Personal View: How IMF’s loan freeze will affect health care in Malawi

No Abstrac

Serological survey of antibodies to Toxoplasma gondii

Toxoplasmosis is one of the most prevalent parasitic infections of man and livestock, and its transmission has usually been attributed to ingestion of undercooked or raw meat from infected livestock, with the infection rate in those animals being an important risk predictor of human disease, high in Iran and Ardabil State. During a study on this public health problem, we tested serum samples from cattle, goats, sheep and chicken from the State of Ardabil, Iran, for IgG antibodies to Toxoplasma gondii by enzyme-linked immunosorbent assay (ELISA). Antibodies to Toxoplasma gondii were found in 30% (60/200) of sheep, 15% (30/200) of goats and 9% (18/200) of cattle, and none were found in chicken sera. Despite the differences in feeding habits of each species, the rate of infection of the animals tested could be attributed to livestock management methods, whose improvement could reduce infection. African Journal of Health Sciences Vol. 13 (1-2) 2008: pp. 131-13

Shortage of health workers in the Malawian public health services system: how do parliamentarians perceive the problem?*

The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solution. In this paper, I present the finding from a qualitative study of Hansards (official verbatim record of parliamentary speeches) analysed by discourse analysis. Parliamentarians identified the shortage of health workers as resulting from death, retirement and brain drain to other countries mostly the UK, Saudi Arabia and South Africa. Training more health workers, training new but lower cadres of health workers not marketable to the outside world, improving the working conditions and remuneration of health workers are suggested as some of the solutions. Even without the brain drain of health workers to other countries, Malawi\'s health sector personnel numbers are not adequate to serve the needs of the country. Relying on training more health workers in the numbers normally produced from the prevailing training institutions is unlikely to remove the shortages. African Journal of Health Sciences Vol. 13 (1-2) 2008: pp. 124-13

Perceptions towards private medical practitioners\' attachments for undergraduate medical students in Malawi

Objective To describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors' offices. Method Qualitative cross sectional study conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis. Results In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. The lack of formal post-graduate qualifications by most private medical practitioners, and nationally-approved continued medical education programs were mentioned as reasons to suspect that private medical practitioners (PMPs) could be outdated in skills and knowledge. Private medical practitioners however reported participation in credible continued professional development (CPD) programs although these were not necessary for re-registration. Students and faculty suggested that the need for privacy in private institutions unlike in the public teaching hospitals as one reason why patients may not be willing to participate in the teaching in PMPs facilities. The fact that the patients profiles with regard to disease presentation (mostly ambulatory) and higher socio-economic status may be different from patients attending the public, free for service teaching hospital was not seen as a desirable attribute to allocate students to PMPs clinics. Conclusion Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students. Malawi Medical Journal Vol. 21 (1) 2009: pp. 6-1

Point of View: The importance of Leadership towards universal health coverage in Low Income Countries

Universal health coverage—defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection—was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries

How are health professionals earning their living in Malawi?

BACKGROUND: The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. METHODS: The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. RESULTS: Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. CONCLUSION: Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects

Prevalence and correlates of hunger among primary and secondary school children in Malawi: results from the 2009 Global School-based Health Survey

Background: Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.Methods: The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chisquared test and logistic regression.Results: A total of 2359 students were available for analysis. The overall selfreported prevalence of hunger within the last 30 days was 12.5%  (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger.Conclusion: Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger

What motivates community health volunteers in Mecanhelas district, Mozambique? Report from a qualitative study

No Abstract. Ghana Medical Journal Vol. 38(1) 2004: 24-2

An assessment of sex work in Swaziland: barriers to and opportunities for HIV prevention among sex workers

The HIV situation in virtually all southern African countries is a generalised epidemic. Despite the fact that almost all adult age and social groups have high HIV prevalence estimates, sex workers are disproportionally affected, with prevalence estimates higher than the general population. In a qualitative study of 61 male and female sex workers in Swaziland, we found that while poverty drove many into sex work, others reported motivations of pleasure or “sensation seeking”, and freedoms from the burden of marriage as perceived benefits of sex work. We also found that penile-vaginal sex was not universal in male-female sexual encounters; and motivation by sex workers for non-condom use included intention to earn more money from unprotected sex, desire for sexual pleasure, and not having time to use condoms. Many sex workers expressed doubts over an alternative lifestyle, even if that change afforded them money to meet their daily necessities. The findings from this study suggest that treating sex workers as a homogenous group that is driven into, or maintain sex work only because of poverty may be problematic, and could hamper HIV-relevant interventions aimed at reducing their vulnerability to sexually transmitted infections

The quality of care of diabetic patients in rural Malawi: A case of Mangochi district.

BACKGROUND: Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied. OBJECTIVE: The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district. METHODS: This was a cross sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 20012 and 2013. Qualitative data were also collected using semi-structured interviews with eight Key Informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients' master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data. RESULTS: Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes (40.0 % (n=30) and 22.7 (n=17) respectively. The majority of patients were taking their medicines regularly 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them left. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters. CONCLUSION: Quality of diabetes care provided to diabetic patients attended to Mangochi hospital was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education