Inactivation of pathogens in ecological sanitation latrines in Malawi: An observational follow up study

IntroductionIn Malawi, EcoSan sludge from ecological sanitation (EcoSan) latrines has been found to contain helminths, Salmonella and E. coli above WHO recommended levels making sludge unsuitable for direct handling and use on food crops. This research investigated survival of pathogens in EcoSan sludge with time after sealing the pit.MethodAn observational longitudinal follow-up study was conducted where EcoSan latrines were followed from August 2015 to July 2016 in Blantyre and Chikwawa in Southern Malawi. The study enrolled 51 latrines in total with 35 latrines [13 fossa alterna (FAs) and 22 urine diverting dry latrines (UDDLs)] remaining at the end of study. Samples were collected five times from each latrine and examined for helminths, Salmonella and E. coli in the laboratory. Poisson regression was employed to assess factors that significantly contribute to pathogen die off at p<0.05.ResultsAverage concentrations of all pathogens investigated reduced over 12-month follow-up period except for Salmonella which increased. A. lumbricoides, increased to 2.3 viable eggs during the second sampling and decreased to 0.4 viable eggs per gram after 12 months of follow-up. Time was the only consistent predictor for concentration of helminths. Type of latrine and location were not significant predictors of helminths concentration (p>0.05). However, Salmonella and E. coli colonies were significantly higher in UDDLs (Blantyre) than FAs (Chikwawa) (p<0.05).ConclusionPathogen concentration was highest after recommended six months of storage posing a public health risk to those handling and using it for agriculture purposes. It is therefore recommended that the current guidelines be reviewed to suit Malawi context. A storage period of one year or more is recommended.

Challenges to Hygiene Improvement in Developing Countries

Hygiene is defined as conditions or practices conducive to maintaining health and preventing disease. Hygiene has been shown to reduce diarrheal diseases and assist to improve social outcomes in the community. Improving hygiene faces several problems especially in countries with low income per capita of population. Currently, many developing countries already struggle to cope with consistent water shortages and rapid urbanization causing more pressure to limited resources which in turn result in poor hygienic practices in the communities. The common types of hygiene include personal hygiene, water hygiene, food hygiene, and hygiene during waste handling. Different nongovernmental and governmental organizations face different challenges in achieving high levels of hygiene in communities. Some of these challenges include poverty, lack of political commitment, lack of full community participation, inadequate gender inclusion, inadequate data, lack of coordination among actors, and behavioral issues. To reduce these challenges, several measures have been proposed including community empowerment, pushing for equitable access to hygiene needs, advocating for political commitment, promoting gender equity, and enhancing youth involvement

Challenges in implementation of a combined WASH and food hygiene intervention to reduce diarrhoeal diseases in children under age of five years

Recently published results of rigorously designed and evaluated WASH studies have shown minimal impacts on primary health outcomes, e.g. diarrheal disease. Reasons and speculation for these findings have been reported including the possible impacts of collective efficacy, social capital and the limitations of reporting systems. Within this context, this poster outlines the methods used in an ongoing integrated WASH and food hygiene intervention study being conducted in Southern Malawi. This cluster randomized before and after trial with a control is being supported by the Sanitation and Hygiene Applied Research for Equity (SHARE) Consortium, and aims to determine the relative impact of a combined WASH and food hygiene study with a food hygiene study alone on diarrheal disease in the rural district of Chikwawa

Malawi Policy and Research Lanscaping and Stakeholder Analysis for Wash Sector

Malawi has an estimated population of about 15 million, 85% of whom reside in rural areas. High population growth rates, coupled with high rates of migration to urban areas, have placed pressure on the demand for safe water and improved sanitation services

Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi

This research was conducted by the Scotland Chikwawa Health Initiative. We would like to thank Sothin Ziba and Rossanie Daudi for their contribution to the facilitation of the focus group discussions. This study was funded by the Scottish Government grant MW22.Peer reviewedPublisher PD

Is manure from ecological sanitation latrines safe for use to fertilize crops? A review of evidence from literature

Studies have shown that manure harvested in ecological sanitation (ecosan) latrines has more thermo tolerant bacteria and helminthic eggs than the World Health Organisation (WHO) recommendation. The review was aimed at assessing adequacy of available guidelines on use of ecosan to produce safe manure. Relevant literature was searched and critically reviewed. Literature on effect on pathogen die off was not consistent from one study to the next and in some situations conflicting results have been found. Guidelines on waiting period after pit is sealed differed from one country to the next and there is an agreement that six months waiting period is not enough to produce safe manure. There is need for further research in real latrine situation to investigate all potential factors that affect pathogen die off. These may assist to explain inconsistencies in literature on pathogen die off and assist to develop specific guidelines for different locations

Assessment of implementation of the health management information system at the district level in southern Malawi

Background Despite Malawi’s introduction of a health management information system (HMIS) in 1999, the country’s health sector still lacks accurate, reliable, complete, consistent and timely health data to inform effective planning and resource management.Methods A cross-sectional survey was conducted wherein qualitative and quantitative data were collected through in-depth interviews, document review, and focus group discussions. Study participants comprised 10 HMIS officers and 10 district health managers from 10 districts in the Southern Region of Malawi. The study was conducted from March to April 2012. Quantitative data were analysed using Microsoft Excel and qualitative data were summarised and analysed using thematic analysis.Results The study established that, based on the Ministry of Health’s minimum requirements, 1 out of 10 HMIS officers was qualified for the post. The HMIS officers stated that HMIS data collectors from the district hospital, health facilities, and the community included medical assistants, nurse–midwives, statistical clerks, and health surveillance assistants. Challenges with the system included inadequate resources, knowledge gaps, inadequacy of staff, and lack of training and refresher courses, which collectively contribute to unreliable information and therefore poorly informed decision-making, according to the respondents. The HMIS officers further commented that missing values arose from incomplete registers and data gaps. Furthermore, improper comprehension of some terms by health surveillance assistants (HSAs) and statistical clerks led to incorrectly recorded data.Conclusions The inadequate qualifications among the diverse group of data collectors, along with the varying availability and utilisation different data collection tools, contributed to data inaccuracies. Nevertheless, HMIS was useful for the development of District Implementation Plans (DIPs) and planning for other projects. To reduce data inconsistencies, HMIS indicators should be revised and data collection tools should be harmonised

Social outcomes of a community-based water, sanitation and hygiene intervention

Social benefits of water, sanitation and hygiene (WASH) interventions are less documented compared to health benefits such as the reduction of diarrheal diseases. Although most decisions in WASH investments are based on potential health outcomes, interventions may also lead to social benefits, such as income generation, increased school enrollment, improved levels of dignity, self-esteem and civic pride, which can have a significant value both personally and to the wider community. This qualitative case study was used to assess the perceived social outcomes of purposively selected stakeholders from a WASH intervention study in Malawi. In-depth Interviews (n = 10), focus group discussions (n = 4) and key informants interviews (n = 10) were conducted with caregivers (male and female), community leaders, traditional leaders and community coordinators. Thematic analysis identified eight social outcomes: formation and strengthening of relationships (n = 32), becoming role models to community members (n = 23), women empowerment (n = 20), time-saving (n = 17), change of status (n = 12), receiving awards (n = 12), reduced medical costs (n = 11) and obtaining new skills (n = 7). Social capital among caregivers was also found to be high. No negative outcomes from the intervention were reported. WASH interventions have multiple, important, but difficult to quantify social benefits which should be measured, reported and considered in WASH investment decision-making

Challenges facing young African scientists in their research careers: A qualitative exploratory study

Background: Africa accounts for 14% of world’s population, and the economies of most African countries are considered to be growing, but this is not reflected in the amount of research published by Africans. This study aimed at identifying the challenges that young African scientists face in their career development.Methods: This was a qualitative exploratory study involving young researchers who attended the Teaching and Research in Natural Sciences for Development (TReND) in Africa scientific writing and communication workshop, which was held in Malawi in September 2015. A semi-structured questionnaire was sent to all workshop participants who consented to taking part in the survey. In total, 28 questionnaires were sent via email and 15 were returned, representing a response rate of 53.6%. Data were analysed using thematic analysis.Results: Young Africans develop their research interests various ways. The most common career-promoting factors identified by the study participants included formal classroom learning, aspirations to attain academic qualifications, work satisfaction, and the desire to fulfill parents’ dreams. Challenges cited by survey respondents included a lack of mentorship, funds, and research and writing skills. Lack of interest in research by policymakers, lack of motivation by peers, and heavy workload (leaving little time for research) were also reported as challenges. Respondents suggested that grants specifically targeting young scientists would be beneficial. Participants also urged for the establishment of mentorship programmes, increasing motivation for research, and more frequent training opportunities.Conclusions: There is need for improved funding for institutional and research network strengthening in Africa, with particular attention given to expanding opportunities for young researchers

Risk factors associated with feeding children under 2 years in rural Malawi – a formative study

Diarrhoeal disease remains one of the leading causes of morbidity and mortality in the under-five population, particularly in low income settings such as sub-Saharan Africa. Despite significant progress in sanitation and water access, faecal-oral infections persist in these populations. Therefore, a better understanding of these transmission pathways, and how potential risk factors can be reduced within low income contexts is needed. This study, conducted in Southern Malawi from June to October 2017, used a mixed methods approach to collect data from household surveys (n = 323), checklists (n = 31), structured observations (n = 80), and microbiological food samples (n = 20). Results showed that food prepared for immediate consumption (primarily porridge for children) posed a low health risk. Poor hygiene practices increased the risk of contamination from shared family meals. Faecal and nosocomial bacteria were associated with poor hand hygiene and unhygienic eating conditions. Leftover food storage and inadequate pre-consumption heating increased the risk of contamination. Improvements in food hygiene and hand hygiene practices at critical points could reduce the risk of diarrhoeal disease for children under 2 years but must consider the contextual structural barriers to improved practice like access to handwashing facilities, soap, food and water storage