Emotive responses to ethical challenges in caring:A Malawi perspective

AbstractThis article reports findings of a hermeneutic phenomenological study that explored the clinical learning experience for Malawian undergraduate student nurses. The study revealed issues that touch on both nursing education and practice, but the article mainly reports the practice issues. The findings reveal the emotions that healthcare workers in Malawi encounter as a consequence of practising in resource-poor settings. Furthermore, there is severe nursing shortage in most clinical settings in Malawi, and this adversely affects the performance of nurses because of the excess workload it imposes on them. The results of the study also illustrate loss of professional pride among some of the nurses, and the article argues that such a demeanour is a consequence of burnout. However, despite these problems, the study also reveals that there are some nurses who have maintained their passion to care

Effect of Cutting Stage and Turning Frequency on Nutritive Value and Digestibility of Two Tropical Forages

In Malawi, feed shortage during the dry season (June-October) is a critical factor affecting smallholder dairying. Though suitable improved forages were long introduced, important parameters that indicate forage and hay quality for dry season feeding have been less well studied. This study evaluated the effect of cutting stage and turning frequency at drying of two tropical forages on nutrient composition and digestibility. A 23 factorial experiment laid out in Randomized Complete Block Design was conducted in Mzuzu milk shed area. Centrosema pubescens and Chloris gayana were established on four plots (5m x 3m) each by 24 dairy farmers; two plots per forage species representing two cuts at 14 and 18 weeks. At harvest, biomass was partitioned and sun-dried as follows: first lot was turned once while the second lot was turned twice daily for four days. Forage hay samples were collected for nutrient composition analysis. All data were subjected to analysis of variance. The results showed that fibre components increased with stage of maturity while CP and digestibility declined but Centrosema pubescens retained quality attributes. There were no significant interactions between forage species, cutting stage and turning frequency. It is concluded that harvesting at 14 weeks produced hay with high nutritive value than at 18 weeks. Frequency of turning had no effect on nutritive value of the hay. It is recommended to promote cultivation of improved pastures for hay making to complement cut and carry system using natural pastures

Malawi's post-independence foreign policy and its influence on development options : a historical institutionalism analysis

Journal article published in The 5th Annual International Conference on Public Administration and Development Alternatives 07 - 09 October 2020, Virtual ConferenceThis paper analyses the causes, processes and systemic factors that have been central to Malawi's post-independence foreign policy and its implication on national development policy options. The paper argues that Malawi's post-independence foreign policy and development direction was mainly adopted in reaction to Kamuzu's failure to win the international support (at an OAU summit) for his quest to break Malawi's land locked status. From a historical institutionalist perspective, it can be argued that this rejection 'carved out' a future foreign policy direction that was deliberately meant to 'rebel' against OAU's prescriptions. Subsequent development policies were actually more of an aftermath of this 'curved out' foreign policy direction. In other words, foreign policy dictated the development policy options. The findings are drawn from available documentary sources (new and old) and review of existing literature. The paper is not bringing in new evidence but through a re-examination of the said existing evidence, in the context of historical institutionalism, the paper provokes and recasts a new and fascinating debate on Malawi's post-independence foreign policy architecture

Colostomy as a bridge to definitive pediatric surgical care: A sub-Saharan African experience

Available data, however, points to a wide variety of surgical conditions, with the majority falling into three major diagnostic categories, injuries, congenital anomalies, and surgical infections.1 In Africa, children constitute more than half the population.2 Despite high patient volume, very few dedicated pediatric surgeons are available, with only one pediatric surgeon to approximately two million children in Africa, compared with 1:100,000 in North America.3 Owing to this dearth of pediatric surgical workforce, surgical disease in children is not often managed, and if managed, is predominantly managed by a general surgeon who may lack familiarity with complex pediatric surgical procedures. There is little information in the literature regarding the clinical indications for pediatric patients receiving colostomies, complications associated with colostomies, and colostomy reversal rates in sub-Saharan Africa. [...]the aim of this study is to describe the characteristics and outcomes of patients receiving colostomies in a sub-Saharan African setting. [...]during our study period, there were only four patients who returned for reversal of their colostomy, with two colostomy takedowns and two pull-through procedures, with an average of 261.3 ± 288.1 days till reversal (range 36 to 654 days)

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Evaluating AI adoption in healthcare: Insights from the information governance professionals in the United Kingdom

BackgroundArtificial Intelligence (AI) is increasingly being integrated into healthcare to improve diagnostics, treatment planning, and operational efficiency. However, its adoption raises significant concerns related to data privacy, ethical integrity, and regulatory compliance. While much of the existing literature focuses on the clinical applications of AI, limited attention has been given to the perspectives of Information Governance (IG) professionals, who play a critical role in ensuring responsible and compliant AI implementation within healthcare systems.ObjectiveThis study aims to explore the perceptions of IG professionals in Kent, United Kingdom, on the use of AI in healthcare delivery and research, with a focus on data governance, ethical considerations, and regulatory implications.MethodsA qualitative exploratory design was employed. Six IG professionals from NHS trusts in Kent were purposively selected based on their roles in compliance, data governance, and policy enforcement. Semi-structured interviews were conducted and thematically analysed using NVivo software, guided by the Unified Theory of Acceptance and Use of Technology (UTAUT).ResultsThematic analysis revealed varying levels of AI knowledge among IG professionals. While participants acknowledged AI’s potential to improve efficiency, they raised concerns about data accuracy, algorithmic bias, cybersecurity risks, and unclear regulatory frameworks. Participants also highlighted the importance of ethical implementation and the need for national oversight.ConclusionAI offers promising opportunities in healthcare, but its adoption must be underpinned by robust governance structures. Enhancing AI literacy among IG teams and establishing clearer regulatory frameworks will be key to safe and ethical implementation