Borehole Water Pollution and its Implication on health on the Rural Communities of Malawi

This study analyzed borehole water quality data collected by the Water Section of the Ministry of Irrigation and Water Development since 1980s. This study was done in order to verify the rightness of the public view that borehole water is synonymous to potable water. The study analyzed water quality data of 5,324 boreholes occurring throughout Malawi. The objective of the study was to determine the extent to which borehole water salts such as: fluorides, nitrates, iron and chlorides are occurring above the concentrations recommended as safe limit of drinking water by the World Health Organization (WHO). The study observes that of the 27,913 boreholes in Malawi, only 5,324 boreholes had been tested for water quality representing about 19.1% of the total boreholes. Of these 1,676 boreholes had chemical concentration above those recommended by WHO for safe limit of drinking water, representing 31.5% of the water quality tested boreholes. The study observed that: 567 boreholes had iron, 142 boreholes had fluorides, 81 boreholes had chlorides and 19 had nitrates above those recommended by WHO for safe limits for drinking water respectively. The implication of these findings is that a large number of rural communities in Malawi are continuously ingesting borehole water that has adverse levels of chemical toxicity. The detrimental impacts on human health of such toxicity may require many years of exposure before their impacts are recognized and by that time many rural communities would already have adversely been affected.Keywords: Borehole water; chemical toxicity; rural communities; ingestio

Influence of gendered roles on legume utilization and improved child dietary intake in Malawi

The relationship between gender roles, legume production, utilization and child feeding practices in rural smallholder households of Dedza and Ntcheu districts in Malawi was investigated and analyzed. A cross-sectional research study was conducted with legume farming households with children aged 6-23 months who were part of the Africa RISING ‘mother trial’ or ‘baby trials’ for two farming seasons (2014/2015 to 2015/2016). Africa RISING project encourages smallholder farmers to grow legumes namely, groundnut (Arachis hypogaea), cowpea (Vigna unguiculata), pigeon pea (Cajanus cajan) and soya bean (Glycin max) as one way of improving the wellbeing of smallholder farmers. The key objective of the research was to assess the influence of gender roles, legume production, utilization and infant and young child dietary intake. In total, 291 households with children 6-23 months were targeted. Eight focus group discussions (FDGs) for in-depth qualitative data were conducted. Two 24-hour dietary recalls and food frequency questionnaires were used to collect data on infant and young child feeding (IYCF) practices. Data collected were extracted, arranged, recorded and analyzed by using SPSS version 21. About 18% of children aged 6-23 months received a minimum dietary diversity (the consumption of four or more food groups from the seven food groups), 2.5% received a minimum acceptable diet (indicator measures both the minimum feeding frequency and minimum dietary diversity, as appropriate for various age groups) and 37.5% of children received a minimum meal frequency (frequency of receiving solid, semi-solid, or soft foods at the minimum numbers of two and three times for children aged 6–8 months, and 9–23 months, respectively). Control on use of income by women had a positive and significant association with minimum dietary diversity (P<0.05), minimum meal frequency (P<0.05) and minimum acceptable diets (P<0.05) among children of both sexes. Children aged 6-23 months from households where women were actively involved in partial processing and budgeting of legumes met minimum dietary diversity than children from nonparticipating households. Women farmers were more knowledgeable about legumes; played an important role in seed selection, storage and processing; however, the findings signal an opportunity to increase women’s income by involving them in market information. Increasing legume production at household level does not mean increasing the nutritional status among children (6-23 months). Several factors related to gender roles, markets accessibility and legume utilization have an effect on infant and young child feeding practices

Taking up the cudgels against gay rights? Trends and trajectories in African Christian theologies on homosexuality

Against the background of the HIV epidemic and the intense public controversy on homosexuality in African societies, this article investigates the discourses of academic African Christian theologians on homosexuality. Distinguishing some major strands in African theology, that is, inculturation, liberation, women’s and reconstruction theology, the article examines how the central concepts of culture, liberation, justice, and human rights function in these discourses. On the basis of a qualitative analysis of a large number of publications, the article shows that stances of African theologians are varying from silence and rejection to acceptance. Although many African theologians have taken up the cudgels against gay rights, some “dissident voices” break the taboo and develop more inclusive concepts of African identity and African Christianity

New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area

Background: Due to the potential risk of iron supplementation in iron replete children, it is important to properly identify children who may require iron supplementation. However, assessment of the iron status has proven to be difficult, especially in children living in areas with high infection pressure (including malaria). Aims and Methods: Biochemical iron markers were compared to bone marrow iron findings in 381 Malawian children with severe anaemia. Results: Soluble transferrin receptor/log ferritin (TfR-F index), using a cut-off of 5.6, best predicted bone marrow iron stores deficiency (sensitivity 74%, specificity 73%, accuracy 73%). In order to improve the diagnostic accuracy of ferritin or sTfR as a stand-alone marker, the normal cut-off value needed to be increased by 810% and 83% respectively. Mean cell haemoglobin concentration (MCHC), using a cut-off of 32.1 g/dl, had a sensitivity of 67% and specificity of 64% for detecting iron stores deficiency. Conclusion: TfR-F index incorporated the high sensitivity of sTfR, a proxy for cellular iron need, and the high specificity of ferritin, a proxy for iron stores. In areas with a high infection pressure, the TfR-F index best predicted iron deficiency. However, in settings where diagnostic tests are limited, MCHC may be an acceptable alternative screening test

Improved method for assessing iron stores in the bone marrow

Background: Bone marrow iron microscopy has been the "gold standard'' method of assessing iron deficiency. However, the commonly used method of grading marrow iron remains highly subjective. Aim: To improve the bone marrow grading method by developing a detailed protocol that assesses iron in fragments, in macrophages around fragments and in erythroblasts. Methods: A descriptive study of marrow aspirates of 303 children (aged 6-60 months) with severe anaemia and 22 controls (children undergoing elective surgery) was conducted at hospitals in southern Malawi (2002-04). Results: Using an intensive marrow iron grading method, 22% and 39% of cases and controls had deficient iron stores, and 40% and 46% had functional iron deficiency, respectively. Further evaluation of the iron status classification by the intensive method showed that functional iron deficiency was associated with significantly increased C-reactive protein concentrations (126.7 (85.6) mg/l), and iron stores deficiency with significantly increased soluble transferrin receptor concentrations (21.7 (12.5) mg/ml). Conclusions: Iron assessment can be greatly improved by a more intense marrow examination. This provides a useful iron status classification which is of particular importance in areas where there is a high rate of inflammatory conditions

Impact of foot-and-mouth disease on mastitis and culling on a large-scale dairy farm in Kenya

Foot and mouth disease (FMD) is a highly transmissible viral infection of cloven hooved animals associated with severe economic losses when introduced into FMD-free countries. Information on the impact of the disease in FMDV-endemic countries is poorly characterised yet essential for the prioritisation of scarce resources for disease control programmes. A FMD (virus serotype SAT2) outbreak on a large-scale dairy farm in Nakuru County, Kenya provided an opportunity to evaluate the impact of FMD on clinical mastitis and culling rate. A cohort approach followed animals over a 12-month period after the commencement of the outbreak. For culling, all animals were included; for mastitis, those over 18 months of age. FMD was recorded in 400/644 cattle over a 29-day period. During the follow-up period 76 animals were culled or died whilst in the over 18 month old cohort 63 developed clinical mastitis. Hazard ratios (HR) were generated using Cox regression accounting for non-proportional hazards by inclusion of time-varying effects. Univariable analysis showed FMD cases were culled sooner but there was no effect on clinical mastitis. After adjusting for possible confounders and inclusion of time-varying effects there was weak evidence to support an effect of FMD on culling (HR = 1.7, 95% confidence intervals [CI] 0.88-3.1, P = 0.12). For mastitis, there was stronger evidence of an increased rate in the first month after the onset of the outbreak (HR = 2.9, 95%CI 0.97-8.9, P = 0.057)

Healthcare designers’ use of prescriptive and performance-based approaches

In the UK, healthcare built environment design is guided by a series of long-established design standards and guidance issued by the Department of Health. More recently, healthcare design focus has broadened to encompass new approaches, supported by large bodies of credible research evidence. It is therefore timely to rethink how healthcare design standards and guidance should be best expressed to suit ‘designerly ways’ of using evidence, to improve their use and effectiveness in practice. This research explored how designers use performance and prescriptive approaches during the healthcare design process. Three in-depth healthcare built environment case studies were used to explore how designers employed such approaches during the design of selected exemplar design elements. Results show that design elements in the pre and conceptual design phases significantly employed performance-based approaches, and due to project-unique circumstances, prescriptive solutions were often significantly modified based on performance criteria. For design elements in the detailed and technical design phases, there was a significant use of solutions based on prescriptive approaches, whilst performance-based criteria were used to evaluate design solutions. This research proposes a performance-based, specification-driven healthcare design with supplementary prescriptive specifications provided for optimum healthcare environment design

Biofortified Maize Improves Selenium Status of Women and Children in a Rural Community in Malawi: Results of the Addressing Hidden Hunger With Agronomy Randomized Controlled Trial

Background: Selenium deficiency is widespread in the Malawi population. The selenium concentration in maize, the staple food crop of Malawi, can be increased by applying selenium-enriched fertilizers. It is unknown whether this strategy, called agronomic biofortification, is effective at alleviating selenium deficiency. Objectives: The aim of the Addressing Hidden Hunger with Agronomy (AHHA) trial was to determine whether consumption of maize flour, agronomically-biofortified with selenium, affected the serum selenium concentrations of women, and children in a rural community setting. Design: An individually-randomized, double-blind placebo-controlled trial wasconducted in rural Malawi. Participants were randomly allocated in a 1:1 ratio to receive either intervention maize flour biofortified with selenium through application of selenium fertilizer, or control maize flour not biofortified with selenium. Participant households received enough flour to meet the typical consumption of all household members (330 g capita−1 day−1) for a period of 8 weeks. Baseline and endline serum selenium concentration (the primary outcome) was measured by inductively coupled plasma mass spectrometry (ICP-MS). Results: One woman of reproductive age (WRA) and one school-aged child (SAC) from each of 180 households were recruited and households were randomized to each group. The baseline demographic and socioeconomic status of participants were well-balanced between arms. No serious adverse events were reported. In the intervention arm, mean (standard deviation) serum selenium concentration increased over the intervention period from 57.6 (17.0) μg L−1 (n = 88) to 107.9 (16.4) μg L−1 (n = 88) among WRA and from 46.4 (14.8) μg L−1 (n = 86) to 97.1 (16.0) μg L−1 (n = 88) among SAC. There was no evidence of change in serum selenium concentration in the control groups Conclusion: Consumption of maize flour biofortified through application of selenium-enriched fertilizer increased selenium status in this community providing strong proof of principle that agronomic biofortification could be an effective approach to address selenium deficiency in Malawi and similar settings. Clinical Trial Registration http://www.isrctn.com/ISRCTN85899451, identifier: ISRCTN85899451