Community knowledge variation, bed-net coverage, the role of a district health care system and their implications for malaria control in Southern Malawi

This paper presents data on the pattern of knowledge of caregivers, bed-net coverage and the role of a rural district healthcare system, and their implications for malaria transmission, treatment, prevention and control in Chikhwawa, southern Malawi, using multi-level logistic regression modelling with Bayesian estimation. The majority of caregivers could identify the main symptoms of malaria, that the mosquito was the vector, and that insecticide-treated nets (ITN) could be used to cover beds as an effective preventative measure, although cost was a prohibitive factor. Use of bed nets displayed significant variation between communities. Groups that were more knowledgeable on malaria prevention and symptoms included young mothers, people who had attended school, wealthy individuals, those residing closest to government hospitals and health posts, and communities that had access to a health surveillance assistant (HSA). HSAs should be trained on malaria intervention programmes, and tasked with the responsibility of working with village health committees to develop community-based malaria intervention programmes. These programmes should include appropriate and affordable household improvement methods, identification of high-risk groups, distribution of ITNs and the incorporation of larval control measures, to reduce exposure to the vector and parasite. This would reduce the transmission and prevalence of malaria at community level

Scotland Chikwawa Health Initiative - improving health from community to hospital

The Scotland Chikwawa Health Initiative is a three year programme funded by the Scottish Executive International Development Fund which aims to achieve measurable reductions in major causes of disease and death in four villages within the Chikwawa District of Malawi alongside improving the hospital environment for the good of both staff and patients. The initiative has developed a holistic approach to health improvements through the provision of infrastructure at both health facilities and within communities, and training of government personnel and community volunteers. Specific areas targeted have included water and sanitation, maternal health, and communicable disease control with provision of training and materials to facilitate interventions and health education. At the end of the second year the programme has already seen reductions in diarrhoeal disease (30% overall in target communities), improved access to safe water, an increase in the uptake of growth monitoring and immunisations in children under the age of five years (15% increase since training volunteers), improved safe delivery of babies within the community (245 babies delivered safely in target communities with 25 referred due to complications) and increased community health activity (training and integration of village health committees, water point committees, traditional birthing attendants and health surveillance assistants). The programme hopes to act as a model for the District to follow in other communities to achieve it’s obligations under the Malawi Ministry of Health Essential Health Package

Barriers to maternal health service use in Chikhwawa, Southern Malawi

Introduction: Research was conducted to get a community’s perspective on the factors contributing to continued maternal and neonatal deaths. The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization.Methods: Qualitative data was obtained through focus group discussions with community leaders, women, men and youth in the catchment areas of three remote health centres. A total of fourteen focus groups were held: three each with community leaders, men, women, boys and two with girls.Data was transcribed and analyzed manually through the use of thematic analysis.Results: The discussions revealed the following as barriers to maternal health service utilization: walking long distances to access health facilities, lack of midwives, lack of or insufficient items to be used during delivery, long stay and rude health personnel. Seeking help from Traditional Birth Attendants (TBAs) during delivery was a common option because TBAs are within reach, do not demand many items for delivery, and treat the women with respect.Conclusion: This study suggests some factors that are contributing to the high burden of maternal deaths in Malawi. Interventions should be developed and implemented to improve the barriers reported

Care-seeking for diarrhoea in Southern Malawi : attitudes, practices and implications for diarrhoea control

This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4% statistically higher than the national average at 17%. Using hierarchically built data from a survey of 1,403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS) last time a child in their family had diarrhoea . However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73%) mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC), distance to the nearest health facility, and maternal age . Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs) are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and proper coordination of delivery of resources and services; availability of adequate healthcare workers at all levels; affordability to accessibility of healthcare resources and services to all communities; acceptability and quality of care; intensification of health education messages on the use and management of ORS, and prompt and timely treatment of diarrhoeal illness

The pattern of variation between diarrhoea and malaria coexistence with corresponding risk factors in, Chikhwawa, Malawi : a bivariate multilevel analysis

Developing countries face a huge burden of infectious diseases, a number of which co-exist. This paper estimates the pattern and variation of malaria and diarrhea coexistence in Chikhwawa, a district in Southern Malawi using bivariate multilevel modelling with Bayesian estimation. A probit link was employed to examine hierarchically built data from a survey of individuals (n = 6,727) nested within households (n = 1,380) nested within communities (n = 33). Results show significant malaria [σ2ul = 0.901 (95% CI : 0.746,1.056) ] and diarrhea [σ2ul = 1.009  (95% CI : 0.860,1.158) ] variations with a strong correlation between them [ru(1,2) = 0.565 ] at household level. There are significant malaria [σ2v1 = 0.053 (95% CI : 0.018,0.088) ] and diarrhea [σ2v2 = 0.099 (95% CI : 0.030,0.168 ] variations at community level but with a small correlation [rv(1,2) = 0.124 ] between them. There is also significant correlation between malaria and diarrhea at individual level [re(1,2) 0.241]. These results suggest a close association between reported malaria-like illness and diarrheal illness especially at household and individual levels in Southern Malawi

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

Classification and quality of groundwater supplies in the Lower Shire Valley, Malawi – Part 2 : classification of borehole water supplies in Chikhwawa, Malawi

This paper compares data gathered from a study of the chemical and bacteriological quality of drinking-water from 28 rural borehole supplies in Chikhwawa, Malawi, with a tiered classification scheme (Class 0 being ideal through to Class III being unsuitable for drinking without prior treatment) developed by investigators from the Institute for Water Quality Studies, Department of Water Affairs and Forestry, South Africa. In general, the majority of borehole water supplies were classified as Class 0 or Class I supplies based upon the chemical analysis and bacteriological examination. However the classification of a borehole water supply was variable and depended upon the parameter, date of sampling and whether or not it was based on the mean or individual concentration. A number of boreholes were classified as II or III as they contained elevated levels of fluoride and nitrate suggesting that consumption over short or prolonged periods of time may lead to adverse or serious health effects, such as skeletal fluorosis in adults and methaemoglobinaemia in infants. Research is required to develop practicable, affordable and sustainable methods to enable villagers to treat Class II/III water supplies and improve the quality of their drinking-water to a class suitable for human consumption

Serving up Data on Nutrient Composition of Aquatic Foods

The nutrient values of fish and other aquatic foods can alleviate ‘hidden hunger’ or micronutrient deficiencies for many people in a range of geographies. But nutrient measures for many species, food types and geographies are unavailable, and are prohibitively expensive to measure. So, databases that house the data that do exist are incredibly valuable for health practitioners, fisheries managers, researchers and policy makers. There are many databases out there - each useful, overlapping and distinct in different ways. Here is a summary of these powerful databases the types of data they hold and how they compare

Pattern of Maternal Knowledge and Its Implications for Diarrhoea Control in Southern Malawi: Multilevel Thresholds of Change Analysis

A survey was conducted in Southern Malawi to examine the pattern of mothers’ knowledge on diarrhoea. Diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average at 17%. Using hierarchically built data from a survey, a multilevel threshold of change analysis was used to determine predictors of knowledge about diarrhoeal aetiology, clinical features, and prevention. The results show a strong hierarchical structured pattern in overall maternal knowledge revealing differences between communities. Responsible mothers with primary or secondary school education were more likely to give more correct answers on diarrhoea knowledge than those without any formal education. Responsible mothers from communities without a health surveillance assistant were less likely to give more correct answers. The results show that differences in diarrhoeal knowledge do exist between communities and demonstrate that basic formal education is important in responsible mother’s understanding of diseases. The results also reveal the positive impact health surveillance assistants have in rural communities

Serving up Data on Nutrient Composition of Aquatic Foods

The nutrient values of fish and other aquatic foods can alleviate ‘hidden hunger’ or micronutrient deficiencies for many people in a range of geographies. But nutrient measures for many species, food types and geographies are unavailable, and are prohibitively expensive to measure. So, databases that house the data that do exist are incredibly valuable for health practitioners, fisheries managers, researchers and policy makers. There are many databases out there - each useful, overlapping and distinct in different ways. Here is a summary of these powerful databases the types of data they hold and how they compare