Malawi

Drawing on a semi-autoethnography of a development project in northern Ethiopia, this article engages the role and power of indicators in the development sector. It both demonstrates and questions the power usually ascribed indicators when seen as an authoritative bureaucratic tool, while also showing how actors-and I was one of them-at various levels of the aid chain merely perform compliance with the indicators as a way to manage new and externally imposed demands. As the indicators 'travel' from the top, through the aid chain's multiple nodes, to the level of beneficiaries, they convey policy priorities top-down, but are seemingly complied with bottom-up, demonstrating both their formative power and the scope for brokerage and manipulation of externally imposed policies. Interestingly, this form of brokerage and reactivity from below are also enabled and orchestrated by the top, i.e. by the same actors who conveyed the indicators, to maintain and reproduce aid relations.

Antiretroviral medications can reduce rates of mother-to-child transmission of human immunodeficiency virus (HIV) to less than 5%. However, in 2011, only 57% of HIV-infected pregnant women in low- and middle-income countries received a World Health Organization (WHO)-recommended regimen for prevention of mother-to-child transmission (PMTCT), and an estimated 300,000 infants acquired HIV infection from their mothers in sub-Saharan Africa; 15,700 (5.2%) of these infants were born in Malawi. An important barrier to PMTCT in Malawi is the limited laboratory capacity for CD4 cell count, which is recommended by WHO to determine which antiretroviral medications to start. In the third quarter of 2011, the Malawi Ministry of Health (MOH) implemented an innovative approach (called "Option B+"), in which all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. Since that time, several countries (including Rwanda...

Rates of abnormal visual inspection with acetic acid and prevalence of high-risk human papillomavirus (HPV) subtypes have not been well characterized in HIV-infected women in Malawi. We performed a prospective cohort study of visual inspection with acetic acid (N = 440) in HIV-infected women aged 25--59 years, with a nested study of HPV subtypes in first 300 women enrolled. Of 440 women screened, 9.5% (N = 42) had abnormal visual inspection with acetic acid with 69.0% (N = 29) having advanced disease not amenable to cryotherapy. Of 294 women with HPV results, 39% (N = 114) of women were positive for high-risk HPV infection. Only lower CD4 count (287 cells/mm3 versus 339 cells/mm3, p = 0.03) and high-risk HPV (66.7% versus 35.6%, p < 0.01) were associated with abnormal visual inspection with acetic acid. The most common high-risk HPV subtypes in women with abnormal visual inspection with acetic acid were 35 (33.3%), 16 (26.7%), and 58 (23.3%). Low CD4 cell count was associated wit...

Blood culture is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream (such as bacteremia, septicemia amongst others). The blood culture represents a critical tool for the health care professional as a means of detecting the dangerous presence of living organism in the blood stream. A positive blood culture can suggest a definitive diagnosis, enable the targeting of therapy against the specific organisms and provide prognostic value (Bryan C.S 1989). In blood culture, false positive arises due to contamination which occurs when organisms that are not actually present in a blood sample are grown in culture. Faced with a positive blood culture result, clinicians must determine whether the organism represents a clinically significant infection associated with great risk of morbidity and mortality. Further complicating the issue in recent years is the increasing use of central venous catheters (CVC) and other indwelling vascular access devices (Anonymous

Blood culture is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream (such as bacteremia, septicemia amongst others). The blood culture represents a critical tool for the health care professional as a means of detecting the dangerous presence of living organism in the blood stream. A positive blood culture can suggest a definitive diagnosis, enable the targeting of therapy against the specific organisms and provide prognostic value (Bryan C.S 1989). In blood culture, false positive arises due to contamination which occurs when organisms that are not actually present in a blood sample are grown in culture. Faced with a positive blood culture result, clinicians must determine whether the organism represents a clinically significant infection associated with great risk of morbidity and mortality. Further complicating the issue in recent years is the increasing use of central venous catheters (CVC) and other indwelling vascu...

and Natural Resources (LUANAR) and Total Land Care (TLC) of Malawi. It is funded by the German Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung (BMZ), the CGIAR Research Program on Water, Land and Ecosystems (WLE) and CGIAR Fund donors. The views expressed and information contained in this document are, however, not necessarily those of or endorsed by BMZ, CGIAR, nor the project's implementing institutions, which can accept no responsibility or liability for such views, completeness or accuracy of the information or for any reliance placed on them. CIAT encourages wide dissemination of its printed and electronic publications for maximum public benefit. Thus, in most cases, colleagues working in research and development should feel free to use CIAT materials for noncommercial purposes. However, the Center prohibits modification of these materials, and we expect to receive due credit. Though CIAT prepares its publications with considerable care, the Center does not guarantee their accuracy and completeness.

Healthy and safe organic food plays a crucial role in environmental protection and
biodiversity conservation. Organic agriculture is an approach to cultivating healthy
and safe food and other agricultural products that rely on natural methods and
processes, avoiding the use of synthetic fertilizers, pesticides, genetically modified
organisms (GMOs), and other synthetic substances. The primary goal of organic
agriculture is to preserve the health of soil, plants, animals, humans, and the
environment by promoting sustainable practices that support biological diversity.
Organic farming methods, such as crop rotation and composting, provide a
sustainable approach to agriculture by improving soil structure, increasing fertility,
and reducing ecological risks. Organic agriculture is continuously evolving,
introducing new technologies and approaches that enhance sustainability and
productivity. Research indicates that organic farming supports greater plant and
animal species diversity compared to conventional agriculture, reduces greenhouse
gas emissions—critical for combating climate change—and offers significant health
benefits to consumers, including food richer in nutrients. By promoting and
supporting organic agriculture, we can achieve a sustainable balance between food
production and the conservation of natural resources, ensuring long-term
sustainability, environmental health, and biodiversity conservation on our planet.

This study was done during the study period November 2020 to September 2022, during which 47 patients of leprosy were examined of whom 36 were Lepromatous leprosy in Ophthalmology department if Rajah Muthiah Medical College and Hospital. In our study 80.06% of Lepromatous leprosy patients had ocular manifestations, of whom maximum prevalence was present in 61-75 age group. The major ocular manifestations present were Madarosis (61.11%), Iridocyclitis (50%), Lagophthalmos (11.11%), corneal anesthesia (22.22%), corneal Hypoesthesia (16.67%), exposure keratitis (8.33%) and corneal opacity (8.33). BCVA-3/60 to PL (U/L)-18.06% BCVA-3/60 to PL (B/L)-2.8% Most of the patients of Lepromatous leprosy had Bilateral Polyneuropathy. The most common nerve affected in Lepromatous leprosy was found to be ulnar nerve and Radial cutaneous nerve. The ocular symptoms occurred more in patients of WHO grade 2 Disability than grade 2 or grade 1. Ocular symptoms occurred mostly in patients who completed Leprosy treatment.

BACKGROUND The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes. METHODS In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. RESULTS A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediatetransfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P = 0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group. CONCLUSIONS There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggeredtransfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring. (Funded by the Medical Research Council and Department for International Development; TRACT Current Controlled Trials number, ISRCTN84086586.

BACKGROUND Severe anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level. METHODS In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. The primary outcome was 28-day mortality. RESULTS A total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (±SD) volume of total blood transfused per child was 475±385 ml and 353±348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P = 0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days. CONCLUSIONS Overall mortality did not differ between the two transfusion strategies.

In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10 %), 6-month mortality and relapse (6 %). A definitive trial to establish best transfusion and treatment strategies to prevent both early and delayed mortality and relapse is warranted. TRACT is a multicentre randomised controlled trial of 3954 children aged 2 months to 12 years admitted to hospital with severe anaemia (haemoglobin &lt; 6 g/dl). Children will be enrolled over 2 years in 4 centres in Uganda and Malawi and followed for 6 months. The trial will simultaneously evaluate (in a factorial trial with a 3 x...

Objectives  To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and December 2010.Methods  Routine data on patient with TB category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB only, TB/HIV co‐infected patients not on ART and TB/HIV co‐infected patients on ART using chi‐square tests. Trends over time illustrate strengths and weaknesses of integrated service provision.Results  Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear‐positive pulmonary TB (PTB) was highest among HIV‐negative patients with TB (34.9%); extra‐pulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children &lt;15 years, EPTB and smear‐positive PTB were more common among TB‐only patients. Time trends ...

Harmful use of alcohol ranks among the top five risk factors for disease, disability and death worldwide. However, not all individuals who consume alcohol throughout life are addicted and our premise is that addiction implies a chain of consumption that produces harmful effects. The objective of this study was to evaluate whether self-assessed past drinking problems-our measure of harmful alcohol consumption-affect the current alcohol consumption patterns. We expected that drinking problems in the past could have a positive effect on current alcohol consumption. Using Portuguese data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we applied an ordered probit model, given the ordered nature of the dependent variable. Our dependent variable measures the current consumption using categories listed in ascending order of alcohol intake frequency (from less than once a month to daily consumption). Our results suggest that harmful alcohol consumption in the past is an important determinant of current alcohol consumption. Self-assessed past drinking problems had a positive effect on the first five lower categories of current alcohol consumption frequency-less than once a month to up to six days a week. Therefore, to reduce non-communicable avoidable diseases related to the use of alcohol, policies should consider the individuals' decisions regarding alcohol consumption during their lifetime, and specific policies should focus on individuals with past drinking problems.

The science and practice of medicine and its primary source plays an important role in identifying the new molecule of drug through both synthetically and from that of natural origin. Most of the developing countries have adopted traditional medical practice as an integral part of their culture. Historically, all medicinal preparations were derived from plants, whether in the simple form of raw plant materials or in the refined form of crude extracts, mixtures, etc. The aim of this study was to evaluate the Cytotoxic Activity of Clerodendrum inerme (Family: Verbenaceae) and Caesalpinia crista (Family: Leguminosaceae), two widely distributed shrubs of the Sundarbans mangrove forest. A general cytotoxicity of all the extracts of C. inerme and C. crista were determined by Brine Shrimp Lethality Bioassay where the chloroformic extract of bark of C. inerme has the lowest LC 50 value of 5µg/ml. The ethanolic and chloroformic extracts of leaf of C. inerme and methanolic extracts of bark of C. crista also exhibited a significant cytotoxic activity with LC 50 values of 10µg/ml, 9.10µg/ml and 10µg/ml, respectively. In this investigation 0.5% chloramphenicol was used as the reference which LC 50 value was 10µg/ml.

In Malawi, maize seeds are a sociopolitical currency and the government’s primary tool for addressing severe and chronic food and seed insecurity. The large-scale government and donor-sponsored seed subsidy program (FISP) favors the distribution of commercial hybrid/OPV seed in order to augment yields; yet policy analysis suggests that exclusively addressing seed security through the formal seed sector risks undermining local systems of seed exchange. These informal systems have been documented repositories of locally-adapted crop varieties that possess a variety of desirable production and organoleptic qualities. Recently, community seed banks (CSBs) have emerged as an alternative, NGO-led development initiative aimed at improving seed access by providing a plethora of social and economic services beyond germplasm storage. To understand the role CSBs in maize seed systems, 60 semi-structured interviews were conducted with smallholders in two districts of Northern Malawi as part of ...

Background: Malawi is one of the countries in the Sub-Saharan region of Africa which is severely affected by the HIV pandemic. This being the case, student nurses' clinical encounters include caring for patients with HIV and AIDS. Such encounters evoke emotions of fear among nursing students and emotion management is essential as it promotes emotional engagement and compassionate care. Objectives: The study explored the clinical learning experience of undergraduate nursing students in Malawi, with an aim of gaining an understanding of the nature of their experience. Design: This was a hermeneutic phenomenological study. Setting: The study took place at a university nursing college in Malawi. Participants: Participants for the study were purposively selected and consisted of thirty undergraduate nursing students. Methods: Conversational interviews were conducted to obtain participants' accounts of their experience and a framework developed by modifying Colaizzi's procedural steps guided the phenomenological analysis. Results: The participating students reported of their experience during the early years of their studies, which depicted their experience as novice students and they also reported of their current experience at the time of the study, depicting their experience as senior students. The study findings revealed fear of contracting HIV infection among nursing students during the early years of their studies. Consequently, students avoided taking care of such patients, which depicts emotional detachment. As students progressed with their studies, they realised that patients with HIV and AIDS needed more support because of the problems they experienced. Students changed their attitude towards the patients and provided care compassionately, which portrays emotional engagement. Conclusion: The study findings illustrate that nursing students need to work on their emotions in order to provide compassionate care, which is consistent with the concept of emotional labour. The paper argues that emotional labour is essential in promoting compassionate care.

To describe oxygen concentrator functioning in two countries with widespread, long-term use of concentrators as a primary source of oxygen for treating children. D E S I G N : A systematic assessment of concentrators in the paediatric wards of 15 hospitals in Malawi and nine hospitals in Mongolia. R E S U LT S : Oxygen concentrators had been installed for a median of 48 months (interquartile range [IQR] 6-60) and 36 months (IQR 12-96), respectively, prior to the evaluation in Malawi and Mongolia. Concentrators were the primary source of oxygen. Three quarters of the concentrators assessed in Malawi (28/36) and half those assessed in Mongolia (13/25) were functional. Concentra-tors were found to remain functional with up to 30 000 h of use. However, several concentrators were functioning very poorly despite limited use. Concentrators from a number of different manufacturers were evaluated, and there was marked variation in performance between brands. Inadequate resources for maintenance were reported in both countries. C O N C L U S I O N : Years after installation of oxygen concentrators, many machines were still functioning, indicating that widespread use can be sustained in resourcelimited settings. However, concentrator performance varied substantially. Procurement of high-quality and appropriate equipment is critical, and resources should be made available for ongoing maintenance.

Background: There is limited understanding of health care providers' attitudes towards HIV-infected individuals' reproductive choices, as well as knowledge about safer conception. Our study objective was to explore provider-level factors that serve as barriers and/or facilitators to the provision of reproductive and safer conception services for men and women living with HIV. Methods: Twenty-five providers were interviewed in four focus group discussions about their attitudes regarding childbearing by HIV-infected clients, reproductive health and HIV knowledge, and views and knowledge of safer conception. Results: Providers reported ambivalence about supporting childbearing among their clients with HIV. They raised concerns about HIV-infected individuals having children, and in certain cases expressed judgment that people with HIV should not have children because of these concerns. Providers lack specific knowledge about safer conception strategies and have low level of knowledge of reproductive health, the efficacy of PMTCT, and the risks of pregnancy for HIV-infected women. Conclusions: Providers in our setting have complex attitudes about HIV-infected clients having children and lack knowledge to appropriately counsel clients about reproductive health and safer conception. Our findings highlight need for further research in this area as well as the need for provider training in reproductive health and safer conception.

greatly underreported worldwide. Further study is needed to determine if antipsychotics other than clozapine cause myocarditis or cardiomyopathy, particularly lithium, chlorpromazine, fluphenazine, haloperidol, and risperidone, and to consider the comparative risks and effectiveness of antipsychotics. This is especially important given the recent finding that older and newer drugs have similar efficacy. 9 Antipsychotic drugs should also be considered in unexplained sudden deaths in psychotic patients. We thank the national centres that contribute data to the WHO international drug monitoring programme. The opinions and conclusions, however, are not necessarily those of the various national centres or of the WHO. Roland Orre was central in developing the bayesian confidence propagation neural network as a routine tool for signal detection in the WHO database of drug adverse reactions. Contributors: DMC suggested the study and made a provisional investigation of the data, AB and IRE planned and designed the study; AB carried out the study; and IRE, AB, and ML evaluated the results. RHBM drafted the first report of the study, AB and IRE wrote the paper, and all authors contributed to modifying the manuscript and the final editing of the paper. IRE is the guarantor. Funding: None. Competing interests: None declared.

SETTING-A large urban pediatric human immunodeficiency virus (HIV) clinic in Lilongwe, Malawi. OBJECTIVE-To identify demographic and clinical risk factors for mortality in children coinfected with HIV and tuberculosis (TB). DESIGN-A retrospective cohort study of HIV-infected children (aged <18 years) enrolled between October 2004 and October 2010 with at least one current or historical TB diagnosis. Descriptive statistics and logistic regression analyses were performed to determine factors associated with mortality. RESULTS-A total of 1561 patients met the inclusion criteria, representing 32% of patients ever enrolled. Median age at TB diagnosis was 3.8 years (interquartile range 1.5-7.4); 60.9% had severe immune suppression and 47.6% of those with available data had some degree of acute malnutrition at TB diagnosis. Of the 1113 patients with known outcomes, 225 (20.2%) died. Children with TB-HIV co-infection not initiated on anti-retroviral therapy (ART) at any time were 8.8 times more likely to die compared to those initiated on ART 0-2 months after initiation of antituberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immuno-suppression and World Health Organization Stage IV were also associated with mortality.

The East African Rift System (EARS) has played a central role in our understanding of human origins and vertebrate evolution in the late Cenozoic of Africa. However, the distribution of fossil sites along 3 the rift is highly biased toward its northern extent, and the types of paleoenvironments are primarily restricted to fluvial and lacustrine settings. Here we report the discovery of the first fossil sites from the Urema Rift at Gorongosa National Park (central Mozambique) at the southern end of the EARS, and reconstruct environmental contexts of the fossils. In situ and surface fossils from the lower member of the Mazamba Formation, estimated to be of Miocene age, comprise mammals, reptiles, fishes, invertebrates, palms, and dicot trees. Fossil and geological evidence indicates a coastal-plain paleoenvironmental mosaic of riverine forest/woodland and estuarine habitats that represent the first coastal biomes identified in the Neogene EARS context. Receiving continental sediment from source terranes west of today's Urema Graben, estuarine sequences accumulated prior to rifting as compound incised-valley fills on a low-gradient coastal plain following transgression. Modern environmental analogues are extremely productive habitats for marine and terrestrial fauna, including primates. Thus, our discoveries raise the possibility that the Miocene coastal landscapes of Gorongosa were ecologically-favorable habitats for primates, providing relatively stable maritime climate and ecosystem conditions, year-round freshwater availability, and food both from terrestrial and marine sources. The emerging fossil record from Gorongosa is beginning to fill an important gap in the paleobiogeography of Africa as no fossil sites of Neogene age have previously been reported from the southernmost part of the EARS. Furthermore, this unique window into past continentalmargin ecosystems of central Mozambique may allow us to test key paleobiogeographic hypotheses during critical periods of primate evolution.

Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to enrich maternal and child diets with the objective of preventing undernutrition during the first 1,000 days. Scaling up the delivery of supplements such as SQ-LNS hinges on understanding private demand and creatively leveraging policy-relevant factors that might influence demand. We used longitudinal stated willingness-to-pay (WTP) data from contingent valuation studies that were integrated into randomized controlled nutrition trials in Ghana and Malawi to estimate private valuation of SQ-LNS during pregnancy, postpartum, and early childhood. We found that average stated WTP for a day&#39;s supply of SQ-LNS was more than twice as high in Ghana than Malawi, indicating that demand for SQ-LNS (and by extension, the options for effective delivery of SQ-LNS) may be very context specific. We also examined factors associated with WTP, including intervention group, household socioeconomic status, birth outcomes, child ...

Background/aims: In the coming two decades significant increases in the burden of blindness are anticipated unless concerted efforts are made to improve eye care in developing countries. Evidence of changing prevalence rates or numbers of blind people are few. The change in blindness prevalence and the number of blind people in an adult population of Malawi was measured over a 16 year period. Methods: In 1999 a population based survey of blindness in adults (age 50+) was conducted in Chikwawa district of Malawi. Visual acuity and cause of vision loss were recorded for each eye independently. Blindness was defined as presenting better eye vision of <6/60. Findings from a 1983 survey of blindness in the same district (using similar methods) were re-analysed to be comparable with the survey conducted in 1999. Results: Among 1630 enumerated adults 89% were examined. The age adjusted prevalence of blindness in the adult population was 5.4% and more common in women than men. In each age group the prevalence of blindness was lower in 1999 than in 1983; the overall reduction in blindness was 31%. During this period the 50+ population in Malawi increased almost twofold. Extrapolating the Chikwawa district data to the Malawi population reveals that the number of blind people has increased by 24%; the increase is primarily because of the large increase in the size of the most elderly group, aged 70 and above. Conclusion: The majority of blind people in Chikwawa (1983 and 1999) are in the age group 70 and over. This group has had the largest proportional increase in population size in this time. Services in this population have improved in the intervening 16 years and yet there was still an increase in the number of blind people. There was little change in excess blindness in women, suggesting that the same barriers that prevented utilisation of services in 1983 probably persist in 1999. Efforts to reach the most elderly and to reach women are needed to lead to a reduction in blind people in settings such as rural Malawi.

This paper describes the morphological evolution of-ile suffix across four Bantu languages selected from the Nyasa-Tanganyika corridor. The suffix-ile which is traditionally an aspect (perfective) marker is changing and becoming amenable to different roles across Bantu languages. This poses a challenge in specifying its roles as a tense and/or an aspect marker unless attention is paid to an individual language. The findings presented in this paper indicate that in the languages under study, the suffix-ile functions as both a tense and an aspect marker. It co-occurs with pre-root formatives to mark different past tenses. In Nyakyusa, in particular, the suffix marks different categories of aspect, namely anterior, non-progressive and indefinite conditional aspect. However, in Ndali, Malila and Nyiha, the suffix-ile marks only the non-progressive aspect. In this view, this paper concludes that the-ile suffix is gradually vanishing in the forms for aspect meanwhile it extends its roles into marking different tense categories.

The importance of human capital has been increased during the last period because many financial institutions and banks faced a lot of problems. The reason of facing these problems or crises is that those companies had a lack of trained and professional staff. So, banks around the globe noticed this problem and tried very hard to attract the well trained employees and improve their employees’ skills. This study examines the impact of human capital on banking financial performance for Jordan Islamic Bank (JIB) during 2000 – 2014. The Dependent variable is financial performance which was presented by net income, return on assets, and return on equity. Meanwhile, the independent variable is human capital which was measured by number of employees, number of branches and offices, number of courses and seminars, and finally number of the participants in the courses and seminars. The researchers found a positive and significant relationship between net income and number of employees, but t...

What is the key question? ► Are the low lung volumes previously reported in adults from Malawi a result of impaired lung development in early life or accelerated lung function decline in adulthood or both, and does biomass smoke exposure influence the rate of decline in the same way as tobacco smoke exposure? What is the bottom line? ► In an adult population with high biomass smoke exposure, we found rates of lung function decline comparable with healthy nonsmokers in high-income countries and lung function z-scores consistent with those reported in children from the same rural Malawian community. Why read on? ► We report the first longitudinal lung function data from a population-representative cohort in sub-Saharan Africa: the results suggest that exposure to biomass fuel smoke may be less harmful than exposure to tobacco smoke or traffic-related air pollution, as reported in highincome settings.

Post World War Two socio-economic development assessments show bleak as well as paradoxical trends in the developing world, given the efforts of nationalist governments and the donor community to improve people&#x27;s quality of life. While assessments agree that the development project ...

Malaria continues to pose a significant threat to pregnant women in sub-Saharan Africa, including Ghana, where the uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) remains below optimal levels. This study explored factors influencing IPTp-SP uptake among 300 postpartum mothers in Asunafo North Municipal using a descriptive cross-sectional design. Data were gathered through pretested questionnaires, and statistical analyses included descriptive, bivariate, and multivariate methods, with logistic regression used to assess relationships at a significance level of α = 0.05. A significant proportion (43.7%) of participants received three or more doses of IPTp-SP, while 56.3% received two or fewer doses. Key barriers to uptake included being unmarried (AOR = 0.36, [95% CI 0.145–0.881], p = 0.025) and unemployed (COR = 0.61, [95% CI 0.38–0.98], p = 0.042). Fewer antenatal care (ANC) visits (≤3 times) were strongly associated with lower odds of receiving three or more doses (AOR = 0.03, [95% CI 0.01–0.83], p &lt; 0.001). Higher IPTp-SP uptake was positively linked to the perceived severity of malaria in pregnancy (AOR = 0.19, [95% CI 1.02–4.20], p = 0.045) and the perceived benefits of IPTp-SP (AOR = 0.39, [95% CI 0.19–0.78], p = 0.008). Perceived susceptibility to malaria did not significantly affect uptake. Sociodemographic factors such as age, education, and parity showed no significant associations. Major barriers included time and financial constraints related to ANC attendance. The study underscores the need for better alignment between ANC attendance and IPTp-SP administration, and suggests that future research should evaluate ANC interventions to enhance IPTp-SP uptake and reduce malaria-related complications.

The aim of this study was to investigate the outcomes of sutureless, manual small-incision cataract surgery (SICS) in rural sub-Saharan Africa using standard intraocular lenses (IOLs). In order to assess the quality of surgery, we prospectively evaluated the visual outcomes of 1455 consecutive cataract operations performed in 2006 in patients ≥40 years at Nkhoma Eye Hospital, Malawi. All operations used standard 22-dioptre IOLs without pre-operative biometry. Outcomes were categorised according to the World Health Organization criteria, and causes of a poor outcome were recorded. Mean age of patients was 71.5 ± 9.5 years, and 53 % were female. Pre-operatively, 64 % of eyes had a visual acuity (VA) &lt;6/60, and 41.3 % of eyes were blind (VA &lt; 3/60). Without correction (uncorrected VA), nearly eighty percent (78.7 %) achieved a &#x27;good&#x27; outcome (VA 6/6-6/18), 19.8 % were &#x27;borderline&#x27; (VA &lt; 6/18-6/60), and 1.5 % had a poor (VA &lt; 6/60) outcome. With pinhole-c...

The global burden of anemia is large especially in sub-Saharan Africa, where HIV is common and lifestyles are changing rapidly with urbanization. The effects of these changes are unknown. Studies of anemia usually focus on pregnant women or children, among whom the burden is greatest. We describe prevalence and risk factors for anemia among rural and urban men and women of all ages in Malawi. We analyzed data from a population-wide cross-sectional survey of adults conducted in two sites, Karonga (rural) and Lilongwe (urban), commencing in May 2013. We used multinomial logistic regression models, stratified by sex to identify risk factors for mild and moderate-to-severe anemia. Anemia prevalence was assessed among 8,926 men (age range 18-100 years) and 14,978 women (age range: 18-103 years). Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 8.2, 6.7 and 1.2% in rural men; 19.4, 12.0 and 7.4% in rural women; 5.9, 5.1 and 0.8% in urban men; and 23.4, 13.6 and...

Lymphatic filariasis (LF) and human immunodeficiency virus (HIV) are major public health problems. Individuals may be co-infected, raising the possibility of important interactions between these two pathogens with consequences for LF elimination through annual mass drug administration (MDA). We analysed circulating filarial antigenaemia (CFA) by HIV infection status among adults in two sites in northern Malawi, a region endemic for both LF and HIV. Stored blood samples and data from two geographically separate studies were used: one a recruitment phase of a clinical trial of anti-filarial agent dosing regimens, and the other a whole population annual HIV sero-survey. In study one, 1,851 consecutive adult volunteers were screened for HIV and LF infection. CFA prevalence was 25.4% (43/169) in HIV-positive and 23.6% (351/1487) in HIV-negative participants (p=0.57). Geometric mean CFA concentrations were 859 and 1660 antigen units per ml of blood (Ag/ml) respectively, geometric mean rat...

The effect of food supplementation provided by the World Food Programme to patients and their families enrolled in a predominantly HIV/AIDS home based care programme in Bangwe Malawi is assessed. The survival and nutritional status of patients and the nutritional status of their families recruited up to six months before a food supplementation programme started are compared to subsequent patients and their families over a further 12 months. 360 patients, of whom 199 died, were studied. Food supplementation did not improve survival but had an effect (not statistically significant) on nutritional status. Additional oil was given to some families; it may have improved survival but not nutritional status. Food supplementation to HIV/AIDS home based care patients and their families does not work well. This may be because the intervention is too late to affect the course of disease or insufficiently targeted perhaps due to problems of distribution in an urban setting. The World Food Progr...

Emerging from the worst harvest in a decade, the Government of Malawi implemented one of the most ambitious and successful assaults on hunger in the history of the African continent. Through a national input subsidy program, coinciding with better rainfall conditions, maize production doubled in 2006 and almost tripled in 2007. From a 43 % national food deficit in 2005, Malawi achieved a 53 % surplus in 2007, some of which was exported to neighboring countries. An associated decline in the price of maize conveys important benefits to low-income urban

In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one’s partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and l...

The randomised controlled trial (RCT) is considered the scientific foundation of medical practice in evidence based medicine. Therefore, the evidence it brings should put an end to controversies. But this was not the case if we look at the demonstration of the protective role of male circumcision (MC) against HIV/AIDS infection. Although based on a series of epidemiological investigations, culminating in RCTs, the benefits of MC are a controversial subject in the medical and scientific community. The RCTs are considered too reductionist; they allow for control during the investigation but are divorced from real-life conditions. In fact, evidence appears as a social,construction, relying on,more than objective factors, sometimes prejudices and misconceptions. Articles published on MC in scientific journals over nearly two decades and the reactions they elicited, both inside and outside the,medical community are analysed. Data produced within RCTs have been criticised, notably for the...

The sexual and reproductive health issues of adolescents have been a matter of serious concern globally. This is due to the fact that adolescents as a group in most cases engage in very dangerous risky sexual behaviour that exposes them to several health problem as such sexually transmitted infectious (STIs) including HIV/AIDS; unwanted pregnancies which eventually leads to grave consequences of abortion and other complications. There are health care services and programmes put in place to address these challenging health issues confronting them. Jr is against this backdrop that this paper seeks to look at the challenges
facing adolescents in Nigeria, the need to reduce the occurrences of reproductive health complications. The paper also explored the current trends, and policies associated with their reproductive health. 2Key words: Restructuring, Adolescent, Sexual and Reproductive, Health Issue, Nigeria.