More Than Brides Alliance: Baseline report, Malawi

The More Than Brides Alliance seeks to improve the lives of adolescent girls and includes activities across multiple domains (reproductive health, education, gender norms, and livelihoods, to name a few). The Population Council conducted baseline surveys of adolescents in select areas of two districts in Malawi as part of an evaluation of interventions to delay marriage. The goals of the baseline were to: 1) provide information about the current situation and context for adolescent girls in select areas in Malawi in order to inform the intervention; 2) provide a benchmark against which changes resulting from the intervention may be measured at the midline and endline periods; and 3) identify themes in need of further exploration through qualitative research. The study found significant differences between districts, and vulnerabilities emerged upon examining the data by education level and marital status. These findings suggest that girls in these communities have a demonstrated need for interventions to address these vulnerabilities. Findings from the baseline study will be used both to evaluate changes over time that may be attributable to the MTBA intervention and to inform programmatic staff seeking to understand the populations

Ward Round - Crocodile bites in Malawi: microbiology and surgical management

We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation. Malawi Medical Journal Vol. 21 (1) 2009: pp. 29-3

Crop residues as a potential renewable energy source for Malawi's cement industry

Crop residues have been undervalued as a source of renewable energy to displace coal in the national energy mix for greenhouse emission reduction in Malawi. Switching to crop residues as an alternative energy source for energy-intensive industries such as cement manufacturing is hampered by uncertainties in crop residue availability, cost and quality. In this study, future demand for energy and availability of crop residues was assessed, based on data at the sub-national level. Detailed energy potentials from crop residues were computed for eight agricultural divisions. The results showed that the projected total energy demands in 2020, 2025 and 2030 were approximately 177 810 TJ, 184 210 TJ and 194 096 TJ respectively. The highest supply potentials were found to be in the central and southern regions of Malawi, coinciding with the locations of the two clinker plants. Crop residues could meet 45–57% of the national total energy demand. The demand from the cement industry is only 0.8% of the estimated biomass energy potential. At an annual production of 600 000 t of clinker and 20% biomass co-firing with coal, 18 562 t of coal consumption would be avoided and 46 128 t of carbon dioxide emission reduction achieved per year. For sustainability, holistic planning and implementation would be necessary to ensure the needs of various users of crop residues are met. Furthermore, there would be a need to address social, economic and environmental barriers of the crop residue-based biomass energy supply chain. Future research should focus on local residue-to-product ratios and their calorific values

Two 'transitions': the political economy of Joyce Banda's rise to power and the related role of civil society organisations in Malawi

This is an Accepted Manuscript of an article published by Taylor & Francis in Review of African Political Economy on 21/07/2014, available online: http://www.tandfonline.com/doi/abs/10.1080/03056244.2014.90194

Covid-19 and the Return of the State in Africa

Abstract: As African countries battled the Covid-19 crisis in 2020, one of the questions that were raised was whether the state was taking a central stage in the affairs of society, especially solutions to major problems. The question was triggered by the fact that there has been a decline in the capacity, role and prestige of the state in Africa for decades. Yet it seems that the responses to Covid-19, following the WHO guidelines, have placed the state at the centre, without dislocating other stakeholders like the private sector and the civil society. This paper uses the evidence from a select number of African countries of different sizes in various regions of the continent to provide an empirical perspective on the role of the state in Covid-19 responses in 2020 to answer the question of whether Covid-19 has occasioned a return of the state, thus reversing the neoliberal designs in favour of a lean and mean state in Africa

Photoluminescent diamond nanoparticles for cell labeling: study of the uptake mechanism in mammalian cells

Diamond nanoparticles (nanodiamonds) have been recently proposed as new labels for cellular imaging. For small nanodiamonds (size <40 nm) resonant laser scattering and Raman scattering cross-sections are too small to allow single nanoparticle observation. Nanodiamonds can however be rendered photoluminescent with a perfect photostability at room temperature. Such a remarkable property allows easier single-particle tracking over long time-scales. In this work we use photoluminescent nanodiamonds of size <50 nm for intracellular labeling and investigate the mechanism of their uptake by living cells . By blocking selectively different uptake processes we show that nanodiamonds enter cells mainly by endocytosis and converging data indicate that it is clathrin mediated. We also examine nanodiamonds intracellular localization in endocytic vesicles using immunofluorescence and transmission electron microscopy. We find a high degree of colocalization between vesicles and the biggest nanoparticles or aggregates, while the smallest particles appear free in the cytosol. Our results pave the way for the use of photoluminescent nanodiamonds in targeted intracellular labeling or biomolecule deliver

Self-reported disability in relation to mortality in rural Malawi: a longitudinal study of over 16 000 adults.

OBJECTIVES: We investigated whether self-reported disability was associated with mortality in adults in rural Malawi. SETTING: Karonga Health and Demographic Surveillance Site (HDSS), Northern Malawi. PARTICIPANTS: All adults aged 18 and over residing in the HDSS were eligible to participate. During annual censuses in 2014 and 2015, participants were asked if they experienced difficulty in any of six functional domains and were classified as having disabilities if they reported 'a lot of difficulty' or 'can't do at all' in any domain. Mortality data were collected until 31 December 2017. 16 748 participants (10 153 women and 6595 men) were followed up for a median of 29 months. PRIMARY AND SECONDARY OUTCOME MEASURES: We used Poisson regression to examine the relationship between disability and all-cause mortality adjusting for confounders. We assessed whether this relationship altered in the context of obesity, hypertension, diabetes or HIV. We also evaluated whether mortality from non-communicable diseases (NCD) was higher among people who had reported disability, as determined by verbal autopsy. RESULTS: At baseline, 7.6% reported a disability and the overall adult mortality rate was 9.1/1000 person-years. Adults reporting disability had an all-cause mortality rate 2.70 times higher than those without, and mortality rate from NCDs 2.33 times higher than those without. CONCLUSIONS: Self-reported disability predicts mortality at all adult ages in rural Malawi. Interventions to improve access to healthcare and other services are needed

Cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with femoral shaft fractures in Malawi

Background and purpose — In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of femoral shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST. Patients and methods — This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with femoral shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty. Results — Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66–0.76) and 0.77 (CI 0.71–0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer’s perspective, or$1,035 from the societal perspective. Interpretation — IMN was cost saving and more effective than ST in the treatment of adult femoral shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.publishedVersio

Addressing Inequity to Achieve the Maternal and Child Health Millennium Development Goals: Looking Beyond Averages.

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs

The global development project contested: the local politics of the PRSP process in Malawi

Development, in an age of globalizations, has indeed become a global project. However, this project remains contested and contestable. While much attention has been given to this contestation at a macro-policy level, the dynamics of such contestations on the ground remain less studied. Noting that development projects, policies and programs are themselves products of power relations and social struggles, this paper focuses on the dynamics of these relations and struggles in relation to the dissemination of the global development project in Malawi. Drawing from the experiences and fractious journey from 2000 to 2006 of the broad-based civil society network involved in Malawi’s ongoing PRSP process, the paper shows how local actors draw creatively on globalized discourses of participation and representation to contest and confound the objectives of the elites, thereby complicating the channels through which the global development project is promulgated