A national approach to systematic transboundary aquifer assessment and conceptualisation at relevant scales : a Malawi case study

Study Focus: Integrated water resource management (IWRM) of transboundary aquifers (TBA’s) is becoming increasingly important. Without adequate and accurate scientific knowledge of their extent and characteristics, uninformed policy creation could lead to unsustainable management of these vital resources. This is particularly important within the Southern African Development Community (SADC) where up to 85% of domestic water is supplied by groundwater. In this paper, Malawi is used as a case study to critically evaluate the current transboundary aquifer assessment frameworks within the region and their value in promoting IWRM. A series of illustrative conceptual models of TBA interactions pertinent to the Malawian national border are presented and we consider how TBA assessments may be integrated to national IWRM and strategic policy development. New hydrological insights for the region: Current TBA assessments of Malawi and the wider SADC neglect multiple aspects needed for a national scale management plan. This includes full border TBA system identification alongside, given the geology of the region, consideration of the discontinuous nature of basement complex aquifers and localised alluvial deposits that both result in smaller scale aquifer units. Conceptualising such local scale complexity and encouraging countries to develop a strategy that systematically examines TBA systems along their national border at relevant scales will allow for more focused conjunctive policy creation and sustainable management of TBA’s

Making the case for improved planning, construction and testing of water supply infrastructure in Malawi

Detailed surveys of poorly functioning rural water supply points (boreholes fitted with handpumps) in the Southern Region of Malawi show that poor functionality is most commonly caused by a) poor water resource (quantity and quality) and b) sub-standard borehole construction. Only 24% of surveyed water points showed problems caused by poor handpump operation, maintenance and management. The majority of problems observed are caused by sub-standard construction of water points prior to commissioning for use, and are typically permanent and irremediable. These issues are contributing to excessive service delivery costs through a) extended down times, b) disproportionate maintenance requirements and c) abandoned infrastructure; the resulting burden precipitates the failure of community based management approaches. This burden could be dramatically reduced by ensuring water points are proven to comply with Malawian Government standards, prior to commissioning for use. Water points not meeting these standards must not be commissioned for use

Implementation of Antiretroviral Therapy for Life in Pregnant/Breastfeeding HIV+ Women (Option B+) Alongside Rollout and Changing Guidelines for ART Initiation in Rural Zimbabwe: The Lablite Project Experience.

BACKGROUND: Lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (Option B+) was rolled out in Zimbabwe from 2014, with simultaneous raising of the CD4 treatment threshold to 500 cells per cubic millimeter in nonpregnant/breastfeeding adults and children 5 years and over. METHODS: Lablite is an implementation project in Zimbabwe, Malawi, and Uganda evaluating ART rollout. Routine patient-level data were collected for 6 months before and 12 months after Option B+ rollout at a district hospital and 3 primary care facilities in Zimbabwe (2 with outreach ART and 1 with no ART provision before Option B+). RESULTS: Between September 2013 and February 2015, there were 1686 ART initiations in the 4 facilities: 91% adults and 9% children younger than 15 years. In the 3 facilities with established ART, initiations rose from 300 during 6 months before Option B+ to 869 (2.9-fold) and 463 (1.5-fold), respectively, 0-6 months and 6-12 months after Option B+. Post-Option B+, an estimated 43% of pregnant/breastfeeding women needed ART for their own health, based on World Health Organization stage 3/4 or CD4 ≤350 per cubic millimeter (64% for CD4 ≤500). Seventy-four men (22%) and 123 nonpregnant/breastfeeding women (34%) initiated ART with CD4 >350 after the CD4 threshold increase. Estimated 12-month retention on ART was 79% (69%-87%) in Option B+ women (significantly lower in younger women, P = 0.01) versus 93% (91%-95%) in other adults (difference P < 0.001). CONCLUSIONS: There were increased ART initiations in all patient groups after implementation of World Health Organization 2013 guidelines. Retention of Option B+ women was poorer than retention of other adults; younger women require attention because they are more likely to disengage from care

Scalable Transdiagnostic Early Assessment of Mental Health (STREAM): a study protocol

Introduction Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant ‘detection gap’ where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions. Methods and analysis The STREAM project will enrol and assess 4000 children aged 0–6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves. Ethics and dissemination Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research—Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health—Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences

Geogenic Fluoride Risk in Groundwater (Map)

Map, Geogenic Fluoride Risk in Groundwate

Direct inference and control of genetic population structure from RNA sequencing data

RNAseq data can be used to infer genetic variants, yet its use for estimating genetic population structure remains underexplored. Here, we construct a freely available computational tool (RGStraP) to estimate RNAseq-based genetic principal components (RG-PCs) and assess whether RG-PCs can be used to control for population structure in gene expression analyses. Using whole blood samples from understudied Nepalese populations and the Geuvadis study, we show that RG-PCs had comparable results to paired array-based genotypes, with high genotype concordance and high correlations of genetic principal components, capturing subpopulations within the dataset. In differential gene expression analysis, we found that inclusion of RG-PCs as covariates reduced test statistic inflation. Our paper demonstrates that genetic population structure can be directly inferred and controlled for using RNAseq data, thus facilitating improved retrospective and future analyses of transcriptomic data

Sedimentary Geology (Map)

Map, Sedimentary Geolog

The Aquifer Groups of Malawi (Map)

Map, The Aquifer Groups of Malaw

Three Aquifer Groups of Malawi (Map)

Map, Three Aquifer Groups of Malaw

Water Resource Areas and Water Resource Units of Malawi (Map)

Map, Water Resource Areas and Water Resource Units of Malaw