The double burden of human resource and HIV crises: a case study of Malawi

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. Nevertheless, there is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both: Lesotho, Zimbabwe, Zambia, Mozambique, the Central African Republic and Malawi

Neo?patrimonialism, Institutions and Economic Growth: The Case of Malawi, 1964–2009

For significant periods Malawi's economy has performed as well or better than might have been expected given its geographical location and natural resource endowments. Underlying these promising episodes is a pattern of centralised, long?horizon rent management and technocratic integrity. This case study of ‘developmental patrimonialism’ found that the period 1965–79 was one of centralised, long?horizon rent management and a vertically disciplined technocracy, and the economy grew healthily; 1980–94, by contrast, was a period in which rent management drifted. Although it remained quite centralised, it became geared more to the short term, while the civil service began to deteriorate as it was politicised. These resulted in a comparatively directionless reform programme. The situation deteriorated still further under President Bakili Muluzi (1994–2004). This was a period of decentralised, short?horizon rent management and a further deterioration of the state bureaucracy. The economy entered a tailspin. A recovery was made during the first term of President Bingu wa Mutharika (2004–09), who reintroduced some aspects of long?horizon rent centralisation and promoted a more vertically disciplined technocracy

Seed system security assessment: southern Malawi

A Seed System Security Assessment (SSSA) was carried out across Southern Malawi in October 2011. It reviewed the functioning of the seed systems farmers use, both formal and informal, and assessed whether farmers could access seed of adequate quantity and quality in the short and medium term. The work covered 3 Districts, Zomba, Balaka and Chikhwawa, which were chosen to include a range of agro­‐ecologies and possible seed security constraints. Field research encompassed: farmer interviews, seed/grain mar ket analysis, consultation with traders, focus group discussions (including discussions with women’s groups), and key -­‐ informant sessions. Background papers were also commissioned on: a) the formal breeding sector’s structures and processes; b) the formal seed sector and fertilizer structures and processes; and c) current decentralized seed multiplication and distribution initiatives

The Political Economy of Adaptation through Crop Diversification in Malawi

This article demonstrates the politics of the policy processes of adaptation using the case of crop diversification. Competing narratives among different actors illustrate the complexity of practically translating crop diversification in practice. The context in which policy processes take place matter a great deal since adaptation policies' chance of success cannot be judged abstractly in their theoretical or technical attributes without considering the institutional, political and cultural context in which they are applied. This draws attention to the fact that policy processes are less of a linear sequence but more of a political process, underpinned by a complex mesh of interactions and ramifications between a wide range of stakeholders who are driven and constrained by the competing interests and contexts in which they operate

Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

BACKGROUND: Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. METHODS: Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. RESULTS AND CONCLUSION: Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria transmission

Healthcare seeking practices and barriers to accessing under-five child health services in urban slums in Malawi: a qualitative study

BACKGROUND: Access to child health services is an important determinant of child health. Whereas, child health indicators are generally better in urban than rural areas, some population groups in urban areas, such as children residing in urban slums do not enjoy this urban health advantage. In the context of increasing urbanisation and urban poverty manifesting with proliferation of urban slums, the health of under-five children in slum areas remains a public health imperative in Malawi. This paper explores healthcare-seeking practices for common childhood illnesses focusing on use of biomedical health services and perceived barriers to accessing under-five child health services in urban slums of Lilongwe, Malawi’s capital city. METHODS: Qualitative data from 8 focus group discussions with caregivers and 11 in-depth interviews with key informants conducted from September 2012 to April 2013 were analysed using conventional content analysis. RESULTS: Whereas, caregivers sought care from biomedical health providers, late care-seeking also emerged as a major theme and phenomenon. Home management was actively undertaken for childhood illnesses. Various health system barriers: lack of medicines and supplies; long waiting times; late facility opening times; negative attitude of health workers; suboptimal examination of the sick child; long distance to health facility; and cost of healthcare were cited in this qualitative inquiry as critical health system factors affecting healthcare-seeking for child health services. CONCLUSIONS: Interventions to strengthen the health system’s responsiveness to expectations are essential to promote utilisation of child health services among urban slum populations, and ultimately improve child health and survival. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1678-x) contains supplementary material, which is available to authorized users

Supporting Children with Disabilities in Low- and Middle- Income Countries: Promoting Inclusive Practice within Community-Based Childcare Centres in Malawi through a Bioecological Systems Perspective

RLOsGiven the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer ‘caregiver’ in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.ESRC-DFI

Tenure insecurity and investment in soil conservation: evidence from Malawi

Tenure insecurity can have important consequences for the conservation of natural resources. This paper focuses on two main sources of tenure insecurity, informal short-term tenancy contracts, and customary gender-biased inheritance practices. Using a large plot-level dataset from Malawi, the analysis employs a linear probability model with household fixed effects and finds that both sources of insecurity have a negative effect on soil conservation investments. These findings suggest that future land reforms should deal with the informality of the land rental market and address the gap between users and owners of land created by existing customary practices

Marked Reduction in Prevalence of Malaria Parasitemia and Anemia in HIV-Infected Pregnant Women Taking Cotrimoxazole With Or Without Sulfadoxine-Pyrimethamine Intermittent Preventive Therapy during Pregnancy in Malawi

Background. Effectiveness of cotrimoxazole (CTX) compared with sulfadoxine-pyrimethamine (SP) intermittent-preventive-therapy (IPTp) for malaria in HIV-infected pregnant women is unknown. We examined effectiveness of CTX with or without SP-IPTp versus SP-IPTp at reducing malaria parasitemia and anemia