Air quality assessment of carbon monoxide, nitrogen dioxide and sulfur dioxide levels in Blantyre, Malawi: a statistical approach to a stationary environmental monitoring station

Air quality in urban areas is a cause of concern because of increased industrial activities that contribute to large quantities of emissions. The study assess levels and variations of carbon monoxide (CO), nitrogen dioxide (NO2) and sulfur dioxide (SO2) in Blantyre, Malawi using a stationary environmental monitoring station (EMS). Results show that CO level (2.47 ± 1.23 mg m-3) were below the Malawian limit value (10.31 mg m-3). Although, NO2 (4.02 ± 2.47 mg m-3) and SO2 (8.58 ± 2.88 mg m-3) were significantly higher than allowable Malawian Standards (0.52 and 0.23 mg m-3, respectively). Discernible variations in hourly, diurnal, monthly and seasonal CO, SO2 and NO2 were apparent. Independent t-test confirmed that day time values were higher than those at night (p < 0.05). Thus, variations in local weather affect the disparity in hourly and diurnal values. Analysis of variance (ANOVA) confirmed significant variations in monthly observations. Moreover, independent t-test showed that wet season CO (2.32 mg m-3), SO2 (5.10 mg m-3) and NO2 (9.41 mg m-3) levels were higher than dry season values (CO = 2.32 mg m-3; SO2 = 3.42 mg m-3; NO2 = 8.13 mg m-3). A hierarchical cluster analysis (HCA) divided the 10 months into three groups based on distribution of CO, SO2 and NO2, air temperature, wind speed and wind direction. Furthermore, factor analysis (FA) showed that air temperature had significant contribution to variations in mean values of CO, SO2 and NO2 for the entire study period. The study shows a need for constant urban air quality monitoring in Blantyre and all urban areas in Malawi. It is recommended that the experimental site widen the scope of the study by utilizing the flexibility of the EMS. Key words: Air pollutants, principal component analysis, developing countries, environmental monitoringstation, Kaiser normalization

Assessing population aging and disability in sub-Saharan Africa: lessons from Malawi?

The study of Payne and colleagues is, to our knowledge, the first empirical study to report disability states, and to estimate transitions between them, for Malawi's population of 45 years of age and older. The study provides detailed estimates for healthy life expectancy (HALE, an estimate of equivalent years of good health), which differ from those recently published by the Global Burden of Disease study (GBD) [2],[3]. The GBD estimates that in Malawi 50-year old women can expect to live 76.1% of their remaining 23.4 years in good health and 50-year old men can expect to live 76.7% of their remaining 20.6 years in good health [2]. In contrast, Payne and colleagues estimated that women aged 45 years spend only 42% of 28.0 remaining years in good health, and men 59% of 25.4 years

Assessment of changes in drinking water quality during distribution: A case study of Area 25 Township in Lilongwe, Malawi

The quality of drinking water at the point of delivery to the consumer is crucial in safeguarding people’s health. This study assesses changes in drinking water quality during distribution at Area 25 Township in Lilongwe, Malawi. Water samples were collected from the exit point of the treatment plant, storage tank and taps at consumers’ households. All samples were tested using standard procedures for pH, turbidity, feacal coliforms, manganese, lead, zinc and residual chlorine. One-way ANOVA showed some significant water quality changes during distribution but the average values fell within World Health Organisation (WHO) and Malawi Bureau of standards (MBS) allowable levels for pH, turbidity, feacal coliforms, manganese, lead, zinc and residual chlorine (p < 0.05). Tap water at Area 25 Township is generally safe for human consumption.Key words: Drinking water, distribution system, biochemical parameters, human health

Evidence to support HIV prevention for adolescent girls and young women (AGYW) and their male partners: Results from Malawi Dreams studies with AGYW, male partners of AGYW, men living with HIV, and program implementing partners

Project SOAR, led by the Population Council, in partnership with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted a research portfolio to generate evidence to reduce HIV risk among adolescent girls and young women (AGYW) and their male partners. The objectives of this implementation research were to generate evidence for describing HIV-related risk factors among AGYW; assess the extent to which the overall DREAMS project contributed toward the goal of reducing HIV risk among AGYW; and understand the characteristics of male partners and how to link them to HIV services, as well as retain men living with HIV in care. (DREAMS is an initiative that aims to ensure that AGYW aged 15–24 have an opportunity to live Determined, Resilient, Empowered AIDS-free, Mentored, and Safe lives.) The findings of the study, conducted in the Zomba and Machinga districts and detailed in this report, aimed to inform HIV prevention programs and policies with the goal of improving health programming and overall well-being of AGYW and men in Malawi and other similar settings

Assessment of community-based ART service model linking female sex workers to HIV care and treatment in Blantyre and Mangochi, Malawi

The Population Council and partners (through Project SOAR) conducted this study to assess whether acquiring antiretroviral treatment medication through community-based drop-in centers would appeal to female sex workers in this context, to describe any observed effects on treatment outcomes, and to identify opportunities for improvement should this model be selected for future scale-up

Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi

Malawi’s national guidelines recommend that infants exposed to the human immunodeficiency virus (HIV) be tested at 6 weeks of age. Rollout of services for early infant diagnosis has been limited and has resulted in the initiation of antiretroviral therapy (ART) in very few infants

A Reduction in Adult Blood Stream Infection and Case Fatality at a Large African Hospital following Antiretroviral Therapy Roll-Out

Introduction Blood-stream infection (BSI) is one of the principle determinants of the morbidity and mortality associated with advanced HIV infection, especially in sub-Saharan Africa. Over the last 10 years, there has been rapid roll-out of anti-retroviral therapy (ART) and cotrimoxazole prophylactic therapy (CPT) in many high HIV prevalence African countries. Methods A prospective cohort of adults with suspected BSI presenting to Queen's Hospital, Malawi was recruited between 2009 and 2010 to describe causes of and outcomes from BSI. Comparison was made with a cohort pre-dating ART roll-out to investigate whether and how ART and CPT have affected BSI. Malawian census and Ministry of Health ART data were used to estimate minimum incidence of BSI in Blantyre district. Results 2,007 patients were recruited, 90% were HIV infected. Since 1997/8, culture-confirmed BSI has fallen from 16% of suspected cases to 10% (p<0.001) and case fatality rate from confirmed BSI has fallen from 40% to 14% (p<0.001). Minimum incidence of BSI was estimated at 0.03/1000 years in HIV uninfected vs. 2.16/1000 years in HIV infected adults. Compared to HIV seronegative patients, the estimated incidence rate-ratio for BSI was 80 (95% CI:46–139) in HIV-infected/untreated adults, 568 (95% CI:302–1069) during the first 3 months of ART and 30 (95% CI:16–59) after 3 months of ART. Conclusions Following ART roll-out, the incidence of BSI has fallen and clinical outcomes have improved markedly. Nonetheless, BSI incidence remains high in the first 3 months of ART despite CPT. Further interventions to reduce BSI-associated mortality in the first 3 months of ART require urgent evaluation

Outcome Assessment of a Dedicated HIV Positive Health Care Worker Clinic at a Central Hospital in Malawi: A Retrospective Observational Study

BACKGROUND: Malawi has one of the world's lowest densities of Health Care Workers (HCW) per capita. This study evaluates outcomes of a dedicated HCW HIV clinic in Malawi, created at Zomba Central Hospital in January 2007. METHODS AND FINDINGS: Retrospective cohort data was analyzed comparing HCW clinic patient baseline characteristics and treatment outcomes at 18 months after inception, against those attending the general HIV clinic. In-depth interviews and focus group discussions were conducted to explore perceptions of patients and caregivers regarding program value, level of awareness and barriers for uptake amongst HCW. 306 patients were enrolled on antiretroviral therapy (ART) in the HCW HIV clinic, 6784 in the general clinic. Significantly (p<0.01) more HCW clients were initiated on ART on the basis of CD4 as opposed to WHO Stage 3/4 (36% vs.23%). Significantly fewer HCW clients defaulted (6% vs.17%), and died (4% vs.12%). The dedicated HCW HIV clinic was perceived as important and convenient in terms of reduced waiting times, and prompt and high quality care. Improved confidentiality was an appreciated quality of the HCW clinic however barriers included fear of being recognized. CONCLUSIONS/SIGNIFICANCE: Outcomes at the HCW clinic appear better compared to the general HIV clinic. The strategy of dedicated clinics to care for health providers is a means of HIV impact mitigation within human resource constrained health systems in high prevalence settings

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+).

INTRODUCTION: Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the "model of care") and (ii) explore associations between the "model of care" and health facility-level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. METHODS: A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. RESULTS: Among 141 health facilities, four "models of care" were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the "model of care" applied; factors independently associated with ART retention were district location, patient volume and the "model of care" applied. CONCLUSIONS: A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the "model of care" chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations