Explaining high transport costs within Malawi - bad roads or lack of trucking competition ?

What are the main determinants of transport costs: network access or competition among transport providers? The focus in the transport sector has often been on improving the coverage of"hard"infrastructure, whereas in reality the cost of transporting goods is quite sensitive to the extent of competition among transport providers and scale economies in the freight transport industry, creating monopolistic behavior and circular causation between lower transport costs and greater trade and traffic. This paper contributes to the discussion on transport costs in Malawi, providing fresh empirical evidence based on a specially commissioned survey of transport providers and spatial analysis of the country’s infrastructure network. The main finding is that both infrastructure quality and market structure of the trucking industry are important contributors to regional differences in transport costs. The quality of the trunk road network is not a major constraint but differences in the quality of feeder roads connecting villages to the main road network have significant bearing on transport costs. And costs due to poor feeder roads are exacerbated by low volumes of trade between rural locations and market centers. With empty backhauls and journeys covering small distances, only a few transport service providers enter the market, charging disproportionately high prices to cover fixed costs and maximize markups.Transport Economics Policy&Planning,Rural Roads&Transport,Roads&Highways,Banks&Banking Reform,Rural Transport

Antibiotic Resistance in Oral Streptococci: The prevalence, diversity, stability, and fitness cost of Tn916 -Tn1545 family in oral streptococcal isolates

Oral streptococci are important members of the oral microbiome that are gathering more attention due to the presence of antimicrobial resistance determinants and their association with mobile genetic elements. Mobile genetic elements such as the ICE, Tn916 are abundant in bacterial populations and have been implicated in the spread of antibiotic resistance. Despite their abundance, little is known regarding the presence, diversity, and evolutionary dynamics of these ICEs in oral streptococci. The work presented in this thesis addresses the prevalence, diversity, stability, and fitness cost of the Tn916 family in oral streptococcal isolates. We report that the wild-type Tn916 is the most prevalent member of this family detected was wild-type Tn916. In terms of diversity, we detected two additional members of this family of ICEs, besides Tn916, namely Tn6815 and Tn6816. As the conjugative transfer of these Tn916-Tn1545 family elements was high, we assessed the effect these elements have on the new host (Streptococcus oralis) in the absence of selective pressure. We, therefore, determined the relative fitness cost associated with the acquisition of these elements and their stability in the absence of selective pressure. The findings of this work showed that upon acquisition Tn916, imposes a reduction in relative fitness ranging from 6% to 25% at time zero (T0). Amelioration of the observed fitness cost was observed within 500 generations, and the ICEs were stable in the absence of selection for up to 1000 generations. Analysis of the number of copies of Tn916 in the transconjugants with both digital droplet PCR (ddPCR) copy number analysis and whole genome sequencing (WGS) indicated no changes in the copy number, elements sequence and insertion sites in the evolution experiment. Taken together, the findings of this work reaffirm the role that Tn916 elements play in the spread of antibiotic resistance among oral streptococci

The Impact of Structural Adjustment Policies (SAPs) on Manufacturing Growth in Malawi

Malawi has been implementing structural adjustment reforms since 1981 in search of a way to revive its declining economic growth triggered by the oil shocks and general world economic recession of the mid and late 1970’s. These structural reforms were meant to liberalise the economy, broaden and diversify the production base towards non-primary products and allocate resources more productively. Since the theory of Structural Adjustment Programmes (SAPs) has industrial growth, manufacturing in particular, at the centre of its argument for reviving economic growth, this paper primarily aims at establishing whether or not the claim that structural adjustments lead to manufacturing growth has been applicable to Malawi. By comparing the before (1960-1980) and after SAP (1981-1998) manufacturing industry’s growth levels, this study has found out that SAPs have assisted in improving manufacturing growth in Malawi though dismally. This dismal performance is evidenced by manufacturing growth volatilities and low average annual growth rates of 2.8% during the SAP implementation period compared to an average of 1.9% per annum before SAPs. However, despite this dismal growth of the manufacturing sector, there has been a production shift in the economy though not much from agriculture to industry as was the thrust of the structural adjustment. The manufacturing sector’s share of GDP has been rising over the SAP implementation period while that of agriculture especially the agricultural tradable sector has been declining giving hope for a structural move towards industry. This is evidenced by increased share of manufacturing in GDP from 16% before SAPs to 23% in the SAP period while decreasing the share of agriculture from 46% to 41% during similar periods. Despite this economy shift towards the industrial sector, however, GDP growth has been both volatile and declining averaging only 2.5% per annum during the entire SAP implementation period unlike the vibrant 6% per annum before SAPs. This only shows how much little effect the SAPs have had in reversing the declining economic growth trend of the Malawi economy with much of the growth still largely dependent on the agricultural sector. Malawi has continued to produce more and more volumes of agricultural produce for exports and yet due to declining terms of trade, the export values have been very small to assist in bringing the economy back on track. The study further reveals that despite the SAPs having assisted in improving manufacturing growth in Malawi, the sector’s growth has been characterised with incessant volatilities especially in the later part of the 1990’s when Malawi’s traditional donors were withholding economic reform funds due to the government’s failure to meet key economic stabilisation targets of low inflation, low interest rates and prudential spending. Malawi, being an agrarian economy dependent on external factors like climatic changes and international terms of trade, already faces volatilities in the availability of foreign exchange at various times of the year. This has in turn led to volatilities in the exchange rates, inflation levels, interest rates and GDP growth rates making sustainable manufacturing industry growth difficult. The study then, amongst others, recommends that Malawi needs to continue to fully implement economic reforms that are aimed at macroeconomic stability and promotion of industrial sector such as the formulation of an industrial policy separate from the Trade policy which can help to shape the course and pace of industrialisation in Malawi. Further, in order to draw meaningful government interventions and sound implementation of SAPs, it is important to conduct a micro-level study on manufacturing firms so as to find out how SAPs have so far impacted on manufacturing firm’s technical efficiency, capacity utilisation, allocative efficiency, market attaining distributive efficiency, and labour efficiency. Such a study would help in identifying if SAPs have been on the right track in helping to achieve their other main purpose of economic efficiency in the manufacturing sector.Manufacuring, growth, SAPs, economic reforms, malawi

Factors Influencing Extension Workers’ Behavioural Intentions Towards Digital Farm Technologies in Malawi

Information and Communication and digital farm technologies are vital in improving agriculture produc-tion. Despite introducing digital farm technologies in Malawi, the country continues to have low agriculture production. The country has a low uptake of technology, which is a major driving factor of agriculture productivity. Therefore, this research aims to examine factors that influence the behavioural intention of extension workers towards using digital farm technologies to improve agriculture production. The research covers 14 districts of Malawi, where the digital farm technology, National Agriculture Management Infor-mation System (NAMIS), is currently operational. Centring on the Theory of Planned Behaviour and the quantitative study approach showed that perceived behaviour control and subjective norms influence be-haviour intention. At the same time, attitude is not a significant determinant of behaviour intention of using digital farm technologies

Determinants of vaccination coverage in Malawi: Evidence from the demographic and health surveys

The purpose of this paper is to identify groups of children in Malawi who are less or not reached by vaccination services by using data from the Demographic and Health Surveys conducted in Malawi in 1992, 1996, 2000 and 2004. These surveys have shown that the proportion of children aged 12- 23 months who were fully vaccinated by 12 months of age has been decreasing: it was 67% in 1992, then 55%, 54% and 51% in 1996, 2000 and 2004, respectively. The review has also shown that birth order of the child, residence (rural/ urban) and mother's education are major determinants of the immunization status of the child. Malawi Medical Journal Biology Vol. 19 (2) 2007: pp. 79-8

A comparative study of sclerotherapy with phenol versus surgical treatment for hydrocoele

Background: A comparision for the effectiveness, side effects and outcome of sclerotherapy using phenol and surgical treatment for hydrocoele was done at UTH in Lusaka, Zambia..Materials: A total of 80 patients were randomly divided into 2 groups of 40 hydrocoeles each. Group A underwent phenol sclerotherapy and Group B underwent hydrocelectomy.Results: In sclerotherapy group 47.5%, 32.5%, and 15% of the hydrocoele were cured with 1 to 3 injections, respectively, but 4% were not cured. There were no complaints of localized pain or infection in these cases. All patients returned to normal activities on the same day. In hydrocelectomy group, all the patients were cured. There was pain postoperatively in 73.5% of the patients and localized infection in 9%, while 65% required an average of 4 days of rest and were absent from work for 10 days.Conclusion: Sclerotherapy for hydrocoele using phenol is as efficient as hydrocelectomy for cure, has a low risk of complications and allows the patients to return to normal activity on the same day. Sclerotherapy is recommended as an option for treatment of hydrocoele

Patterns of Musculoskeletal Diseases seen in Zambian Children

Background: Musculoskeletal disorders are a common cause of long-term pain and physical disability affecting many people worldwide and have an enormous economic and social impact on the individual, society and national health systems. Although the burden of disease due to musculoskeletal disorders is said to be on the rise in the developing world, the full extent of this burden remains unknown.Objectives: To describe the patterns of musculoskeletal disorders seen in Zambian children aged below 15 years as baseline for future orthopaedic research, training and health management policy.Methods: Through a hospital-based cross-sectional study design, relevant data was collected onto an evaluation form from medical records of 1246 patients at the University Teaching Hospital (UTH), Zambian-Italian Orthopaedic Hospital (ZIOH) and the Flying-Specialist (FLYSPEC) nationwide orthopaedic outreach. The data was then entered into a spreadsheet and imported into SPSS for analysis.Results: Congenital abnormalities, other noncongenital deformities, and traumatic fracture dislocations were the commonest conditions affecting the 1246 sampled children with prevalence rates of 0.49, 0.22 and 0.14 respectively. Most patients presented late (more than 3months from the onset of their condition) with 509 (42.2%) having travelled for more than 10 kilometres to get to their treatment sites. 561 (45.4%) had been treated conservatively prior to their presentation to orthopaedics with another 471 (38.1%) having received no treatment at all.Conclusion: congenital abnormalities, noncongenital limb deformities and traumatic conditions were the commonest musculoskeletal disorders in that order. More males than females were afflicted though this distribution was different within the age ranges. Most of these patients presented late and distance to health facility was strongly correlated to late presentation. Furthermore, at first presentation these children receive little or no appropriate treatment from the first-line health workers at local health centres.Keywords: Musculoskeletal diseases, Children, Zambia

Prevalence of acute deep vein thrombosis according to HIV status following major orthopaedic surgery at the University Teaching Hospital, Lusaka, Zambia

Background: Hypercoagulable states and immobilization following lower limb, pelvic, and spinal surgery increases the risk of deep vein thrombosis (DVT). It is also suggested that HIV alone increases the risk of deep vein thrombosis. However no study has been done to determine the prevalence of deep vein thrombosis in HIV seropositive individuals who have undergone lower limb orthopaedic surgery in the Zambian context. We therefore conducted this study to determine the prevalence of deep vein thrombosis in patients who are HIV seropositive in comparison to those who are HIV seronegative after undergoing lower limb orthopaedic surgery. Methods: A total of 42 Patients were enrolled. Of these 23 (54 %) were HIV negative controls and 19 (46 %) were HIV positive patients who underwent lower limb surgery or spinal surgery. Demographic and HIV status data was collected prior to surgery. After surgery a blood sample was tested for fibrinogen degradation products (D-dimer) levels. The patients were then monitored for the development of clinical DVT and those that developed clinical DVT had an ultrasound to confirm the diagnosis. Results: The majority (81%) of the study population were under the age of 50 years. The mean values of D-dimers were 2.33 ± 1.65 μg/ml for the HIV negative group and 2.55 ±1.50 μg/ml for the HIV positive group. The number of positive D-dimer results was similar in the two groups, 94.7% for the HIV cohort and 95.7% in the negative group (X 2 0.19 p=0.89). There was a positive correlation between the D-dimer value and the type of surgery done in both the HIV positive group (R 0.390 p = 0.049) and the HIV negative group (R 0.398 at p = 0.03). In both group’s hip and knee surgeries gave higher values of D-dimers. There was no statistical difference in the occurrence of a positive D-dimer and CD4 count (X2 0.95 p=0.89). The combined prevalence of clinical DVT confirmed by compression ultrasonography in the entire study population was 4.8%. The prevalence in the HIV seropositive group and HIV seronegative groups were 5.3% and 4.3% respectively (X2 0.19 p= 0.89). None of the patients received preoperative DVT prophylaxis due to cost but both patients that developed DVT received antithrombotic treatment. Conclusions: There was no significant difference in the prevalence of DVT between patients who were HIV seronegative and seronegative following major lower limb and spinal orthopaedic surgery. Both groups had raised D-dimer values. Keywords: deep vein thrombosis; HIV; D-dimer; Doppler ultrasound