratum 2.1, while in stratum 3.1 most individuals were harvested after reaching their lengthat-maturity. The dependence of catch-composition and size-selection on area indicates that management interventions for this fishery need to be area-specific. Since the fishery targets a diverse species assemblage, effort limitation or area closure may be the only viable management options, until such time as additional biological and fisheries data are available for the application of stock assessment models

Social and demographic factors associated with morbidities in young children in Egypt: A Bayesian geo-additive semi-parametric multinomial model.

Globally, the burden of mortality in children, especially in poor developing countries, is alarming and has precipitated concern and calls for concerted efforts in combating such health problems. Examples of diseases that contribute to this burden of mortality include diarrhoea, cough, fever, and the overlap between these illnesses, causing childhood morbidity and mortality. Methods: To gain insight into these health issues, we employed the 2008 Demographic and Health Survey Data of Egypt, which recorded details from 10,872 children under five. This data focused on the demographic and socio-economic characteristics of household members. We applied a Bayesian multinomial model to assess the area-specific spatial effects and risk factors of co-morbidity of fever, diarrhoea and cough for children under the age of five. Results: The results showed that children under 20 months of age were more likely to have the three diseases (OR: 6.8; 95% CI: 4.6-10.2) than children between 20 and 40 months (OR: 2.14; 95% CI: 1.38-3.3). In multivariate Bayesian geo-additive models, the children of mothers who were over 20 years of age were more likely to have only cough (OR: 1.2; 95% 2 CI: 0.9-1.5) and only fever (OR: 1.2; 95% CI: 0.91-1.51) compared with their counterparts. Spatial results showed that the North-eastern region of Egypt has a higher incidence than most of other regions. Conclusions: This study showed geographic patterns of Egyptian governorates in the combined prevalence of morbidity among Egyptian children. It is obvious that the Nile Delta, Upper Egypt, and south-eastern Egypt have high rates of diseases and are more affected. Therefore, more attention is needed in these areas. Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist