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

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

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

Healthy settings approach – is it the key to holistic community health and development?

Introduction Despite effective prevention measures existing for priority communicable and non-communicable diseases, rates of infection and incidence continue to be high. However, to achieve prevention, we must address barriers to effective prevention, such as the influence of cultural, economic, environmental and social factors, and the need for communities to take ownership of their development. The Scotland Chikwawa Health Initiative seeks to achieve this through a healthy settings approach. This pilot seeks to develop model villages using a process of community-led prioritisation and action planning. The process and outcomes of the priority setting are outlined here. Methodology The SCHI programme targets the Mfera Area of Chikwawa District (1800 households) and includes villages (n=18), schools (n=3), markets (n=2) and a healthy facility. The approach was community-led and used transect walks (n=18), and FGDs (n=108), to identify key priorities (self generated) and levels of satisfaction (basic and social needs) of community members (leadership, men, women, marginalized and youth). These were conducted over a six-month period and were consolidated into village profiles, which were then used to support the development of village action plans. Priority setting also considered issues of social capital, communication and effective leadership, and their impact on sustainable health improvements. Results Priority setting outcomes showed variation in the priorities and levels of satisfaction both between villages and communities therein. Consistent areas of satisfaction included religion and recreation, and the priorities of food security, water access and health access were universal. Levels of social capital varied widely between population groups, with youth showing the lowest sense of belonging, and a low level of trust between communities, villages and extension workers overall. Conclusions The development of the village profiles, community dialogue and feedback provided SCHI with a strong base from which to develop bespoke healthy settings approach

Care-seeking behaviour and implications for malaria control in Southern Malawi

Although malaria is a controllable and preventable disease, it remains among the leading causes of mortality and morbidity in southern Malawi. The importance of early diagnosis and prompt treatment with hospital prescribed drugs and effective home management to control malaria is well established; however, these in part depend on how households make their decisions when family members have suffered from malaria. This study examines the behaviour of households with regard to decisions they make in managing malaria illness. Using hierarchically built data from a survey of 1,400 mothers nested within 33 communities, a series of two-level logistic regression models with Bayesian estimation was used to determine predictors of care-seeking behaviour towards malaria when a family member or a child was perceived to have malaria. The results show that most families normally visit or use medication prescribed at health facilities for both adult (80%) and child (86%) members when they are perceived to have malaria. The main obstacle to accessing the nearest health facility was distance and transport costs (73%) and the main problems encountered at health facilities were long waiting time or absence of health workers (73%) and shortage of drugs (35%). Among the main predictor variables for choices of treatment for childhood malaria was the absence of a health surveillance assistant for those that visited hospitals [β=0.56; 95% CI:-0.86,-0.26]; bought medication from open markets [β=0.51; 95% CI:0.20,0.82]; and those that used other traditional methods or did nothing [β=0.70; 95% CI:-0.04,1.44; p=0.06].. The results have an important role to play in the control and prevention of malaria in Malawi. The results reveal the need for increased awareness about the dangers of purchasing drugs from non-medical and/or uncertified private institutions and sources such as those found in open markets. They also show the important role of community health workers in the delivery of health systems. The study recommends empowerment of community health workers through rigorous and relevant health promotion programmes to update both their knowledge and their skills in communication and counselling

Care-seeking behaviour with regard to attitude, practices, limitations and implications for diarrhoea control in the Southern Malawi.

This article discusses care-seeking behaviour with regard to attitude, practices, limitations and implications for diarrhoea control in the Southern Malawi

Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi

A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children's hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools

Classification and quality of groundwater supplies in the Lower Shire Valley, Malawi – Part 1 : physico-chemical quality of borehole water supplies in Chikhwawa, Malawi

This paper presents data on the physico-chemical quality of groundwater supplies in Chikhwawa, Malawi. Eighty-four water samples were collected and analysed for a range of chemical constituents (Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, Mg, Mn, Ni, Pb, Se, V, Zn, K, Na,Cl-, F-, NO3-, SO42-), pH, temperature, electrical conductivity and turbidity, from 28 boreholes located in 25 remote, rural villages (n=3 per village) distributed along the east (n=15) and west (n=10) banks of the Shire River. Samples were collected every 2 months during the wet season, over a period of 5 months (December to April). Results were compared with national (Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL)) and international (World Health Organization Guideline Values (WHO GV)) drinking-water standards. In general, most parameters complied with the Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL) for borehole water supplies. The MBS MPL standards for iron, sodium and nitrate were slightly exceed at a few boreholes, technically rendering the water supply unwholesome but not necessarily unfit for human consumption. In contrast, significantly high nitrate (< 200 mg/ℓ) and fluoride (< 5 mg/ℓ) concentrations at levels which constitute a significant risk to the health of the consumer were detected in borehole samples in a number of villages and warrant further investigation. Water committee members complained of problems associated with taste (saltiness or bitterness) and appearance (discoloured water) primarily on the west bank, presumably as a result of the high sodium and chloride levels, and precipitation of soluble iron and manganese, respectively. This resulted in some water collectors reverting to the use of surface water sources to obtain drinking-water, a practice which should be dissuaded through the education of water and village health committees