Population Differences in Death Rates in HIV-Positive Patients with Tuberculosis.

SETTING: Randomised controlled clinical trial of Mycobacterium vaccae vaccination as an adjunct to anti-tuberculosis treatment in human immunodeficiency virus (HIV) positive patients with smear-positive tuberculosis (TB) in Lusaka, Zambia, and Karonga, Malawi. OBJECTIVE: To explain the difference in mortality between the two trial sites and to identify risk factors for death among HIV-positive patients with TB. DESIGN: Information on demographic, clinical, laboratory and radiographic characteristics was collected. Patients in Lusaka (667) and in Karonga (84) were followed up for an average of 1.56 years. Cox proportional hazard analyses were used to assess differences in survival between the two sites and to determine risk factors associated with mortality during and after anti-tuberculosis treatment. RESULTS: The case fatality rate was 14.7% in Lusaka and 21.4% in Karonga. The hazard ratio for death comparing Karonga to Lusaka was 1.47 (95% confidence interval [CI] 0.9-2.4) during treatment and 1.76 (95%CI 1.0-3.0) after treatment. This difference could be almost entirely explained by age and more advanced HIV disease among patients in Karonga. CONCLUSION: It is important to understand the reasons for population differences in mortality among patients with TB and HIV and to maximise efforts to reduce mortality

Present day challenges in understanding the geomagnetic hazard to national power grids

Power grids and pipeline networks at all latitudes are known to be at risk from the natural hazard of geomagnetically induced currents. At a recent workshop in South Africa, UK and South African scientists and engineers discussed the current understanding of this hazard, as it affects major power systems in Europe and Africa. They also summarised, to better inform the public and industry, what can be said with some certainty about the hazard and what research is yet required to develop useful tools for geomagnetic hazard mitigation

Carbon sequestration and selected hydraulic characteristics under conservation agriculture and traditional tillage practices in Malawi

Conservation agriculture (CA) is increasingly promoted among smallholder farmers of sub-Saharan Africa in a quest to improve food security while sustaining the natural resource base of the agro-ecosystems where agriculture is based. The aim of this study was to investigate the effects of CA and traditional tillage on soil organic carbon (SOC) and selected hydraulic properties in two contrasting agro-ecological zones of Malawi. Six farmers hosted on-farm trials in each location, with each farmer having the following treatments: CA with continuous sole maize (CA-SM), CA with maize–legume intercrops (CA-ML), and traditional tillage with continuous sole maize (CT-SM). Soil samples were randomly collected in October 2015, from farmers’ fields located in Chipeni, Chinguluwe, Lemu, and Zidyana where CA had been implemented for 10 years (2005–2015) at six depth intervals: 0–10, 10–20, 20–40, 40–60, 60–80, and 80–100 cm. Bulk density, soil water characteristics, and pore size distribution were determined using undisturbed core samples. At all sites, CA improved total SOC, carbon stocks, and the stable fraction of particulate organic carbon. Maize–legume intercropping under CA had 35%, 33%, and 73% more total SOC than CT-SM in Chipeni, Lemu, and Zidyana respectively. In Chinguluwe and Lemu, CA-ML had 0.54 and 0.50 g kg–1 respectively more stable fraction of particulate organic carbon (POMP) than CT-SM; whereas in Chipeni, CA-SM had 0.73 g kg–1 higher POMP compared with CT-SM. CA also improved soil porosity, pore size distribution, and water retention capacity by increasing the proportion of mesopores and micropores compared with CT-SM. Thus, changing management practices from CT-SM to CA has the potential to improve the soil organic matter and soil hydraulic properties across agro-ecological zones in Malawi, which is important for sustainable agriculture. Farmers should be encouraged to minimise tillage, retain residues as mulch on the soil surface, and practice crop rotation

Productivity and profitability of maize-legume cropping systems under conservation agriculture among smallholder farmers in Malawi

A study was conducted from 2014 to 2017 in Malawi to elucidate the short-term effects of maize-legume intercropping and rotation systems under conservation agriculture (CA) and conventional tillage (CT) on crop productivity and profitability. Twelve farmers hosted on-farm trials per district, in three districts, with each farmer having six plots. The design of the study was randomised complete block design arranged in a split plot fashion with tillage as main plot and cropping systems as sub-plots, with each farmer acting as a replicate. CA had 1400 and 3200 kg ha−1 more maize grain yield in the second and third seasons, respectively compared with CT. In the first two seasons, CT had 310, 180 and 270 kg ha−1 more cowpea, soybean and pigeon pea grain yields in Salima, Mzimba and Mangochi districts, respectively, compared with CA. Similarly, CA had 1100 and 950 kg ha−1 more groundnut grain yields than CT in Salima and Mzimba districts in the second and third seasons, respectively. Over the three-year study period, partial land equivalent ratio for maize ranged from 0.78 to 1.24. Largest net returns were achieved by intercropping maize with pigeon pea in Mangochi and rotating maize and groundnut in Mzimba and Salima districts

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi

Background Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations.Aim To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables.Methods We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or bloodborne infection. We performed the haematological tests at the Malawi- Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories.Results Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer’s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer’s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups.Conclusions Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results

Reverse transcriptase drug resistance mutations in HIV-1 subtype C infected patients on ART in Karonga District, Malawi

<p>Abstract</p> <p>Background</p> <p>Drug resistance testing before initiation of, or during, antiretroviral therapy (ART) is not routinely performed in resource-limited settings. High levels of viral resistance circulating within the population will have impact on treatment programs by increasing the chances of transmission of resistant strains and treatment failure. Here, we investigate Drug Resistance Mutations (DRMs) from blood samples obtained at regular intervals from patients on ART (Baseline-22 months) in Karonga District, Malawi. One hundred and forty nine reverse transcriptase (RT) consensus sequences were obtained via nested PCR and automated sequencing from blood samples collected at three-month intervals from 75 HIV-1 subtype C infected individuals in the ART programme.</p> <p>Results</p> <p>Fifteen individuals showed DRMs, and in ten individuals DRMs were seen from baseline samples (reported to be ART naïve). Three individuals in whom no DRMs were observed at baseline showed the emergence of DRMs during ART exposure. Four individuals who did show DRMs at baseline showed additional DRMs at subsequent time points, while two individuals showed evidence of DRMs at baseline and either no DRMs, or different DRMs, at later timepoints. Three individuals had immune failure but none appeared to be failing clinically.</p> <p>Conclusion</p> <p>Despite the presence of DRMs to drugs included in the current regimen in some individuals, and immune failure in three, no signs of clinical failure were seen during this study. This cohort will continue to be monitored as part of the Karonga Prevention Study so that the long-term impact of these mutations can be assessed. Documenting proviral population is also important in monitoring the emergence of drug resistance as selective pressure provided by ART compromises the current plasma population, archived viruses can re-emerge</p

Quantifying the daily economic impact of extreme space weather due to failure in electricity transmission infrastructure

Extreme space weather due to coronal mass ejections has the potential to cause considerable disruption to the global economy by damaging the transformers required to operate electricity transmission infrastructure. However, expert opinion is split between the potential outcome being one of a temporary regional blackout and of a more prolonged event. The temporary blackout scenario proposed by some is expected to last the length of the disturbance, with normal operations resuming after a couple of days. On the other hand, others have predicted widespread equipment damage with blackout scenarios lasting months. In this paper we explore the potential costs associated with failure in the electricity transmission infrastructure in the U.S. due to extreme space weather, focusing on daily economic loss. This provides insight into the direct and indirect economic consequences of how an extreme space weather event may affect domestic production, as well as other nations, via supply chain linkages. By exploring the sensitivity of the blackout zone, we show that on average the direct economic cost incurred from disruption to electricity represents only 49% of the total potential macroeconomic cost. Therefore, if indirect supply chain costs are not considered when undertaking cost-benefit analysis of space weather forecasting and mitigation investment, the total potential macroeconomic cost is not correctly represented. The paper contributes to our understanding of the economic impact of space weather, as well as making a number of key methodological contributions relevant for future work. Further economic impact assessment of this threat must consider multiday, multiregional event

Improving the productivity and resilience of smallholder farmers with maize-legume and legume-legume systems in Malawi

Smallholder farmers in southern africa must cope with declining soil fertility and production risks associated with frequent droughts (jayne et al., 2014). Legume integration through rotations or intercropping in maize-based farming systems are promoted to increase crop diversification and soil fertility. Anovel strategy, doubled up legumes, could help develop production systems that fulfil sustainable intensification (SI) indicators. It is however crucial to understand resource competition in mixed cropping systems under variable soil and climate conditions

Insecticide-treated net effectiveness at preventing Plasmodium falciparum infection varies by age and season

Abstract Background After increasing coverage of malaria interventions, malaria prevalence remains high in Malawi. Previous studies focus on the impact of malaria interventions among children under 5 years old. However, in Malawi, the prevalence of infection is highest in school-aged children (SAC), ages 5 to 15 years. This study examined the interaction between age group and insecticide-treated net (ITN) use for preventing individual and community-level infection in Malawi. Methods Six cross-sectional surveys were conducted in the rainy and dry seasons in southern Malawi from 2012 to 2014. Data were collected on household ITN usage and demographics. Blood samples for detection of Plasmodium falciparum infection were obtained from all household members present and over 6 months of age. Generalized linear mixed models were used to account for clustering at the household and community level. Results There were 17,538 observations from six surveys. The association between ITN use and infection varied by season in SAC, but not in other age groups. The adjusted odds ratio (OR) for infection comparing ITN users to non-users among SAC in the rainy season and dry season was 0.78 (95% CI 0.56, 1.10) and 0.51 (0.35, 0.74), respectively. The effect of ITN use did not differ between children under five and adults. Among all non-SACs the OR for infection was 0.78 (0.64, 0.95) in those who used ITNs compared to those that did not. Community net use did not protect against infection. Conclusions Protection against infection with ITN use varies by age group and season. Individual estimates of protection are moderate and a community-level effect was not detected. Additional interventions to decrease malaria prevalence are needed in Malawi.http://deepblue.lib.umich.edu/bitstream/2027.42/135726/1/12936_2017_Article_1686.pd

Bed net use among school-aged children after a universal bed net campaign in Malawi

Abstract Background Recent data from Malawi suggest that school-aged children (SAC), aged 5–15 years, have the highest prevalence of Plasmodium falciparum infection among all age groups. They are the least likely group to utilize insecticide-treated nets (ITNs), the most commonly available intervention to prevent malaria in Africa. This study examined the effects of a universal ITN distribution campaign, and their durability over time in SAC in Malawi. This study identified factors that influence net usage among SAC and how these factors changed over time. Methods Cross-sectional surveys using cluster random sampling were conducted at the end of each rainy and dry season in southern Malawi from 2012 to 2014; six surveys were done in total. Mass net distribution occurred between the first and second surveys. Data were collected on household and individual net usage as well as demographic information. Statistical analyses used generalized linear mixed models to account for clustering at the household and neighbourhood level. Results There were 7347 observations from SAC and 14,785 from young children and adults. SAC used nets significantly less frequently than the rest of the population (odds ratio (OR) from 0.14 to 0.38). The most important predictors of net usage among SAC were a lower ratio of people to nets in a household and higher proportion of nets that were hanging at the time of survey. Older SAC (11–15 years) were significantly less likely to use nets than younger SAC (5–10 years) [OR = 0.24 (95 % CI: 0.21, 0.28)]. The universal bed net campaign led to a statistically significant population-wide increase in net use, however net use returned to near baseline within 3 years. Conclusions This study suggests that a single universal net distribution campaign, in combination with routine distribution through health clinics is not sufficient to cause a sustained increase in net usage among SAC. Novel approaches to ITN distribution, such as school-based distribution, may be needed to address the high prevalence of infection in SAC.http://deepblue.lib.umich.edu/bitstream/2027.42/134523/1/12936_2016_Article_1178.pd