Hydrological and Water Quality Characteristics of Rivers Feeding into Small Earth Dams for Rural Water Supply: A Case Study of Traditional Authority Kalolo in Lilongwe District

The obligation to ensure adequate and clean water supply to everyone, has necessitated the development of small earth dams for rural water supply in developing countries. In Malawi, there are approximately 750 small and medium dams most of which are used multiple purposes. However, in most cases, the sustainability of these dams is challenged by gross catchment mismanagement and improper designs and set up. In this study, FDC analysis, in conjunction with water quality assessment, was used to evaluate the reliability of rivers flows that supply small earth dams designed for rural water supply in Malawi, using Kalolo area in Lilongwe district as a case study. FDC analysis showed that over 80% of the time, all rivers in the study area would not meet the target community’s water demand, without the dams in place. Water quality assessments show biological contamination as the major water quality problem. Significant seasonal variation in water quality is evident, with the dry season having generally better biological water quality. Further, the study categorized the catchments areas as moderately to largely modified using rapid ecological assessment method. Therefore, the low biological water quality may be attributed to uncontrolled anthropogenic activities in the catchment, arising from lack of proper catchment management. It is then recommended that construction of such small earth dams should be preceded by thorough scientific design through appropriate engineering and environmental studies, encompassing hydrological, geological, ecological and socio-economic factors, if the small earth dams are to result into long term outputs.Keywords: River flow; small earth dams; flow duration curve; water quality; rural water supply

Impacts of Rainfall and Forest Cover Change on Runoff in Small Catchments: A Case Study of Mulunguzi and Namadzi Catchment Areas in Southern Malawi

The impacts of climate change on water resources have received much attention globally especially in the last 30 years. Rainfall, the main driver of the hydrological cycle, has been varying in parts of the world in various ways. The picture is more complicated if impacts of land cover changes on water resources are also taken into consideration. These two pose challenges which require an integrated approach to address. Not many of such studies have been conducted in Malawian catchments and other tropical regions. In this study, annual, seasonal and monthly series of rainfall and river discharge of the Mulunguzi and Namadzi River catchments, two small sub-catchments in the Lake Chilwa catchment area, were analysed for trends using the non parametric Mann-Kendall statistic and Sens slope estimator. Further, Linear regression and the RainRU model were applied to establish whether the relationship between rainfall and runoff in the two catchments has changed. Furthermore, linear regression was used to establish how increased forest cover has influenced river flows in the two catchments. The results suggest that rainfall in the Mulunguzi catchment has decreased significantly at all scales and this has also led to reduced river flows. Increased forest cover since the pre 1950s has also resulted in reduced flows but this is not as significant as the rainfall decrease. In the Namadzi catchment, the rainfall trends suggest a varying pattern with no obvious straight trends. At annual and some months timescale, the rainfall has increased significantly. The river flow on the other hand suggests an overall declining pattern. This pattern is well linked with significant forest area increments which have occurred since 1995. It is therefore important that more detailed studies should be conducted to gain further insight to these relations as both catchments are important socioeconomically.Keywords: Land use; land cover; river flow; rainfall; climate change

Drinking water quality and identification of fluoritic areas in Machinga, Malawi

There is prevalence of dental fluorosis in certain parts of Machinga District that can be attributed to elevated drinking water fluoride content in the areas. Therefore, it is important to know the actual quality of water within the district and identify specific fluoride endemic areas that may require immediate adoption of remedial measures to manage the water resource and thus protect consumers. In this study, drinking water samples were collected from boreholes and pipes at 23 sampling sites, mostly villages within the district, for fluoride and other water physicochemical parameters during dry and rainy seasons of 2004 and 2005 respectively. Fluoride endemic sites were identified from the fluoride data. A survey of school children was also done in order to examine symptoms of dental fluorosis. Levels of fluoride ranged from 0.35 to 10.30 mg/L with 70 % of the sites sampled indicating levels above the World Health Organization (WHO) guideline of 1.50 mg/L. Fluoride endemic areas were identified as those villages around Mtubwi F.P School and Liwonde L.E.A School. This finding was supported by the prevalence of a high proportion of dental fluorosis in standard 3 and 4 pupils in these two schools. Values of pH ranged from 6.70 to 9.37; electroconductivity from 1950 to 31000 mS/cm; turbidity from 0.00 to 2.41, Formazin Turbidity Units (FTU); phosphates from 0.0 to 1.88mg/L; nitrates from trace to 58 mg/L; hardness from 1.08 to 276 mg CaCO3/L; sulphates from 6.09 to 109.98 mg/L; chlorides from 0.003 to 0.576 mg/L; carbonates from 2.01 to 85.30 mg/L and bicarbonates from 51.02 to 677.52 mg/L. Correlation of fluoride with other drinking water parameters was assessed using simple graphical methods. Positive correlation was observed between concentrations of fluoride with pH, total dissolved solids and carbonates, while phosphates correlated negatively with the fluorides. No correlation was observed between concentrations of fluoride with nitrates, electroconductivity, total hardness, carbonates and chlorides.Keywords: Machinga; fluoride; fluorosis; physicochemical parameter

A cross-sectional study to evaluate second line virological failure and elevated bilirubin as a surrogate for adherence to atazanavir/ritonavir in two urban HIV clinics in Lilongwe, Malawi

BACKGROUND: Malawi's national antiretroviral therapy program provides atazanavir/ritonavir-based second line regimens which cause concentration-dependent rise in indirect bilirubin. We sought to determine if elevated bilirubin, as a surrogate of atazanavir/ritonavir adherence, can aid in the evaluation of second line virological failure in Malawi. METHODS: We conducted a cross-sectional study of HIV-infected patients ≥15 years who were on boosted protease inhibitor-based second line antiretroviral therapy for at least 6 months in two urban HIV clinics in Lilongwe, Malawi. Antiretroviral therapy history and adherence data were extracted from the electronic medical records and blood was drawn for viral load, complete blood count, total bilirubin, and CD4 cell count at a clinic visit. Factors associated with virological failure were assessed using multivariate logistic regression model. RESULTS: Out of 376 patients on second line antiretroviral therapy evaluated, 372 (98.9%) were on atazanavir/ritonavir-based therapy and 142 (37.8%) were male. Mean age was 40.9 years (SD ± 10.1), mean duration on second line antiretroviral therapy was 41.9 months (SD ± 27.6) and 256 patients (68.1%) had elevated bilirubin >1.3 mg/dL. Overall, 35 (9.3%) patients had viral load >1000 copies/ml (virological failure). Among the virologically failing vs. non-failing patients, bilirubin was elevated in 34.3% vs. 72.0% respectively (p < 0.001), although adherence by pill count was similar (62.9% vs. 60.7%, p = 0.804). The odds of virological failure were higher for adults aged 25-40 years (adjusted odds ratio (aOR) 2.5, p = 0.048), those with CD4 cell count <100 (aOR 17.5, p < 0.001), and those with normal bilirubin levels (aOR 5.4, p < 0.001); but were lower for the overweight/obese patients (aOR 0.3, p = 0.026). Poor pill count adherence (aOR 0.7, p = 0.4) and male gender (aOR 1.2, p = 0.698) were not associated with second line virological failure. CONCLUSIONS: Among patients receiving atazanavir/ritonavir-based second line antiretroviral therapy, bilirubin levels better predicted virological failure than pill count adherence. Therefore, strategic use of bilirubin and viral load testing to target adherence counseling and support may be cost-effective in monitoring second line antiretroviral therapy adherence and virological failure. Drug resistance testing targeted for patients with virological failure despite elevated bilirubin levels would facilitate timely switch to third line antiretroviral regimens whenever available

Rainfall trend analysis and geospatial mapping of the Kelantan River Basin

Trend analysis was widely used as a tool to detect changes in climatic and hydrologic time series data such as rainfall. Fourteen rainfall stations in the Kelantan River Basin were used to detect trends for each of the sub-basin areas. Two objectives of the study are (i) to quantify the changing trends of rainfall of Kelantan River using statistical tests (i.e., Mann-Kendall test and Sen’s slope test) based on monthly, seasonal, and annual time series, and secondly, (ii) to map rainfall trend according to Mann-Kendall test result. Analysis for these two tests revealed that several stations indicated significant increasing and decreasing trends for monthly, seasonal, and annual rainfall time series. The study found that rainfall varies in different months, seasons, and annually as evidenced by the graph and trend maps. Therefore, this information will benefit especially for flood preparation and responses in Kelantan River Basin which annually experiences monsoon flooding

Anemia in people on second line antiretroviral treatment in Lilongwe, Malawi: a cross-sectional study

Abstract Background Anemia is common among people living with HIV infection and is frequently associated with poor quality of life and poor prognosis. It has been well described in antiretroviral naïve individuals and those on non-nucleoside reverse transcriptase inhibitor-based first line antiretroviral therapy (ART) regimens. However there is limited information on anemia for ART experienced individuals on protease inhibitor-based second line ART regimens in resource limited settings. Our objective was to describe the prevalence and risk factors of anemia in this ART experienced population in Malawi. Methods We conducted a cross-sectional study using routine facility data at two HIV clinics in Lilongwe, Malawi. The analysis included individuals receiving protease inhibitor-based second line ART. Clinical and laboratory data were collected at routine clinic visits. We used descriptive statistics, two-sample t-tests and multivariate logistic regression for data analysis. Results Three hundred seventy-seven records were included in this analysis (37% male, median age 41 years, median CD4 count 415 cells/μL). The prevalence of anemia was 125/377 (33.2%) − mild, moderate and severe anemia was 17.5%, 13.8%, and 1.9% respectively. Female participants had a higher prevalence than male participants (43.6% vs. 15.7%, p < 0.001). In multivariate logistic regression, female sex (adjusted odds ratio (aOR) 5.3; 95% CI 2.9–9.5) and a CD4 count <200 cell/ul (aOR 3.1; 95%CI 1.6–6.0) were associated with increased risk of having anemia while a BMI ≥30 kg/m2 (aOR 0.8; 95% CI 0.6–1.0) and being on ART for more than 10 years (aOR 0.4; 95% CI 0.2–0.9) were associated with reduced risk of anemia. Being on a zidovudine- containing ART regimen was not associated with anemia. Conclusion Anemia is common in people on second line ART in Lilongwe, Malawi. Screening for anemia in this population would be a useful strategy; especially for female patients, those who are underweight and have a low CD4 cell counts

Discontinuation of tenofovir disoproxil fumarate from initial ART regimens because of renal adverse events: An analysis of data from four multi-country clinical trials

Tenofovir disoproxil fumarate (TDF), a potent and commonly used antiretroviral drug, is associated with renal tubular dysfunction and renal adverse events. We evaluated the frequency of, time to, and baseline risk factors for discontinuing TDF from initial antiretroviral therapy (ART) regimens because of renal adverse events from presumed tenofovir renal toxicity. We conducted an observational cohort study as a secondary analysis of data from four clinical trials conducted mainly in low- and middle-income countries. We included ART naïve participants living with HIV who started TDF-containing ART regimens in the trials. Participants had to have estimated creatinine clearance (eCrCl) equal to or greater than 60ml/min before starting ART. The primary outcome was the first instance of discontinuing TDF because of renal adverse events attributed to tenofovir renal toxicity during the first 48 weeks after starting ART. We evaluated the cumulative incidence of discontinuing TDF and associated risk factors using Fine and Gray competing risk regression models with a backward elimination variable selection strategy. There were 2802 ART-naïve participants who started TDF-containing ART from the four clinical trials were included in the analysis. Fifty-eight percent were female, the median age was 34 years, and 87% had CD4 cell counts less than 200 cells/μl. Sixty-four participants (2.4%, 95% CI 1.7%-2.8%) discontinued TDF due to renal adverse events. Among the 64 participants, the median time to discontinue TDF was 9.4 weeks (IQR: 3.4–20.7 weeks). From multivariable Fine and Gray regression models, risk factors for discontinuing TDF were older age, CD4 cell count <200 cells/μl, presence and severity of anemia, and eCrCl <90 ml/min. The risk of discontinuing TDF because of renal adverse events was low in participants initiating TDF-containing ART with advanced HIV and normal renal function, attesting to the tolerability of TDF in ART in low- and middle-income countries

Risk factors for early mortality on antiretroviral therapy in advanced HIV-infected adults.

CAPRISA, 2017.Abstract available in pdf