Antiretroviral Therapy in the Malawi Police Force: Access to Therapy and Treatment Outcomes

A national survey was carried out in all the 103 public sector and 38 private sector facilities in Malawi providing antiretroviral therapy (ART) to determine uptake of ART and subsequent treatment outcomes in police force personnel. All patients registered for ART and their subsequent treatment outcomes were censored on December 31st 2006. There were 85168 patients started on ART in both public and private sectors, of whom 463 (0.6%) were police force personnel. Of police force personnel starting ART, 17% were in WHO clinical stage 1 or 2 with a CD4-lymphocyte count of ≤250 cells/μL and 83% were in stage 3 or 4. Treatment outcomes of police force personnel by the end of December 2006 were 302 (65%) alive and on ART at their registration facility, 59 (13%) dead, 30 (7%) lost to follow-up, 1 stopped treatment and 71 (15%) transferred to another facility. Their probability of being alive on ART at 6-, 12- and 18-months was 83.2%, 78.6% and 76.7% respectively. There has been a good access of police force personnel to ART since national scale up commenced with good treatment outcomes, and this should serve as an example for other police forces in the region. Malawi Medical Journal Vol. 20 (1) 2008 pp. 23-2

Spatial and genomic data to characterize endemic typhoid transmission

BACKGROUND: Diverse environmental exposures and risk factors have been implicated in the transmission of Salmonella Typhi, however, the dominant transmission pathways through the environment to susceptible humans remain unknown. Here, we utilize spatial, bacterial genomic, and hydrological data to refine our view of Typhoid transmission in an endemic setting. METHODS: 546 patients presenting to Queen Elizabeth Central Hospital in Blantyre, Malawi with blood culture-confirmed typhoid fever between April 2015 and January 2017 were recruited to a cohort study. The households of a subset of these patients were geolocated, and 256 S. Typhi isolates were whole genome sequenced. Pairwise single nucleotide variant (SNV) distances were incorporated into a geostatistical modeling framework using multidimensional scaling. RESULTS: Typhoid fever was not evenly distributed across Blantyre, with estimated minimum incidence ranging across the city from less than 15 to over 100 cases/100,000/year. Pairwise SNV distance and physical household distances were significantly correlated (p=0.001). We evaluated the ability of river catchment to explain the spatial patterns of genomics observed, finding that it significantly improved the fit of the model (p=0.003). We also found spatial correlation at a smaller spatial scale, of households living <192 meters apart. CONCLUSIONS: These findings reinforce the emerging view that hydrological systems play a key role in the transmission of typhoid fever. By combining genomic and spatial data, we show how multi-faceted data can be used to identify high incidence areas, understand the connections between them, and inform targeted environmental surveillance, all of which will be critical to shape local and regional typhoid control strategies

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 11: The Lake Chiuta Catchment

Groundwater in Water Resource Area 11 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 9: The Songwe River Catchment

Groundwater in Water Resource Area 9 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 7: The South Rukuru and North Rumphi River Catchment

Groundwater in Water Resource Area 7 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 14: The Ruo River Catchment

Groundwater in Water Resource Area 14 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 4: The Linthipe River Catchment

Groundwater in Water Resource Area 4 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity

Assessing the Validity of Sexual Behaviour Reports in a Whole Population Survey in Rural Malawi

Background: Sexual behaviour surveys are widely used, but under-reporting of particular risk behaviours is common, especially by women. Surveys in whole populations provide an unusual opportunity to understand the extent and nature of such under-reporting.Methods: All consenting individuals aged between 15 and 59 within a demographic surveillance site in northern Malawi were interviewed about their sexual behaviour. Validity of responses was assessed by analysis of probing questions; by comparison of results with in-depth interviews and with Herpes simplex type-2 (HSV-2) seropositivity; by comparing reports to same sex and opposite sex interviewers; and by quantifying the partnerships within the local community reported by men and by women, adjusted for response rates.Results: 6,796 women and 5,253 men (83% and 72% of those eligible) consented and took part in sexual behaviour interviews. Probing questions and HSV-2 antibody tests in those who denied sexual activity identified under-reporting for both men and women. Reports varied little by sex or age of the interviewer. The number of marital partnerships reported was comparable for men and women, but men reported about 4 times as many non-marital partnerships. The discrepancy in reporting of non-marital partnerships was most marked for married women (men reported about 7 times as many non-marital partnerships with married women as were reported by married women themselves), but was only apparent in younger married women.Conclusions: We have shown that the under-reporting of non-marital partnerships by women was strongly age-dependent. The extent of under-reporting of sexual activity by young men was surprisingly high. The results emphasise the importance of triangulation, including biomarkers, and the advantages of considering a whole population

Hydrogeology and Groundwater Quality Atlas of Malawi : Water Resource Area 6: The Dwangwa River Catchment

Groundwater in Water Resource Area 6 is interpreted within the same context as presented in the Hydrogeology and Water Quality Atlas Bulletin publication. A general description of the Hydrogeology of Malawi and its various units is provided here to remind the reader of the complexity of groundwater in Malawi and its nomenclature. The various basement geologic units have variable mineralogy, chemistry, and structural history that may be locally important for water quality parameters such as Fluoride, Arsenic and geochemical evolution. Therefore, translation of geologic units to potential hydrostratigraphic units was based on the 1:250,000-scale Geological Map of Malawi compiled by the Geological Survey Department of Malawi (Canon, 1978). Geological units were grouped into three main aquifer groups for simplicity