The Malawi Agricultural Input Subsidy Programme: 2005-6 to 2008-9

Malawi’s implementation of a large scale agricultural input subsidy programme in 2005/6 and subsequent years has attracted significant international interest. This paper reviews the background, processes, achievements and outcomes of the programme over the period 2005/6 to 2008/9. The very large scale disbursement of heavily subsidised fertilisers and (mainly hybrid and composite maize) seed to very large numbers of beneficiaries across the country represents a significant logistical achievement and led to significant increases in national maize production and productivity, and this has contributed to increased food availability, higher real wages and wider economic growth and poverty reduction. However the latter years of the programme have also been accompanied by very high international fertilizer prices and costs and by high maize prices, the latter undermining the programme’s food security, poverty reduction and growth benefits for the majority of Malawian farmers, who are very poor and rely on purchased maize for significant amounts of their staple food requirements. Estimated economic returns to the programme have been satisfactory, given other benefits of the programme not captured in cost benefit analysis. With substantial reductions in both prices and subsidised volumes of fertilisers in subsequent years, there is considerable scope for building on achievements to substantially raise programme effectiveness, efficiency and benefits. Any application of Malawi’s subsidy experience to other countries needs to take account of special characteristics of the Malawian maize economy and of measures needed to raise such programmes’ effectiveness and efficiency and ensure their best fit with and contribution to sustainable development policies

Childbirth information feeds for first time Malawian mothers who attended antenatal clinics

Childbirth information received by mothers during antenatal period influences their satisfaction with the care during perinatal period. It is important for the midwives to know the type of information that satisfies their clients. This study found that the childbirth information that mothers received during antenatal period did not satisfy them. On the other hand, although some of the information received at home was useful, some information had potential to cause fear, anxiety and ill health on the mothers. The information needs of the clients were taken into account when designing a childbirth program for Malawi. Aim The specific objective of the study was to identify childbirth information needs of Malawian women as perceived by Malawian mothers and midwives in order to design a childbirth education program. Methods An exploratory, descriptive qualitative design was used to determine Malawian women’s childbirth information needs. A total of 150 first time mothers who attended antenatal clinics at selected central, district and mission hospitals were interviewed.Four focus group discussions were conducted with four different types of midwives to identify their perceptions of the childbirth information needs of Malawian women. These discussions were complimented by individual interviews with experienced midwives who held key positions in government and non governmental health organizations. Results The content of the childbirth education program for pregnant mothers should include; care during pregnancy, danger signs during pregnancy, labor and after birth, the labor process and the postnatal care for the mother and the baby. Regarding cultural beliefs and taboos of childbirth, it was recommended that they should not be presented as a stand alone topic but be incorporated in other topics such as self care. Cultural beliefs and taboos vary with regions and tribes hence rather than generalizing, midwives should address specific issues prevalent in their work areas. The training manual should be translated into the vernacular language in view of the high illiteracy rate in the country. Conclusion The education program should address self-care during pregnancy, nutrition during pregnancy, common discomforts of pregnancy, danger signs of pregnancy, sexually transmitted diseases and preparation for delivery. The program should also address the labor process, possible complications during labor and birth, caesarean birth and non pharmaceutical pain relief measures in labor. It was also evident that the program should deal with self-care during postnatal period, exclusive breast feeding, care of the newborn baby, danger signs of puerperium, care of the newborn baby and family planning

HIV prevention awareness and practices among married couples in Malawi

In this study we explored the level of awareness and practice on HIV prevention among married couples from selected communities in Malawi. Methods We carried out the study from October to December, 2008 in four communities, two each from Chiradzulu and Chikhwawa districts of Malawi. We conducted face-to-face in-depth interviews with 30 couples in each district using a semi-structured interview guide. The interviews lasted approximately 60-90 minutes. The husbands and wives were interviewed separately. The interviews were audio taped using a digital recorder. We wrote field notes during data collection and later reviewed them to provide insights into the data collection process. We computed descriptive statistics from the demographic data using SPSS version 16.0. We analyzed qualitative data using Atlas ti 5.0 computer software. The coded data generated themes and we present the themes in qualitative narration. Results The couples’ ages ranged from 20 to 53 years, the majority (52%) being in the 20-31year age group. Most of the couples (67%) attained only primary school education and 84% had been married only to the current partner. Most couples (83%) depended upon substance farming and 47% had been married for 3 to 9 years. The number of children per couple ranged from 1 to 10, most couples (83%) having between 1 and 5 children. All couples were aware of HIV prevention methods and talked about them in their marriages. Both wives and husbands initiated the discussions. Mutual fidelity and HIV testing were appropriate for couples to follow the HIV prevention methods. For most couples (54) there was mutual trust between husbands and wives, and members of only a few couples (6) doubted their partners’ ability to maintain mutual fidelity. Actual situations of marital infidelity were however detected among 25 couples and often involved the husbands. A few couples (5) had been tested for HIV. All couples did not favor the use of condoms with a marriage partner as an HIV prevention method. Conclusion The level of HIV prevention awareness among couples in Malawi is high and almost universal. However, there is low adoption of the HIV prevention methods among the couples because they are perceived to be couple unfriendly due to their incompatibility with the socio-cultural beliefs of the people. There is a need to target couples as units of intervention in the adoption of HIV prevention methods by rural communities

Parenting experiences of couples living with human immunodeficiency virus: A qualitative study from rural Southern Malawi

The advent of antiretroviral therapy (ART) has allowed couples living with human immunodeficiency virus (HIV) to live longer and healthier lives. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV (PLWH) to have children. However, little is known about the parenting experiences of couples living with HIV (CLWH). The aim of this qualitative study was to explore and describe parenting  experiences of seroconcordant couples who have a child while living with HIV in Malawi. Data were collected using in-depth interviews with 14 couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa  communities from July to December 2010. The research findings shows that irrespective of kinship organization, economic hardships, food insecurity, gender-specific role expectations and conflicting information from health institutions and media about sources of support underpin their parenting roles. In addition, male spouses are directly involved in household activities, childcare and child feeding decisions, challenging the existing  stereotyped gender norms. In the absence of widow inheritance, widows from patrilineal communities are not receiving the expected support from the deceased husband relatives. Finally, the study has shown that CLWH are able to find solutions for the challenges they encounter. Contrary to existing belief that such who have children depend solely on public aid. Such claims without proper knowledge of local social cultural contexts, may contribute to stigmatizing CLWH who continue to have children. The study is also relevant to PLWH who, although not parents themselves, are confronted with a situation where they have to accept responsibility for raising children from their kin. We suggest the longer-term vision for ART wide access in Malawi to be broadened beyond provision of ART to incorporate social and economic interventions that support the rebuilding of CLWH social and economic lives. The interventions must be designed using a holistic multi-sector approach.Keywords: Malawi, couples, experiences, HIV and AIDS, parentingL’ave`nement de la the´rapie antire´trovirale a permis couples vivant avec le VIH de vivre plus longtemps et en meilleure sante´. La re´duction de la transmission du VIH de la me`re a` l’enfant a encourage´ certaines personnes vivant avec le VIH ont deux enfants. Cependant, on sait peu sur les expe´riences parentales des  couples vivant avec le VIH. Le but de cette e´tude qualitative e´tait d’explorer et de´crire des expe´riences  parentales des couples se´roconcordants qui ont un enfant tout en vivant avec le VIH au Malawi. Les donne´es  ont e´te´ collecte´es abuser des entrevues en profondeur avec des quatorze couples dessein e´chantillonne´s dans les communaute´s matriline´aires et patriline´aires Chiradzulu, Chikhwawa de Juillet jeu. De´cembre 2010.  Les re´sultats de recherche montrent que, inde´pendamment de l’organisation de la parente´, les difficulte´s  e´conomiques, l’inse´curite´ alimentaire, le roˆle des attentes spe´cifiques de genre et des informations  contradictoires des institutions de sante´ et les me´dias au sujet des sources de soutien angoisse leur roˆle  parental En outre, les conjoints de sexe masculin sont directement implique´s dans les activite´s de me´nage,  garde d’enfants et les de´cisions de l’alimentation des enfants, contestant la norme de genre ste´re´otype´s existant. En l’absence de l’he´ritage des veuves, veuves des communaute´s patriline´aires ne rec¸oivent pas le  soutien attendu de la famille du mari de´funt. Enfin, l’e´tude a montre´ que les couples vivant avec le VIH sont  a` l’aise pour trouver des solutions aux de´fis qu’ils rencontrent. Contrairement deux croyance existante que ce  qui ont des enfants de´pendent uniquement sur l’aide publique. Ces revendications sans la connaissance de  contextes socioculturels locaux, peut contribuer a` stigmatiser les couples vivant avec le VIH qui continuent deux  ont des enfants. L’e´tude est e´galement pertinent pour les personnes vivant avec le VIH qui, bien que non les  parents themelves, sont confronte´s a` une situation ou` ils doivent accepter la responsabilite´ d’e´lever les enfants de leurs parents. Nous sugge´rons la vision a` long terme de la the´rapie antire´trovirale large acce`s au Malawi a` eˆtre e´largi au-dela` de la fourniture d’un traitement antire´troviral deux interventions sociales et e´conomiques Incorporer qui soutiennent la reconstruction des couples vivant avec le VIH vie sociale et  e´conomique. Les interventions doivent eˆtre conc¸ues utilisation excessive d’une approche multi-sectorielle  globale.Mots cle´s: Malawi, les couples, les expe´riences, le VIH et le SIDA, la parentalite

The use of exogenous microbial species to enhance the performance of a hybrid fixed-film bioreactor treating coal gasification wastewater to meet discharge requirements

The objective of this study was to determine whether inoculating a hybrid fixed-film bioreactor with exogenous bacterial and diatoma species would increase the removal of chemical oxygen demand, nitrogenous compounds and suspended solids from a real-time coal gasification wastewater to meet environmental discharge requirements specified for petrochemical refineries. The COD removal increased by 25% (45% to 70%) at a relatively high inoculum dosage (370 g∙m−3) and unit treatment cost (12.21 €∙m−3). The molar ratio of monovalent cations to divalent cations (M/D >2) affected nitrification, settling of solids and dewatering of the sludge. The use of a low-charge cationic flocculant decreased the suspended solids in the effluent by 70% (180 mg∙L−1 to 54 mg∙L−1) and increased the sludge dewatering rate by 88% (61 s∙L∙g−1 to 154 s∙L∙g−1) at a unit treatment cost of 2.5 €∙t−1 dry solids. Organic compounds not removed by the indigenous and exogenous microbial species included benzoic acids (aromatic carboxylic acids), 2-butenoic acid (short-chain unsaturated carboxylic acid), I(2H)-isoquinolinone (heterocyclic amine), hydantoins (highly polar heterocyclic compounds), long-chain hydrocarbon length (carbon length > C15) and squalene. These organic compounds can thus be classified as poorly degradable or nonbiodegradable which contributed to the 30% COD not removed by the H-FFBR. The use of exogenous microbial species improved the quality of CGWW; however, not sufficiently to meet discharge requirements. The cost of such treatment to meet discharge requirements would be unsustainable. Alternative technologies need to be investigated for reusing or recycling the CGWW rather than discharging.Keywords: ammonia, catalytic reactor technology, COD, fixed-film bioreactor, hydantoins, thiocyanate

Developmental outcome of very low birth weight infants in a developing country

Background: Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. Methods: The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. Results: 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69-91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85-90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0-93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome. Conclusion: Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age