Uses, benefits and challenges of using rural community telecentres as tools for development: the Case of Vikwa Community Telecentre in Kasungu, Malawi

This paper examines the uses, benefits and challenges of using telecentres as tools for development in Malawi focusing on one community telecentre: Vikwa Community Telecentre in the Kasungu district of Malawi. Quantitative and qualitative data were gathered using a questionnaire administered to 46 users; interviews with the Telecentre Manager; and observation of the categories of people coming to the telecentres; what they were using and challenges sues and challenges within the telecentre. The findings indicate that the users are improving their skills and knowledge, school performance, finding new friends and saving money. The community uses the telecentre to improve work related skills, keep in touch with friends and families and look for jobs. The negative finding is that telecentre usage is uneven as users are generally poor male youths with little education. Furthermore, the users face a number of challenges when using the telecentre. For the telecentre to have more impact on development, the paper recommends that the Vikwa Telecentre should work on attracting all groups of people in the community, change the internet service provider, buy an electricity generator, acquire more books and computers and train staff in customer care.Keywords: development, telecentres, Malawi, multipurpose community telecentres, Vikwa Community Telecentr

Primary motivations for and experiences with paediatric minimally invasive tissue sampling (MITS) participation in Malawi:a qualitative study

Objective: To understand family member consent decision-making influences and experiences in Malawi in order to inform future minimally invasive tissue sampling (MITS) studies. Design: Qualitative study. Setting: Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, which serves as the central referral hospital for southern Malawi and where MITS participants were recruited from. Participants: Families of paediatric MITS participants. Methods: We conducted in-depth interviews with 16 families 6 weeks after the death of paediatric MITS participants. Data were analysed using a combination of thematic content and theoretical framework approaches to explain the findings. Results: Improved cause of death (CoD) ascertainment was the principal motivator for participation to protect remaining or future children. Community burial norms, religious doctrine and relationships with healthcare workers (HCWs) were not reported influencers among family members who consented to the procedure. Primary consenters varied, with single mothers more likely to consent independently or with only female family members present. Clear understanding of MITS procedures appeared limited 6 weeks postprocedure, but research was described as voluntary and preconsent information satisfactory for decision-making. Most families intended to share about MITS only with those involved in the consent process, for fear of rumours or judgement by extended family members and the wider community. Conclusion: Among those who consented to MITS, decision-making was informed by individual and household experiences and beliefs, but not by religious affiliation or experiences with HCWs. While understanding of the MITS procedure was limited at the time of interview, families found informed consent information sufficient for decision-making. Future MITS studies should continue to explore information presentation best practices to facilitate informed consent during the immediate grieving period

Taking from the rural to serve the urban:the Likhubula water project and the slow violence of water abstraction in Malawi

Despite community protests in the Mulanje District of Southern Malawi, the Malawi government in November 2016 launched a $23.5 million project to abstract water from the Likhubula River in rural Mulanje and transport it almost 70 kilometres away to Malawi’s commercial capital of Blantyre. Drawing on findings from ongoing ethnographic observations in Southern Malawi, this paper presents the Likhubula Water Project as a form of slow violence causing social harms that perpetuate colonial legacies. It engages with the complexities of the project, recognising the pressure placed on water resources as a socio-political need in response to the impacts of climate change, population growth and rapid urbanisation while at the same time identifying this as a form of slow violence in which the harms from the water project are not only in the ‘mining’ of water to benefit urban life but also in terms of the disregard for the significance of the water to local communities. We conclude that the act of exposing the area to water exploration and exploitation presents the possibility of perpetuating other forms of environmental harm in areas where there is already significant pressure on land, forest and water resources

Hypothetical acceptability of hospital-based post-mortem pediatric minimally invasive tissue sampling in Malawi: The role of complex social relationships

Background Child mortality rates remain unacceptably high in low-resource settings. Cause of death (CoD) is often unknown. Minimally invasive tissue sampling (MITS)–using biopsy needles to obtain post-mortem samples–for histopathological and microbiologic investigation is increasingly being promoted to improve child and adult CoD attribution. “MITS in Malawi” is a sub-study of the Childhood Acute Illness & Nutrition (CHAIN) Network, which aims to identify biological and socioeconomic mortality risk factors among young children hospitalized for acute illness or undernutrition. MITS in Malawi employs standard MITS and a novel post-mortem endoscopic intestinal sampling approach to better understand CoD among children with acute illness and/or malnutrition who die during hospitalization. Aim To understand factors that may impact MITS acceptability and inform introduction of the procedure to ascertain CoD among children with acute illness or malnutrition who die during hospitalization in Malawi. Methods We conducted eight focus group discussions with key hospital staff and community members (religious leaders and parents of children under 5) to explore attitudes towards MITS and inform consent processes prior to commencing the MITS in Malawi study. We used thematic content analysis drawing on a conceptual framework developed from emergent themes and MITS acceptability literature. Results Feelings of power over decision-making within the hospital and household, trust in health systems, and open and respectful health worker communication with parents were important dimensions of MITS acceptability. Other facilitating factors included the potential for MITS to add CoD information to aid sense-making of death and contribute to medical knowledge and new interventions. Potential barriers to acceptability included fears of organ and blood harvesting, disfigurement to the body, and disruption to transportation and burial plans. Conclusion Social relationships and power dynamics within healthcare systems and households are a critical component of MITS acceptability, especially given the sensitivity of death and autopsy