Malawi

Background: International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper.

North-South partnerships in graduate nursing education can prepare students to address global healthcare issues, increase cultural competence, and build research capacity. However, the current literature does not include a critical and systematic assessment of partnerships using established guidelines. This paper has two objectives: 1) Find and refine a suitable measure to assess a North-South inter-institutional research and clinical partnership in nursing; 2) Pilot test an assessment measure and describe the results of a systematic institutional self-evaluation of a developing North-South research and clinical partnership within a graduate nursing program. The first objective was addressed by searching for, examining and selecting an assessment measure. The second objective was obtained by applying the assessment measure to a developing graduate-level research and clinical partnership between a Canadian School of Nursing and a Malawian College of Nursing; qualitative data collected included information from a document review and subjective experiences of partners. Results showed that when appropriate revisions are made to an existing guideline, it is applicable to use as an assessment measure for North-South inter-institutional research and clinical partnerships. Recommendations for improvement were made, allowing the guideline to be more specific for research and clinical partnerships. Results demonstrated that the existing Canadian-Malawian partnership was strongest in the guideline category of "shaping the purpose and scope of the partnership," and weakest in "partnership implementation and context." This paper implies that: 1) evaluation can strengthen partnerships and enhance educational experience for nursing students; 2) research comparing and contrasting different genres of partnerships could help determine which type is the most appropriate for an institutions' particular outcome goals; and 3) effective establishment and maintenance of North-South partnership occurs through an on-going process of evaluation.

The presence of food-borne pathogens, Escherichia coli 0157:H7, Staphylococcus aureus, Salmonella species, Campylobacter jejuni and non-pathogenic E. coli, in 132 home cooked food samples consisting of maize flour porridge (MFP), (n = 41), fish (n = 37), vegetables (n = 28), beans (n = 13) and "Others" (n = 13), collected from 6 villages in Lungwena, Malawi was investigated. It was found that 35% of the food samples were contaminated with one or more pathogens; with 48%, 8%, 61% and 23% of the food samples being found to harbour E. coli, pathogenic E. coli 0157: H7, S aureus and Salmonella species, respectively. C. jejuni was not detected in any food sample. Using a 95% level of significance, pathogen concentration among food categories demonstrated a statistical difference (p = 0.001). Distribution of pathogens among villages was also found to be significant (p = 0.03). MFP was the most contaminated food. Practices that promote the spread of the pathogens in the rural household kitchens were investigated. Food was thought to be contaminated as a result of poor food handling, preparation and storage practices.

In 1993, Malawi stopped treating patients with chloroquine for Plasmodium falciparum malaria because of a high treatment failure rate (58%). In 1998, the in vitro resistance rate to chloroquine was 3% in the Salima District of Malawi; in 2000, the in vivo resistance rate was 9%. We assayed two genetic mutations implicated in chloroquine resistance (N86Y in the P. falciparum multiple drug resistance gene 1 and K76T in the P. falciparum chloroquine resistance transporter gene) in 82 P. falciparum isolates collected during studies in 1998 and 2000. The prevalence of N86Y remained similar to that in neighboring African countries that continued to use chloroquine. In contrast, the prevalence of K76T was substantially lower than in neighboring countries, decreasing significantly from 17% in 1998 to 2% in 2000 (P < 0.02). However, neither mutation was significantly associated with in vivo or in vitro resistance (P > 0.29). Withdrawal of the use of chloroquine appears to have resulted...

HIV self-testing (HIVST) is increasingly being sought and offered globally, yet there is limited information about the test features that will be required for an HIV self-test to be easy to use, acceptable to users, and feasible for manufacturers to produce. We conducted formative usability research with participants who were naïve to HIVST using five prototypes in Kenya, Malawi, and South Africa. The tests selected ranged from early-stage prototypes to commercially ready products and had a diverse set of features. A total of 150 lay users were video-recorded conducting unsupervised self-testing and interviewed to understand their opinions of the test. Participants did not receive a test result, but interpreted standardized result panels. This study demonstrated that users will refer to the instructions included with the test, but these can be confusing or difficult to follow. Errors were common, with less than 25 % of participants conducting all steps correctly and 47.3 % of participants performing multiple errors, particularly in sample collection and transfer. Participants also had difficulty interpreting results. To overcome these issues, the ideal HIV self-test requires pictorial instructions that are easy to understand, simple sample collection with integrated test components, fewer steps, and results that are easy to interpret.

Across southern Africa (SA), significant maize yield losses are attributed to invasive and parasitic weeds. Abundance of Striga (Striga asiatica) has become more frequent in smallholder farms (<2 ha) in the past decade. Various Striga control practices (SCPs) have been disseminated across SA, yet often, without decision support tools to inform extension officers and researchers which ones are most appropriate for smallholder contexts. System dynamics modeling (SDM) provides an opportunity to evaluate the efficacy of SCPs across multiple seasons in different agroecosystems and their associated environments. We developed a SDM to evaluate the long-term efficacy of four SCPs popularly used in maize-based cropping systems. Observations from studies outlining local soil seedbanks, emergence and flowering rates in farmer fields were used to calibrate the SDM. Model simulations indicate that while a combination of SCPs are necessary to manage the weed, future research should focus on developing smallholder-adapted SCPs that address the attachment stage of the weed's lifecycle (e.g., timely manure application) rather than its germination, emergence or flowering stages. Given the devastating effects S. asiatica has had on food security in Malawi and across SA, it is imperative to develop decision support tools like systems models to evaluate SCPs for smallholders. Models that do not capture the underlying mechanisms driving S. asiatica infestations may provide extension officers with potentially misleading information , and subsequently, the delivery of ineffective SCPs.

Background: Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods: The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results: Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion: Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at community level. There is need for creation of awareness in men so that they sustain their participation in maternal health care activities of their female partners even in the absence of incentives, coercion or invitation.

Background: Although 80% of children with disabilities live in developing countries, there are few culturally appropriate developmental assessment tools available for these settings. Often tools from the West provide misleading findings in different cultural settings, where some items are unfamiliar and reference values are different from those of Western populations.