Socialisation of Malawian women and the negotiation of safe sex

In the past three decades, the HIV pandemic has struck sub-Saharan Africa and resulted in devastating consequences. Increasingly studies have shifted from applying a bio-medical approach to HIV to applying a social approach. This study focuses on applying a social approach. One of the major factors that contributes to the high HIV prevalence is women’s inferior social status. Women are unable to challenge their partners in situations of sexual intimacy and as such they are often at risk of contracting HIV. In Malawi, patriarchyis the dominant ideology structuring gender roles. These gender roles reinforce social hierarchies where women’s capacity to practice agency is significantly decreased. The domestic responsibilities female scholars carry often leads to their drop-out from school. Their lack of formal education, as a result, decreases their ability to pursue income generating activities. Furthermore their inability to acquire income increases their dependence on their partners. It is in part this dependence that perpetuates women’s vulnerability and ultimately increases their risk of contracting HIV. This study focused on how women are socialised to perform certain gendered roles and how this socialisation ultimately affects their capacity to negotiate safe sex.Various institutions and organisations have driven intervention programmes in communities in Malawi in order to address the issue of HIV/AIDS. This study looks at how socialisation of young women living in a peri-urban community in Malawi has changed and how this change has influenced their capacity to negotiate safe sex. The study found that although socialisation had changed and had some impact on increasing female scholars efficacy with regard to their education, they still remain constrained by their social status in a patriarchal context. Through the adapting of the curriculum, schools address issues of gender inequality and the changing roles of women. However, these institutions continue to remain male dominated. This poses an obstacle as they reinforce gender roles of subordinate women and in doing so diminish the impact of the new curriculum. Gender roles continue to make it difficult for women to practice agency in particular with regard to negotiating safe sex. In instances where women have suggested condom use, they have been subjected to domestic abuse or faced the withdrawal of financial support for a given period. This study proposes a continuum of agency ranging from submissive to autonomous. It suggests that women are never entirely submissive or autonomous. They either practice agency by manipulating their boundaries or pushing their boundaries. This study revealed that although there have been significant changes in the process of socialisation, women’s ability to practice agency is considerably limited. Where it is exercised, it often results in separating from their spouses. However, in spite of all the difficulties, women do practice agency on various levels. It also revealed that scholars are developing agency with regards to education. However, social structures continue to reinforce patriarchy. This creates contradictory messages which the scholars are not always able to negotiate.Dissertation (MSocSci)--University of Pretoria, 2013.Sociologyunrestricte

The role of the man is to look for food : lessons from men's involvement in maternal and child health programmes in rural Central Malawi

Many studies purport that in low-income countries, women are often responsible for producing, preparing and purchasing food. Consequently, policies related to food and nutrition overemphasise the role of women, underestimating the potential for cooperation and complementarity between men and women. This focus on women does not account for socially constructed expectations of women that undermine their decision-making in resource allocation. Using desk reviews, in-depth interviews and focus group discussions, our case study in Malawi sought to understand the complementary role of men in maternal and child nutrition. International agreements and Malawi’s policies were reviewed to understand how men’s involvement emerged on the nutrition policy agenda. Policymakers, stakeholders and men and women from rural Central Malawi were interviewed, sharing their experiences of men’s role in maternal and child health. The study found that men’s involvement in maternal and child health has been on the development agenda since as early as 1995. Malawi has made efforts to involve men in these areas through several policy actions and programmes. Contrary to literature suggesting that women are the main producers, procurers and preparers of food, this study found that men in rural Central Malawi are increasingly becoming responsible for providing and purchasing food. Men also play a supportive role in food preparation, helping women access diverse diets during and after pregnancy. They also take up a supportive role in household activities, providing women with assistance in housework and looking after children. The positive change in men’s roles presents an opportunity for exploring how men can contribute to food security and nutrition. Opportunities exist for designing inclusive food and agriculture policies that promote cooperation between men and women in food and nutrition. These policies can challenge misinterpretations of women’s role in food security and the underlying systems that reinforce gender inequalities.S1 File. Semi-structured interview guide.S2 File. Mndandanda wofunsira mafunso ochepa.Feed the Future Innovation Lab for Food Security Policyhttp://www.plosone.orgpm2020Agricultural Economics, Extension and Rural Developmen

A qualitative assessment of gender roles in child nutrition in Central Malawi

This study was part of a baseline study conducted in 2017 as part of the CARE Southern Africa Nutrition Initiative (SANI), a project undertaken with the financial support of the Government of Canada through Global Affairs Canada.BACKGROUND : Child malnutrition persists globally with men and women playing distinct roles to support children’s nutrition. Women frequently carry the bulk of the workload related to food, care, and health, all of which are critical factors in child nutrition. For this reason, development efforts have emphasised women ignoring the potential role of men in supporting children’s nutrition. This study sought to understand the different roles that Malawian men and women play in children’s nutrition. METHODS : This qualitative was conducted in rural Central Malawi as part of a baseline study in 2017 for the CARE Southern Africa Nutrition Initiative. Seventy-six participants were interviewed, including 19 men and 57 women, using focus group discussions and in-depth interviews. We sought to understand the gender distribution of men’s and women’s roles and how these roles influence child nutrition. RESULTS : We found that both men and women were involved in productive, reproductive, and community work. However, consistent with the literature, women carried a disproportionate workload in supporting child nutrition compared to men. Women’s heavier workloads often prevented them from being able to meet children’s food needs. Nevertheless, shifts in gender roles were observed in some of the sampled communities, with men taking up responsibilities that have been typically associated with women. These changes in gender roles, however, did not necessarily increase women’s power within the household. CONCLUSIONS : Traditional gender roles remain prevalent in the sampled communities. Women continue to be primarily responsible for the food, care, and health of the household. Women’s heavy workloads prevent them from providing optimal care and nutrition for children. While efforts to advance gender equality by encouraging men to participate in child care and other household responsibilities appear to have had marginal success, the extent to which these efforts have successfully encouraged men to share power remains unclear. Improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power with women over household decision-making and control over income.CARE Malawi.http://www.biomedcentral.com/bmcpublichealtham2023Agricultural Economics, Extension and Rural Developmen

An analysis of reflections on researcher positionality

Reflexivity is a central tenet of qualitative research. Engaging in self-reflexive praxis allows researchers to identify areas of tension in the research process that need to be further deconstructed. In this paper, we draw on our collective self-reflective experiences as qualitative health researchers whose scholarship is informed by critical and postcolonial feminist epistemologies to offer some guidance on how to approach the concept of insider versus outsider in the research process. Specifically, we analyze recurring methodological tensions related to positionality and outline how they were addressed. The lessons learned from our studies can be instructive to other qualitative researchers.http://nsuworks.nova.edu/tqrpm2022Agricultural Economics, Extension and Rural Developmen

Enhancing the Glopan food systems framework by integrating gender : relevance for women in African agriculture

Globally, gender inequalities constrain food security, with women often disproportionately affected. Women play a fundamental role in household food and nutrition security. The multiple roles women play in various areas of the food system are not always recognised. This oversight emerges from an overemphasis on one aspect of the food system, without considering how this area might affect or be affected by another aspect. This study aimed to draw on international commitments and treaties using content analysis to enhance the Global Panel on Agriculture and Food Security food systems framework by integrating a gender perspective. The study found that generally, there is a consensus on specific actions that can be taken to advance gender equality at specific stages of the food system. However, governance and social systems constraints that are not necessarily part of the food system, but have a significant bearing on men and women’s capacity to effectively participate in the food system, need to be addressed. While the proposed conceptual framework has some limitations, it offers a foundation on which researchers, policymakers and other stakeholders can begin conceptualising the interconnectedness of gender barriers in the food system.https://www.mdpi.com/journal/sustainabilitydm2022Agricultural Economics, Extension and Rural DevelopmentCenter for the Advancement of Scholarshi

Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa.

BACKGROUND: Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The 'Introduction to Information and Communication Technology and eHealth' course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach. METHODS: Two questionnaires were developed and tested for face validity and reliability in a pilot course with 20 CHWs. Those were designed to measure CHWs' knowledge of and attitudes towards the use of ICT, before and after each course, as well as their satisfaction with each learning approach. Following validation, a randomised controlled trial was conducted to assess the effectiveness of the two learning approaches. A total of 40 CHWs were recruited, stratified by position, gender and computer experience, and allocated to the traditional or blended learning group using block randomisation. Participants completed the baseline and follow-up questionnaires before and after each course to assess the impact of each learning approach on their knowledge, attitudes, and satisfaction. Per-item, pre-post and between-group, mean differences for each approach were calculated using paired and unpaired t-tests, respectively. Per-item, between-group, satisfaction scores were compared using unpaired t-tests. RESULTS: Scores across all scales improved after attending the traditional and blended learning courses. Self-rated ICT knowledge was significantly improved in both groups with significant differences between groups in seven domains. However, actual ICT knowledge scores were similar across groups. There were no significant differences between groups in attitudinal gains. Satisfaction with the course was generally high in both groups. However, participants in the blended learning group found it more difficult to follow the content of the course. CONCLUSIONS: This study shows that there is no difference between blended and traditional learning in the acquisition of actual ICT knowledge among community healthcare workers in developing countries. Given the human resource constraints in remote resource-poor areas, the blended learning approach may present an advantageous alternative to traditional learning

The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi

Abstract Background Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART. Methods This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standard-of-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses. Discussion This is a robust evaluation of an innovative facility-based video intervention for pregnant women living with HIV, with the potential to improve maternal and infant outcomes. Trial registration ClinicalTrials.gov, NCT03654898. Registered on 31 August 2018

What are we measuring? Comparison of household food security indicators in the Eastern Cape Province, South Africa

The development of national food security information systems is constrained by a lack of guidance on which indicators to use. This paper compares food security indicators across two seasons (summer and winter) in one of the most deprived areas of the Eastern Cape province of South Africa. The results show that only anthropometric indicators are sensitive enough to differentiate levels of food insecurity. The lack of consistent classification across indicators means that surveys must use a combination of food consumption and experience of hunger measures backed up by anthropometric measures. Targeting interventions is difficult if the measures cannot be relied on. Further investigation is needed to identify a suite of appropriate indicators for a national information and surveillance system.South African Water Research Commission (WRC Project No. Project K5/2172/4), the South African National Research Foundation (Grant numbers CPR20110706000020, 77053 and 80529), the University of Pretoria’s Institutional Research Theme on Food, Nutrition and Well-being, and the University of Pretoria’s Post-Doctoral Fellowship Programme.http://www.tandfonline.com/loi/gefn202017-09-30hb2016Agricultural Economics, Extension and Rural Developmen

Costs of accessing HIV testing services among rural Malawi communities

ABSTRACTHIV testing is free in Malawi, but users may still incur costs that can deter or delay them accessing these services. We sought to identify and quantify these costs among HIV testing service clients in Malawi. We asked residents of communities participating in a cluster randomised trial investigating the impact of HIV self-testing about their past HIV testing experiences and the direct non-medical and indirect costs incurred to access HIV testing. We recruited 749 participants whose most recent HIV test was within the past 12 months. The mean total cost to access testing was US$2.45 (95$2.11–US$2.70). Men incurred higher costs (US$3.81; 95%CI: US$2.91–US$4.50) than women (US$1.83; 95$1.61–US$2.00). Results from a two-part multivariable regression analysis suggest that age, testing location, time taken to test, visiting a facility specifically for an HIV test and district of residence significantly affected the odds of incurring costs to testing. In addition, gender, wealth, age, education and district of residence were associated with significant user costs

Informing prevention of stillbirth and preterm birth in Malawi:development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration

OBJECTIVE: The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials. DESIGN: Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility. SETTING: Antenatal, maternity and specialist neonatal care in Malawi. RESULTS: The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes. CONCLUSIONS: Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research