Search results for: Malawi

Authors: Christopher Manyamba

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Women in Malawi produce perform between 50-70 percent of all agricultural tasks and yet the majority remain food insecure. The aim of his paper is to build on existing mixed evidence that indicates that empowering women in agriculture is conducive to improving food security. The WEAI is used to provide evidence on the relationship between women’s empowerment in agriculture and household food security. A multinomial logistic regression is applied to the Women Empowerment in Agriculture Index (WEAI) components and the Household Hunger Scale. The overall results show that the WEAI can be used to determine household food insecurity; however it has to be contextually adapted. Assets ownership, credit, group membership and leisure time are positively associated with food security. Contrary to other literature, empowerment in having control and decisions on income indicate negative association with household food security. These results could potentially better inform public, private and civil society stakeholders’ dialogues in creating the most effective and sustainable interventions to help women attain long-term food security.

Keywords: food security, gender, empowerment, agriculture index, framework for African food security, household hunger scale

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Authors: Davie Hope Moyo

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The environment is a combination of two things: resources and hazards. One of the hazards that is a result of environmental changes is the occurrence of flooding. Floods are one of the disasters that are highly feared by people because they have a huge impact on the human population and their environment. In recent years, flooding disasters in the Nsanje district are increasing in both frequency and magnitude. This study aims to understand the root causes of this phenomenon. To understand the causes of flooding, this study focused on the case of TA Ndamera in the Nsanje district, southern Malawi. People in the Nsanje district face disruption in their day-to-day life because of floods that affect their communities. When floods happen, people lose their property, land, livestock, and even lives. The study was carried out in order to have a better understanding of the root causes of floods. The findings of this study may help the government and other development agencies to put in place mitigation measures that will make Nsanje District resilient to the occurrence of future flood hazards. Data was collected from the area of TA Ndamera in order to assess the causes of flooding in the district. Interviews, transect walks, and researcher observation was done to appreciate the topography of the district and evaluate other factors that are making the people become vulnerable to the impacts of flooding in the district. It was found that flooding in the district is mainly caused by heavy rainfall in the upper shire, settlements along river banks, deforestation, and the topography of the district in general. The research study ends by providing recommendation strategies that need to be put in place to increase the resilience of the communities to future flood hazards. The research recommends the development of indigenous knowledge systems to alert people of incoming floods, construction of evacuation centers to ease pressure on schools, savings, and insurance schemes, construction of dykes, desilting rivers, and afforestation.

Keywords: disaster causes, mitigation, safety measures, Nsanje Malawi

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Authors: Elisabeth Mamani-Mategula

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Background: Anaemia has significant consequences on both the mother and child's health as it results in maternal haemorrhage, low childbirth weight, premature delivery, poor organ development, and infections at birth and hence the need for treatment. In low-middle income countries, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy which are often poorly tolerated and adhered to. A potential alternative to oral iron is intravenous (IV) iron which allows the saturation of the body’s iron stores quickly. Currently, a randomised controlled trial on the Effect of intravenous iron on Anaemia in Malawian Pregnant women (REVAMP) is underway. Since this is new in Africa and Malawi is the second country to implement it, its acceptability to both the providers and end-users is not known. Suppose the use of IV iron during pregnancy would be acceptable in Malawi, it could change how we treat and manage pregnant women with anaemia and be scaled up throughout Malawi to improve maternal and child health. Objectives: To identify the barriers and facilitators of implementing IV iron in the Malawian healthcare system and identify ‘touchpoints’ and co-develop strategies to support and inform the implementation of the trial Methodology: A qualitative study was conducted with policymakers, government partners, and health managers through in-depth interviews to identify barriers and facilitators relating to the implementation of IV iron in the health system of Malawi. From the interviews, touchpoints were identified that formed the basis of the discussion in further discussing the barriers and suggested solutions in the co-design workshops with the community members and the health workers, respectively. We purposively recruited 20 health workers (10 male, 10 Female). 20 community members (10 male, 10 female) were recruited randomly. Data was collected through group discussions and interactive sessions and was recorded through audios, flip charts, and sticky notes. We familiarized ourselves with the data and identified themes. Results: Two co-design workshops were conducted with different community members and different health worker carders. Identified individual factors included lack of knowledge about anaemia, lack of male involvement, the attitude of health workers and patient non-compliance with appointments. Community factors included myths and misconceptions about IV iron, including associating the use of IV iron with vampirism and covid 19 vaccination. Health system factors identified were a shortage of staff and equipment, unfamiliarity with IV iron and its cost. Discussion: The use of IV iron, as suggested by the community members and health workers, demands civic education through bringing awareness to end-users and training to providers. Through these co-design workshops, community sensitization and awareness, briefing and training of health workers and creation of educational materials were done.

Keywords: acceptability, IV iron, barriers, facilitators, co-design

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Authors: Abel Mahowe

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Furrow erosion is the major problem menacing sustainability of irrigation in Malawi and polluting water bodies resulting in death of many aquatic animals. Many rivers in Malawi are drying due to some poor practices that are being practiced around these water bodies, furrow erosion is one of the cause of sedimentation in these rivers although it has gradual effect on deteriorating of these rivers hence neglected, but has got long term disastrous effect on water bodies. Many aquatic animals also suffer when these sediments are taken into these water bodies. An assessment of effect of manure treatment on furrow erosion was carried out in Sagawika irrigation scheme located in Kasungu District north part of Malawi. The soil on the field was clay loam and had just been tilled. The average furrow slope of 0.2% and was divided into two blocks, A and B. Each block had 20V-shaped furrow having a length of 10 m. Three different manure were used to construct these furrows by mixing it with soil which was moderately moist and 5 furrows from each block were constructed without manure. In each block 5furrow were made using a specific type of manure, and one set of five furrows in each block was made without manure treatment. The types of manure that were used were goat manure, pig manure, and manure from crop residuals. The manure application late was 5 kg/m. The furrow was constructed at a spacing of 0.6 m. Tomato was planted in the two blocks at spacing of 0.15 m between rows and 0.15 m between planting stations. Irrigation water was led from feeder canal into the irrigation furrows using siphons. The siphons discharge into each furrow was set at 1.86 L/S. The ¾ rule was used to determine the cut-off time for the irrigation cycles in order to reduce the run-off at the tail end. During each irrigation cycle, samples of the runoff water were collected at one-minute intervals and analyzed for total sediment concentration for use in estimating the total soil sediment loss. The results of the study have shown that a significant amount of soil is lost in soils without many organic matters, there was a low level of erosion in furrows that were constructed using manure treatment within the blocks. In addition, the results have shown that manure also differs in their ability to control erosion since pig manure proved to have greater abilities in binding the soil together than other manure since they were reduction in the amount of sediments at the tail end of furrows constructed by this type of manure. The results prove that manure contains organic matters which helps soil particles to bind together hence resisting the erosive force of water. The use of manure when constructing furrows in soil with less organic matter can highly reduce erosion hence reducing also pollution of water bodies and improve the conditions of aquatic animals.

Keywords: aquatic, erosion, furrow, soil

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Authors: Nick Toossi, Joseph Hartland

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Background: Malawi is an example of a low resource setting which faces a chronic shortage of doctors and other medical staff. This shortfall is made up for by clinical officers (COs), who are para-medicals trained for 4 years. The literature suggests to improve outcomes surgical skills training specifically should be promoted for COs in district and mission hospitals. Accordingly, the primary author was tasked with developing a basic surgical skills teaching package for COs of Mulanje Mission Hospital (MMH), Malawi, as part of a 4th year medical student External Student Selected Component field trip. MMH is a hospital based in the South of Malawi near the base of Mulanje Mountain and works in an extremely isolated environment with some of the poorest communities in the country. Traveling to Malawi the medical student author performed an educational needs assessment to develop and deliver a bespoke basic surgical skills teaching package. Methodology: An initial needs assessment identified the following domains: basic surgical skills (instrument naming & handling, knot tying, suturing principles and suturing techniques) and perineal repair. Five COs took part in a teaching package involving an interactive group simulation session, overseen by senior clinical officers and surgical trainees from the UK. Non-organic and animal models were used for simulation practice. This included the use of surgical skills boards to practice knot tying and ox tongue to simulate perineal repair. All participants spoke and read English. The impact of the session was analysed in two different ways. The first was via a pre and post Single Best Answer test and the second a questionnaire including likert’s scales and free text response questions. Results: There was a positive trend in pre and post test scores on competition of the course. There was increase in the mean confidence of learners before and after the delivery of teaching in basic surgical skills and simulated perineal repair, especially in ‘instrument naming and handling’. Whilst positively received it was discovered that learners desire more frequent surgical skills teaching sessions in order to improve and revise skills. Feedback suggests that the learners were not confident in retaining the skills without regular input. Discussion: Skills and confidence were improved as a result of the teaching provided. Learner's written feedback suggested there was an overall appetite for regular surgical skills teaching in the clinical environment and further opportunities to allow for deliberate self-practice. Surgical mentorship schemes facilitating supervised theatre time among trainees and lead surgeons along with improving access to surgical models/textbooks were some of the simple suggestions to improve surgical skills and confidence among COs. Although, this study is limited by population size it is reflective of the small, isolated and low resource environment in which this healthcare is delivered. This project does suggest that current surgical skills packages used in the UK could be adapted for employment in low resource settings, but it is consistency and sustainability that staff seek above all in their on-going education.

Keywords: clinical officers, education, Malawi, surgical skills

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Authors: Innocent Pangapanga, Eric Mungatana

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Fall armyworm (FAW) (Spodoptera frugiperda), an invasive lepidopteran pest, has caused substantial yield loss since its first detection in September 2016, thereby threatening the farm productivity food security and poverty reduction initiatives in Malawi. Several stakeholders, including households, have adopted chemical pesticides to control FAW without accounting for its costs on welfare, health and the environment. Thus, this study has used panel data endogenous switching regression model to investigate the impact of FAW and the integrated pest management (IPM) –related practices on-farm productivity and food security. The study finds that FAW substantively reduces farm productivity by seven (7) percent and influences the adoption of IPM –related practices, namely, intercropping, mulching, and agroforestry, by 6 percent, ceteris paribus. Interestingly, multiple adoptions of the IPM -related practices noticeably increase farm productivity by 21 percent. After accounting for potential endogeneity through the endogenous switching regression model, the IPM practices further demonstrate tenfold more improvement on food security, implying the role of the IPM –related practices in containing the effect of FAW at the household level.

Keywords: hunger, invasive fall army worms, integrated pest management practices, farm productivity, endogenous switching regression

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Authors: Charles Bijjah Nkhata, Memory Nekati Mvula, Milton Masautso Kalongonda, Martha Masamba, Isaac Thom Shawa

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Viral Hepatitis is a serious public health concern globally with deaths estimated at 1.4 million annually due to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Hepatitis B and C are the most common viruses that cause liver damage. However, the majority of infected individuals are unaware of their serostatus. Viral Hepatitis has contributed to maternal and neonatal morbidity and mortality. There is no updated data on the Epidemiology of hepatitis B and C among pregnant mothers in Malawi. To assess the epidemiology of Hepatitis B and C viruses among pregnant women at Queen Elizabeth Central Hospital. Specific Objectives • To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at QECH. • To investigate risk factors associated with HBV and HCV infection in pregnant women. • To determine the distribution of HBsAg and Anti-HCV infection among pregnant women of different age group. A descriptive cross-sectional study was conducted among pregnant women at QECH in last quarter of 2021. Of the 114 pregnant women, 96 participants were consented and enrolled using a convenient sampling technique. 12 participants were dropped due to various reasons; therefore 84 completed the study. A semi-structured questionnaire was used to collect socio-demographic and behavior characteristics to assess the risk of exposure. Serum was processed from venous blood samples and tested for HBsAg and Anti-HCV markers utilizing Rapid screening assays for screening and Enzyme Linked Immunosorbent Assay for confirmatory. A total of 84 pregnant consenting pregnant women participated in the study, with 1.2% (n=1/84) testing positive for HBsAg and nobody had detectable anti-HCV antibodies. There was no significant link between HBV and HCV in any of the socio-demographic data or putative risk variables. The findings indicate a viral hepatitis prevalence lower than the set range by the WHO. This suggests that HBV and HCV are rare in pregnant women at QECH. Nevertheless, accessible screening for all pregnant women should be provided. The prevention of MTCT is key for reduction and prevention of the global burden of chronic viral Hepatitis.

Keywords: viral hepatitis, hepatitis B, hepatitis C, pregnancy, malawi, liver disease, mother to child transmission

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Authors: Alice Huffman, Joseph Hartland, Sam Gibbs

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Dermatology is often a neglected specialty in low-resource settings, despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV positive patients. African countries have the highest HIV infection rates and skin conditions are frequently misdiagnosed and mismanaged, because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV positive patients. A literature search within Embase, Medline and Google scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff a list of 15 skin conditions was included and a booklet created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff, alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: dermatology, HIV, Malawi, skin disease

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Authors: Innocent Pangapanga, Eric Mungatana

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Tropical cyclones–related floods (TCRFs) in Malawi have devastating effects on smallholder agriculture, thereby threatening the food security agenda, which is already constrained by poor agricultural innovations, low use of improved varieties, and unaffordable inorganic fertilizers, and fragmenting landholding sizes. Accordingly, households have engineered and indigenously implemented sustainable landscape management (SLM) innovations to contain the adverse effects of TCRFs on farm productivity. This study, therefore, interrogated the efficacy of SLM adoption on farm productivity under varying TCRFs, while controlling for the potential selection bias and unobservable heterogeneity through the application of the Endogenous Switching Regression Model. In this study, we further investigated factors driving SLM adoption. Substantively, we found TCRFs reducing farm productivity by 31 percent, on the one hand, and influencing the adoption of SLM innovations by 27 percent, on the other hand. The study also observed that households that interacted SLM with TCRFs were more likely to enhance farm productivity by 24 percent than their counterparts. Interestingly, the study results further demonstrated that multiple adoptions of SLM-related innovations, including intercropping, agroforestry, and organic manure, enhanced farm productivity by 126 percent, suggesting promoting SLM adoption as a package to appropriately inform existing sustainable development goals’ agricultural productivity initiatives under intensifying TCRFs in the country.

Keywords: tropical cyclones–related floods, sustainable landscape management innovations, farm productivity, endogeneity, endogenous switching regression model, panel data, smallholder agriculture

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Authors: Moses Aron, Elias Mwakilama, Jimmy Namangale

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Spending more time on long queues for a basic service remains a common challenge to most developing countries, including Malawi. For health sector in particular, Out-Patient Department (OPD) experiences long queues. This puts the lives of patients at risk. However, using queuing analysis to under the nature of the problems and efficiency of service systems, such problems can be abated. Based on a kind of service, literature proposes different possible queuing models. However, unlike using generalized assumed models proposed by literature, use of real time case study data can help in deeper understanding the particular problem model and how such a model can vary from one day to the other and also from each case to another. As such, this study uses data obtained from one urban HC for BP, Pediatric and General OPD cases to investigate an average queuing time for patients within the system. It seeks to highlight the proper queuing model by investigating the kind of distributions functions over patient’s arrival time, inter-arrival time, waiting time and service time. Comparable with the standard set values by WHO, the study found that patients at this HC spend more waiting times than service times. On model investigation, different days presented different models ranging from an assumed M/M/1, M/M/2 to M/Er/2. As such, through sensitivity analysis, in general, a commonly assumed M/M/1 model failed to fit the data but rather an M/Er/2 demonstrated to fit well. An M/Er/3 model seemed to be good in terms of measuring resource utilization, proposing a need to increase medical personnel at this HC. However, an M/Er/4 showed to cause more idleness of human resources.

Keywords: health care, out-patient department, queuing model, sensitivity analysis

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Authors: M. K. Mzuza, W. Zhang, L. S. Chapola, M. Tembo

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Shire River is the largest and longest river in Malawi emptying its water into the Zambezi River in Mozambique. Siltation is now a major problem in the Shire River due to catchment degradation. This study analysed soil samples from tributaries of the Shire River to determine sources of sediments that cause siltation using the mineral magnetic approach. Bulk sediments and separated particle size fractions of representative samples were collected from tributaries on the western and eastern sides of the Shire River, and Nkula Dam. Eastern tributaries showed relatively higher ferrimagnetic mineral contents and ferrimagnetic to anti ferromagnetic ratios than western tributaries. Sediments from both sides of the Shire River were distinguished by χARM, SIRM versus χlf and S-100 versus SIRM. Findings in this study showed that most of the sediments originated from the western part of the Shire River. Tributaries on the eastern side of the Shire River had higher values for concentration related parameters (χlf, χfd, χARM, SIRM, HIRM, S-100, and χARM/SIRM) than tributaries on the western side. Bulky and detailed magnetic measurements carried out on particle size fractions provided additional confirmation of magnetic contrasts between the two sides of the river suggesting differences in lithology, topography, climate and weather regimes in the catchments. This study demonstrated that the magnetic approach can provide a reliable means of understanding major sediment sources of Nkula Dam and similar situations. It can also help to assess future variations in sediment composition resulting from catchment changes

Keywords: ferrimagnetic minerals, Shire River, tributaries rivers, particle size , topography

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Authors: G. C. Phiri, E. A. Heil, A. A. Kalimbira, E. Muehlhoff, C. Masangano, B. M. Mtimuni, J. Herrmann, M. B. Krawinkel, I. Jordan

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Background and objectives: High prevalence of undernutrition in Malawi is caused by poor complementary foods. Lack of knowledge of age appropriate food within the household might affect utilization of available resources. FAO-Malawi implemented nutrition education (NE) sessions in 200 villages in Kasungu and Mzimba districts from December 2012 to April 2013 targeting 15 caregivers per village of children aged 6-18 months, grandmothers, spouses and community leaders. Two trained volunteers per village facilitated 10 NE sessions on breastfeeding, food safety and hygiene and complementary feeding using locally available resources. This study assessed the reported dietary diversification practices of infant and young child after nutrition education and the factors that influenced adoption of the practice. Methodology: Questionnaire-based interviews with caregivers were conducted in 16 randomly selected villages (n=108) before training-(t1) and seven months after training-(t2). Knowledge score (KS) was calculated on the indicators breastfeeding, hygiene and complementary feeding. Count regression was performed using SPSS 22. Eight focus group discussions (FGDs) were separately conducted among caregivers and grandmothers in 4 villages. Content analysis was used to analyze FGDs data. Results: Following NE, caregivers' KS significantly increased (p<0.001) between t1 and t2 for breastfeeding (7.7 vs. 9.8, max=18), hygiene (3.8 vs. 5.9, max=7) and complementary feeding (10.2 vs. 16.2, max=26). Caregivers indicated that they stopped preparation of plain-refined maize meal porridge after they gained knowledge on dietary diversification of complementary foods. They learnt mushing and pounding of ingredients for enriched porridge. Whole-maize meal or potatoes were often enriched with vegetables, legumes, small fish or eggs and cooking oil. Children liked the taste of enriched porridge. Amount of enriched porridge consumed at each sitting increase among previously fussy-eater children. Meal frequency increased by including fruits as snacks in child’s diet. Grandmothers observed preparation of enriched porridge among the mothers using locally available foods. Grandmothers liked the taste of enriched porridge and not the greenish color of the porridge. Both grandmothers and mothers reported that children were playing independently after consuming enriched porridge and were strong and healthy. These motivated adoption of the practice. Conclusion: Increased knowledge and skill of preparation and utilisation of locally available foods promoted children’s dietary diversification. Children liking the enriched porridge motivated adoption of dietary diversification.

Keywords: behaviour change, complementary feeding, dietary diversification, IYCN

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Authors: Elida Tafupenji Kamanga

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Cancer of the cervix remains one of the high causes of death among Malawian women. Despite the government introduction of free screening services throughout the country, patronage still remains low and lack of knowledge high. Given the critical role mass media plays in relaying different information to the public including health and its influence on health behaviours, the study sought to analyse Malawi media coverage of the disease and its effectiveness. The findings of the study will help inform media advocacy directed at changing any coverage impeding the effective dissemination of cervical cancer message which consequently will help increase awareness and accessing of screening behaviours among women. A content analysis of 29 newspapers and promotional messages on cervical from a local radio station was conducted for the period from 2012 to 2015. Overall the results showed media coverage in terms of content and frequency increased for the four-year period. However, of concern was the quality of information both media presented to the public. The lapse in information provided means there is little education taking place through the media which could be contributing to the knowledge gap the women have thereby affecting their decision to screen. Also lack of adequate funding to media institutions and lack of collaboration between media institutions and stakeholders involved in the fight against the disease were noted as other contributing factors to low coverage of the disease. Designing messages that are not only informative and educative but also innovative may help increase awareness; improve the knowledge gap and potential adoption of preventive screening behaviour by Malawian women. Conversely, good communication between the media institutions and researchers involved in the fight against the disease through the channelling of new findings back to the public as well as increasing funding towards similar cause should be considered.

Keywords: cervical cancer, effectiveness, media coverage, screening

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Authors: Magdalena Orth, Gunnar Gotz

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Background: Domestic accountability, budget transparency and public financial management (PFM) are considered vital components of good governance in developing countries. The aid modality budget support (BS) promotes these governance functions in developing countries. BS engages in political decision-making and provides financial and technical support to poverty reduction strategies of the partner countries. Nevertheless, many donors have withdrawn their support from this modality due to cases of corruption, fraud or human rights violations. This exit from BS is leaving a finance and governance vacuum in the countries. The evaluation team analyzed the consequences of terminating the use of this modality and found particularly negative effects for good governance outcomes. Methodology: The evaluation uses a qualitative (theory-based) approach consisting of a comparative case study design, which is complemented by a process-tracing approach. For the case studies, the team conducted over 100 semi-structured interviews in Malawi, Uganda, Rwanda and Zambia and used four country-specific, tailor-made budget analysis. In combination with a previous DEval evaluation synthesis on the effects of BS, the team was able to create a before-and-after comparison that yields causal effects. Main Findings: In all four countries domestic accountability and budget transparency declined if other forms of pressure are not replacing BS´s mutual accountability mechanisms. In Malawi a fraud scandal created pressure from the society and from donors so that accountability was improved. In the other countries, these pressure mechanisms were absent so that domestic accountability declined. BS enables donors to actively participate in political processes of the partner country as donors transfer funds into the treasury of the partner country and conduct a high-level political dialogue. The results confirm that the exit from BS created a governance vacuum that, if not compensated through external/internal pressure, leads to a deterioration of good governance. For example, in the case of highly aid dependent Malawi did the possibility of a relaunch of BS provide sufficient incentives to push for governance reforms. Overall the results show that the three good governance areas are negatively affected by the exit from BS. This stands in contrast to positive effects found before the exit. The team concludes that the relationship is causal, because the before-and-after comparison coherently shows that the presence of BS correlates with positive effects and the absence with negative effects. Conclusion: These findings strongly suggest that BS is an effective modality to promote governance and its abolishment is likely to cause governance disruptions. Donors and partner governments should find ways to re-engage in closely coordinated policy-based aid modalities. In addition, a coordinated and carefully managed exit-strategy should be in place before an exit from similar modalities is considered. Particularly a continued framework of mutual accountability and a high-level political dialogue should be aspired to maintain pressure and oversight that is required to achieve good governance.

Keywords: budget support, domestic accountability, public financial management and budget transparency, Sub-Sahara Africa

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Authors: Averalda van Graan, Joelaine Chetty, Malory Links, Agness Mwangwela, Sitilitha Masangwi, Dalitso Chimwala, Shiban Ghosh, Elizabeth Marino-Costello

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Food composition data is becoming increasingly important as dealing with food insecurity and malnutrition in its persistent form of under-nutrition is now coupled with increasing over-nutrition and its related ailments in the developing world, of which Malawi is not spared. In the absence of a food composition database (FCDB) inherent to our dietary patterns, efforts were made to develop a country-specific FCDB for nutrition practice, research, and programming. The main objective was to develop a multi-user, country-specific food composition database, and table from existing published and unpublished scientific literature. A multi-phased approach guided by the project framework was employed. Phase 1 comprised a scoping mission to assess the nutrition landscape for compilation activities. Phase 2 involved training of a compiler and data collection from various sources, primarily; institutional libraries, online databases, and food industry nutrient data. Phase 3 subsumed evaluation and compilation of data using FAO and IN FOODS standards and guidelines. Phase 4 concluded the process with quality assurance. 316 Malawian food items categorized into eight food groups for 42 components were captured. The majority were from the baby food group (27%), followed by a staple (22%) and animal (22%) food group. Fats and oils consisted the least number of food items (2%), followed by fruits (6%). Proximate values are well represented; however, the percent missing data is huge for some components, including Se 68%, I 75%, Vitamin A 42%, and lipid profile; saturated fat 53%, mono-saturated fat 59%, poly-saturated fat 59% and cholesterol 56%. A multi-phased approach following the project framework led to the development of the first Malawian FCDB and table. The table reflects inherent Malawian dietary patterns and nutritional concerns. The FCDB can be used by various professionals in nutrition and health. Rising over-nutrition, NCD, and changing diets challenge us for nutrient profiles of processed foods and complete lipid profiles.

Keywords: analytical data, dietary pattern, food composition data, multi-phased approach

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Authors: Frazer McDonald Ng'oma

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Online Learning in Malawi has only immersed in recent years due to the need to increase access to higher education, the need to accommodate upgrading students who wish to study on a part time basis while still continuing their work, and the COVID-19 pandemic, which forced the closure of schools resulting in academic institutions seeking alternative modes of teaching and Learning to ensure continued teaching and Learning. Realizing that this mode of Learning is becoming a norm, institutions of higher Learning have started pioneering online post-graduate programs from which they can draw lessons before fully implementing it in undergraduate programs. Online learning pedagogy has not been fully grasped and institutions are still experimenting with this mode of Learning until online Learning guiding policies are created and its standards improved. This single case descriptive qualitative research study sought to investigate online postgraduate students’ perceptions and experiences with Student to student interactive pedagogy in their programs. The results of the study are to inform institutions and educators how to structure their programs to ensure that their students get the full satisfaction. 25 Masters students in 3 recently introduced online programs at Kamuzu University of Health Sciences (KUHES), were engaged; 19 were interviewed and 6 responded to questionnaires. The findings from the students were presented and categorized in themes and subthemes that emerged from the qualitative data that was collected and analysed following Colaizzi’s framework for data analysis that resulted in themes formulation. Findings revealed that Student to student interactions occurred in the online programme during live sessions, on class Whatsapp group, in discussion boards as well as on emails. Majority of the students (n=18) felt the level of students’ interaction initiated by the institution was too much, referring to mandatory interactions activities like commenting in discussion boards and attending to live sessons. Some participants (n=7) were satisfied with the level of interaction and also pointed out that they would be fine with more program-initiated student–to–student interactions. These participants attributed having been out of school for some time as a reason for needing peer interactions citing that it is already difficult to get back to a traditional on-campus school after some time, let alone an online class where there is no physical interaction with other students. In general, majority of the participants (n=18) did not value Student to student interaction in online Learning. The students suggested that having intensive student-to-student interaction in postgraduate online studies does not need to be a high priority for the institution and they further recommended that if a lecturer decides to incorporate student-to-student activities into a class, they should be optional.

Keywords: online learning, interactions, student interactions, post graduate students

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Authors: Siwapong Dheera-Aumpon

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Resource misallocation is known to be prevalent in many countries. Such misallocation in the manufacturing sector is large and has a considerable negative effect on aggregate productivity. Thailand is one of the countries having large resource misallocation in the manufacturing sector. Resource misallocation is also known to be widespread in the agricultural sector. It is, therefore, likely that resource misallocation exists in the agricultural sector of Thailand as well. This study aims to evaluate the extent of resource misallocation in Thai rice farming. Using household-level data from 2013 Thai Agricultural Census, this study calculates farm total factor productivity (TFP) controlling for land quality and rain. Similar to the case of Malawi, marginal products of land and capital are found to be related to farm TFP implying large resource misallocation. The output gain from a reallocation of resources to their best use is 67 percent. The gain from reallocation is highest for farms in the southern region and followed by the northeastern region.

Keywords: agriculture, misallocation, productivity, rice

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Authors: Bright Msukwa

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Background: Malawi suffered economic instability, bad weather and massive flooding in the year 2015. A massive flood in the country, mainly in the southern region lead to damage of agriculture products. As a result, one of the heavily affected was Zingwangwa, Blantyre. Methods: We interviewed a selected number of houses residing in donor constructed temporal shelters and those still residing close to the floods prone areas in Zingwangwa, Blantyre. Results: About 67% of the population insisted that they resided on the land, which was prone to the floods as it belonged to their ancestors and their staying was part of preserving ancestral values. The remaining 23% of the population demonstrated economic challenges due to floods that contributed to the damage of their food crops, property and houses. Conclusion: Beliefs can negatively affect economic life improvement if mindsets are not changed among people in the rural area. Recommendation: Improving natural resource management, climate and disaster resilience.

Keywords: economic, belief, walfare, poverty

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Authors: Wiseman Emmanuel Nkhomah, Chiyembekezo Kachimanga, Julia Huggins, Fabien Munyaneza

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Background: Partners In Health – Malawi introduced one of Operational Researches called Primary Health Care (PHC) Surveys in 2020, which seeks to assess progress of delivery of care in the district. The study consists of 5 long surveys, namely; Facility assessment, General Patient, Provider, Sick Child, Antenatal Care (ANC), primarily conducted in 4 health facilities in Neno district. These facilities include Neno district hospital, Dambe health centre, Chifunga and Matope. Usually, these annual surveys are conducted from January, and the target is to present final report by June. Once data is collected and analyzed, there are a series of reviews that take place before reaching final report. In the first place, the manual process took over 9 months to present final report. Initial findings reported about 76.9% of the data that added up when cross-checked with paper-based sources. Purpose: The aim of this approach is to run away from manually pulling the data, do fresh analysis, and reporting often associated not only with delays in reporting inconsistencies but also with poor quality of data if not done carefully. This automation approach was meant to utilize features of new technologies to create visualizations, reports, and dashboards in Power BI that are directly fished from the data source – CommCare hence only require a single click of a ‘refresh’ button to have the updated information populated in visualizations, reports, and dashboards at once. Methodology: We transformed paper-based questionnaires into electronic using CommCare mobile application. We further connected CommCare Mobile App directly to Power BI using Application Program Interface (API) connection as data pipeline. This provided chance to create visualizations, reports, and dashboards in Power BI. Contrary to the process of manually collecting data in paper-based questionnaires, entering them in ordinary spreadsheets, and conducting analysis every time when preparing for reporting, the team utilized CommCare and Microsoft Power BI technologies. We utilized validations and logics in CommCare to capture data with less errors. We utilized Power BI features to host the reports online by publishing them as cloud-computing process. We switched from sharing ordinary report files to sharing the link to potential recipients hence giving them freedom to dig deep into extra findings within Power BI dashboards and also freedom to export to any formats of their choice. Results: This data automation approach reduced research timelines from the initial 9 months’ duration to 5. It also improved the quality of the data findings from the original 76.9% to 98.9%. This brought confidence to draw conclusions from the findings that help in decision-making and gave opportunities for further researches. Conclusion: These results suggest that automating the research data process has the potential of reducing overall amount of time spent and improving the quality of the data. On this basis, the concept of data automation should be taken into serious consideration when conducting operational research for efficiency and decision-making.

Keywords: reporting, decision-making, power BI, commcare, data automation, visualizations, dashboards

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Authors: Emma Louise McKinney

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There is a global move to integrate children who are Deaf and Hearing Impaired into regular classrooms with their hearing peers with an inclusive education framework. This paper examines the current education situation for children who are Deaf and Hearing Impaired in South Africa, Madagascar, Malawi, Zimbabwe, and Namibia. Qualitative data for this paper was obtained from the author’s experiences working as the Southern African Education Advisor for an international organization funding disability projects. It examines some of the challenges facing these children and their teachers relating to education. Challenges include cultural stigma relating to disability and deafness, a lack of hearing screening and early identification of deafness, schools in rural areas, special schools, specialist teacher training, equipment, understanding of how to implement policy, support, appropriate teaching methodologies, and sign language training and proficiency. On the other hand, in spite of the challenges some teachers are able to provide quality education to children who are Deaf and Hearing Impaired. This paper examines both the challenges as well as what teachers are doing to overcome these.

Keywords: education of children who are deaf and hearing impaired, Southern African experiences, challenges, triumphs

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Authors: Wiseman Emmanuel Nkhomah, Chiyembekezo Kachimanga, Moses Banda Aron, Julia Higgins, Manuel Mulwafu, Kondwani Mpinga, Mwayi Chunga, Grace Momba, Enock Ndarama, Dickson Sumphi, Atupere Phiri, Fabien Munyaneza

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Background: Data is key to supporting health service delivery as stakeholders, including NGOs rely on it for effective service delivery, decision-making, and system strengthening. Several studies generated debate on data quality from national health management information systems (HMIS) in sub-Saharan Africa. This limits the utilization of data in resource-limited settings, which already struggle to meet standards set by the World Health Organization (WHO). We aimed to evaluate data quality improvement of Neno district HMIS over a 4-year period (2018 – 2021) following quarterly data reviews introduced in January 2020 by the district health management team and Partners In Health. Methods: Exploratory Mixed Research was used to examine report rates, followed by in-depth interviews using Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). We used the WHO module desk review to assess the quality of HMIS data in the Neno district captured from 2018 to 2021. The metrics assessed included the completeness and timeliness of 34 reports. Completeness was measured as a percentage of non-missing reports. Timeliness was measured as the span between data inputs and expected outputs meeting needs. We computed T-Test and recorded P-values, summaries, and percentage changes using R and Excel 2016. We analyzed demographics for key informant interviews in Power BI. We developed themes from 7 FGDs and 11 KIIs using Dedoose software, from which we picked perceptions of healthcare workers, interventions implemented, and improvement suggestions. The study was reviewed and approved by Malawi National Health Science Research Committee (IRB: 22/02/2866). Results: Overall, the average reporting completeness rate was 83.4% (before) and 98.1% (after), while timeliness was 68.1% and 76.4 respectively. Completeness of reports increased over time: 2018, 78.8%; 2019, 88%; 2020, 96.3% and 2021, 99.9% (p< 0.004). The trend for timeliness has been declining except in 2021, where it improved: 2018, 68.4%; 2019, 68.3%; 2020, 67.1% and 2021, 81% (p< 0.279). Comparing 2021 reporting rates to the mean of three preceding years, both completeness increased from 88% to 99% (in 2021), while timeliness increased from 68% to 81%. Sixty-five percent of reports have maintained meeting a national standard of 90%+ in completeness while only 24% in timeliness. Thirty-two percent of reports met the national standard. Only 9% improved on both completeness and timeliness, and these are; cervical cancer, nutrition care support and treatment, and youth-friendly health services reports. 50% of reports did not improve to standard in timeliness, and only one did not in completeness. On the other hand, factors associated with improvement included improved communications and reminders using internal communication, data quality assessments, checks, and reviews. Decentralizing data entry at the facility level was suggested to improve timeliness. Conclusion: Findings suggest that data quality in HMIS for the district has improved following collaborative efforts. We recommend maintaining such initiatives to identify remaining quality gaps and that results be shared publicly to support increased use of data. These results can inform Ministry of Health and its partners on some interventions and advise initiatives for improving its quality.

Keywords: data quality, data utilization, HMIS, collaboration, completeness, timeliness, decision-making

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Authors: Sibusiso Mkwananzi

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The health of mother and child remain at risk among pregnant adolescents. Nevertheless, these are placed in even greater jeopardy when an expectant adolescent experiences violence. This paper sought to explore the levels and determinants of expecting adolescents in five Southern African countries. The study used the most recent (2010/2015) nationally representative demographic health survey (DHS) data from Malawi, Mozambique, Namibia, Zambia, and Zimbabwe. The highest levels of violence during pregnancy occurred amongst adolescent females living in Zimbabwe at 11.4%, followed by Zambia (8.3%) and Namibia (7.7%). Lowest levels were seen in Mozambique at 3.6%. Additionally, the determinants of experiencing violence during pregnancy included educational attainment, marital status, wealth and place of residence. Expectant adolescents that had a higher likelihood of experiencing violence were married and lived predominantly in rural settings. Higher risk was also associated with lower acquisition of education and poverty. These results show a very similar pattern to the risk factors associated with early pregnancy in the region. The predictors point to issues of possible lowered empowerment amongst younger women in their relationships and the structural challenges faced by this fledgling group. Nevertheless, addressing these dynamics could go a long way in not only decreasing the likelihood of unwanted motherhood at this early stage of the life course, but indeed even ensuring the prevention of violence during wanted early pregnancy. This would lead to improved levels of maternal and child health despite younger maternal age and aid in achieving a number of sustainable development goals.

Keywords: adolescents, determinants, Southern Africa, violence during pregnancy

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Authors: Sunday Nanosi Ndovi, Patrick Albert Chikumba

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In Malawi, smallholder dairy farmers transport unprocessed milk to sell at Milk Bulking Groups (MBGs). MBGs store and chill the milk while awaiting collection by processors. The farmers deliver milk using various modes of transportation such as foot, bicycle, and motorcycle. As a perishable food, milk requires timely transportation to avoid deterioration. In other instances, some farmers bypass the nearest MBGs for facilities located further away. Untimely delivery worsens quality and results in rejection at MBG. Subsequently, these rejections lead to revenue losses for dairy farmers. Therefore, the objective of this study was to optimize routes when transporting milk by selecting the shortest route using time as a cost attribute in Geographic Information Systems (GIS). A spatially organized transport system impedes milk deterioration while promoting profitability for dairy farmers. A transportation system was modeled using Route Analysis and Closest Facility network extensions. The final output was to find the quickest routes and identify the nearest milk facilities from incidents. Face-to-face interviews targeted leaders from all 48 MBGs in the study area and 50 farmers from Namahoya MBG. During field interviews, coordinates were captured in order to create maps. Subsequently, maps supported the selection of optimal routes based on the least travel times. The questionnaire targeted 200 respondents. Out of the total, 182 respondents were available. Findings showed that out of the 50 sampled farmers that supplied milk to Namahoya, only 8% were nearest to the facility, while 92% were closest to 9 different MBGs. Delivering milk to the nearest MBGs would minimize travel time and distance by 14.67 hours and 73.37 km, respectively.

Keywords: closest facility, milk, route analysis, spatial transport

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Authors: Kathleen Cravero, Amanda Nace, Samantha Ski

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The Violence Against Children Surveys (VACS) is nationally representative surveys of male and female youth ages 13-24, designed to measure the burden of sexual, physical, and emotional violence experienced in childhood and adolescence. As of 2019, 24 countries implemented or are in the process of implementing a VACS, covering over ten percent of the world’s child population. Since the first article using VACS data from Swaziland was published in 2009, several peer-reviewed articles have been published on the VACS. However, no publications to date have analyzed the breadth of the work and analyzed how the data are represented in the peer-reviewed literature. In this study, we conducted a literature review of all peer-reviewed research that used VACS data or discussed the implementation and methodology of the VACS. The literature review revealed several important findings. Between 2009 and July 2019, thirty-five peer-reviewed articles using VACS data from 12 countries have been published. Twenty of the studies focus on one country, while 15 of the studies focus on two or more countries. Some countries are featured in the literature more than others, for example Kenya (N=14), Malawi (N=12), and Tanzania (N=12). A review of the research by gender demonstrates that research on violence against boys is under-represented. Only two studies specifically focused on boys/young men, while 11 studies focused only on violence against girls. This is despite research which suggests boys and girls experience similar rates of violence. A review of the publications by type of violence revealed significant differences in the types of violence being featured in the literature. Thirteen publications specifically focused on sexual violence, while three studies focused on physical violence, and only one study focused on emotional violence. Almost 70% of the peer-reviewed articles (24 of the 35) were first-authored by someone at the U.S. Centers for Disease Control and Prevention. There were very few first authors from VACS countries, which raises questions about who is leveraging the data and the extent to which capacities for data liberation are being developed within VACS countries. The VACS provide an unprecedented amount of information on the prevalence and past-year incidence of violence against children. Through a review of the peer-reviewed literature on the VACS we can begin to identify trends and gaps in how the data is being used as well as identify areas for further research.

Keywords: data to action, global health, implementation science, violence against children surveys

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Authors: Mekonen Hailu, Liu Liping

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Cage aquaculture is highly preferred due to higher production per unit volume of water, lower costs of investment, and simpler routine farm management procedures compared to pond systems. In the 1980s, cage culture was first used on a trial basis in sub-Saharan Africa. Over the past 20 years, a small number of prosperous freshwater cage culture operations have started to emerge in Egypt, Rwanda, Kenya, Uganda, Tanzania, Ghana, Malawi, Zambia and Zimbabwe. Brackish and marine cage culture also offers a lot of potential, although this subsector hasn't seen any significant commercial growth to date. In 2019, 263 cage aquaculture installations on the African inland waters on 18 water bodies within eight countries with an estimated 20,114 cages were reported. The lakes Victoria, Kariba, Volta, and River Volta, which together account for 82.9% of all cage aquaculture installations regarded as sub-Saharan Africa's principal cage aquaculture regions (Fig 1). Except few small-scale trials with North African catfish (Clarias gariepinus), almost all farms in Sub-Saharan Africa and Egypt grow Nile tilapia (Oreochromis niloticus). More than 247,398 tonnes of fish are produced yearly from ten African countries through cage aquaculture. The expansion of cage culture in Africa provides job opportunities for both skilled and unskilled workers, nutritious food and foreign currency. The escaping non-native strains of tilapia in Lake Volta and the occurrence of a risky Tilapia lake virus (syncytial hepatitis), which has the potential to wipe out entire populations in both wild and farmed Nile tilapia on Lake Victoria, are threats coming with the expansion of cage aquaculture in Africa. In addition, the installations of 138 cage aquacultures were found in contrary to best cage culture practices. To sustain cage aquaculture development and maintain harmony with other water uses, developers must strictly abide by best practices. Hence, the exclusion of protected areas and small lakes (average depth 5 m or less) should be done, as well an Environmental Impact Assessment should be conducted before establishing the cage farms.

Keywords: Africa, cage aquaculture, production, threats

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Authors: Meinrad Haule Lembuka

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Social work profession one of its primary mission is to restore and maintain human rights where social workers recognise all humanity as equal, and so too the philosophies that have developed across the world’s regions. Ubuntu means African Humanism, where realization of human rights has been a primary role for every member of community to protect other member. Before Universal declaration of human rights, African societies had a long history of embracing human rights through Ubuntu approach model. The article used Ubuntu theory to guide the review process of existing literature since Ubuntu theory since is grounded in African cultural values and ecology, and it was thought that application of Ubuntu theory was relevant to reflect reality of Ubuntu model and indigenization of social work in African context. Results have shown that in realization of human rights, Ubuntu was practiced is termed as model, philosophy, cultural values, way of life or framework originated in sub-sahara Africa and some of remarkably practice model in several African communities such as Angola, (gimuntu), Botswana (muthu), Burkina Faso (maaya), Ghana (biako ye), Malawi (umunthu), Mali (maaya/hadama de ya), Namibia (omundu), Nigeria (mutunchi/iwa/agwa), (bantu), Sierra Leonne (maaya), South Africa (ubuntu/botho) and Tanzania (utu/obuntu/bumuntu). Collective and holistic mechanism of Ubuntu is found through an Ubuntu framework that is contributed by individual, family, community and spirit that is characterised by interconnectedness of all things and beings. Each society has its own name but the practice remained the same and realization of human rights in Africa context was centred through human dignity, Ubuntu is built under cultural values of humanism that brings implications for African social worker to integrate this indigenous model into social work practice in restoring and maintain human rights. Social workers should promote policies and practices that demonstrate respect for human life, difference, support and expansion of cultural knowledge and resources, advocate for programmes and institutions that demonstrate cultural competence and promote policies that safeguard the rights and confirm equity and social justice for all people.

Keywords: African ubuntu, indigenous practice, African humanism, African human rights, social work and human rights

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Introduction: Digital innovations have been useful in supporting a client’s contraceptive user journey from awareness to method initiation. The concept of contraceptive self-care is being promoted globally as a means for achieving universal access to quality contraceptive care; however, information about this approach is limited. An important determinant of the scale of awareness is the message construct, choice of information channel, and an understanding of the socio-epidemiological dynamics within the target audience. Significant gains have been made recently in expanding the awareness base of DMPA-SC -a relatively new entrant into the family planning method mix. The cornerstone of this success is a multichannel promotion campaign themed Discover your Power (DYP). The DYP campaign combines content marketing across select social media platforms, chatbots, Cyber-IPC, Interactive Voice Response (IVR), and radio campaigns. Methodology: During implementation, the project monitored predefined metrics of awareness and intent, such as the number of persons reached with the messages, the number of impressions, and meaningful engagement (link-clicks). Metrics/indicators are extracted through native insight/analytics tools across the various platforms. The project also enlists community mobilizers (CMs) who go door-to-door and engage WRA to advertise DISC’s online presence and support them to engage with IVR, digital companion (chatbot), Facebook page, and DiscoverYourPower website. Results: The result showed that the digital platforms recorded 242 million impressions and reached 82 million users with key DMPA-SC self-injection messaging in the three countries. As many as 3.4 million persons engaged (liked, clicked, shared, or reposted) digital posts -an indication of intention. Conclusion: Digital solutions and innovations are gradually becoming the archetype for the advancement of the self-care agenda. Digital innovations can also be used to increase awareness and normalize contraceptive self-care behavior amongst women of reproductive age if they are made an integral part of reproductive health programming.

Keywords: digital transformation, health systems, DMPA-SC, family planning, self-care

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Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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Authors: Charles Masulani Mwale

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Background: It is argued that 85% of children with the disability live in resource-poor countries where there are few available disability services. A majority of these children, including their parents, suffer a lot as a result of the disability and its associated stigmatization, leading to a marginalized life. These parents also experience more stress and mental health problems such as depression, compared with families of normal developing children. There is little research from Africa addressing these issues especially among parents of intellectually disabled children. WHO encourages research on the impact that child with a disability have on their family and appropriate training and support to the families so that they can promote the child’s development and well-being. This study investigated the parenting experiences, mechanisms of coping with these challenges and psychosocial needs while caring for children with intellectual disabilities in both rural and urban settings of Lilongwe and Mzuzu. Methods: This is part of a larger Mixed-methods study aimed at developing a contextualized psychosocial intervention for parents of intellectually disabled children. 16 focus group discussions and four in-depth interviews were conducted with parents in catchments areas for St John of God and Children of Blessings in Mzuzu and Lilongwe cities respectively. Ethical clearance was obtained from COMREC. Data were stored in NVivo software for easy retrieval and management. All interviews were tape-recorded, transcribed and translated into English. Note-taking was performed during all the observations. Data triangulation from the interviews, note taking and the observations were done for validation and reliability. Results: Caring for intellectually disabled children comes with a number of challenges. Parents experience stigma and discrimination; fear for the child’s future; have self-blame and guilt; get coerced by neighbors to kill the disabled child; and fear violence by and to the child. Their needs include respite relief, improved access to disability services, education on disability management and financial support. For their emotional stability, parents cope by sharing with others and turning to God while other use poor coping mechanisms like alcohol use. Discussion and Recommendation: Apart from neighbors’ coercion to eliminate the child life, the findings of this study are similar to those done in other countries like Kenya and Pakistan. It is recommended that parents get educated on disability, its causes, and management to array fears of unknown. Community education is also crucial to promote community inclusiveness and correct prevailing myths associated with disability. Disability institutions ought to intensify individual as well as group counseling services to these parents. Further studies need to be done to design culturally appropriate and specific psychosocial interventions for the parents to promote their psychological resilience.

Keywords: psychological distress, intellectual disability, psychosocial interventions, mental health, psychological resilience, children

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Authors: Lesibana Rafapa

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Accounts exist of circumcision-anchored cultural initiation in central Africa, East Africa, Southern Africa, North Africa, and West Africa -straddling states like Botswana, Kenya, Lesotho, Malawi, Senegal, South Africa, Zambia, and Zimbabwe. This attests to the continent-wide spread of this cultural practice. In this paper, the writer relates the cultural aspect of circumcision-subsuming initiation among black African cultural groups across the continent to the notion that African cultures are varied yet subscribe to a common central concept. The premise of the paper is that the common practice of initiation for both male and female children that have to be initiated by adults to the tradition and customs of a people coincides with such a central concept. The practice of traditional initiation is as broad as to encompass aspects of spirituality, morality, and social organisation, in the nature of the central concept of which it is a trans-sectional part. Cultural initiation, sometimes referred to as traditional circumcision, constitutes culture-determined rites of passage for the initiates. The study’s aim, the findings of which are presented in this paper, was to probe gender equality in the development and promotion of the cultural practice of initiation. The researcher intended to demonstrate how in South Africa, female circumcision is treated equally or marginalised in efforts of the democratic government to regulate and strengthen the practice of circumcision as part of its broader liberation programme meant to reverse politico-cultural bondage experienced during apartheid rule that the present black regime helped bring to an end. It is argued that the failure to regard female circumcision as equal to its male counterpart is a travesty of the black government’s legislation and policies espousing equality and the protection and empowerment of vulnerable and previously marginalised population groups that include black women. The writer did a desk-top study of the history and characteristics of female circumcision among the black Northern Sotho, VaTsonga, and VhaVenda cultural groups of the Limpopo Province, stretching north to the border of South Africa with Zimbabwe, as well as literature on how political and other authorities exert efforts to preserve and empower the practice. The findings were that male initiation is foregrounded and totalised to represent the practice of initiation as a whole, at the expense of its female counterpart facing marginalisation and unequal regard. It is outlined in this paper how such impoverishment of an otherwise woman-empowering cultural practice deprives hitherto black cultures that suffered brutal repression during apartheid of a fuller recovery much needed in the democratic era. The writer applies some aspects of postcolonial theory and some tropes of feminism in the discussion of an uneven status of cultural circumcision at the hands of present day powers that be.

Keywords: African cultures, female circumcision, gender equality, women empowerment

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