Potential impact of intervention strategies on COVID-19 transmission in Malawi: a mathematical modelling study

Research-to-Policy Partnerships for Evidence-Informed Resource Allocation in Health Systems in Africa: An Example Using the Thanzi Programme

OBJECTIVES

Empirical data on the impact of research-to-policy interventions are scant, with the few attempts mainly focusing on ensuring policymakers' timely access to evidence and evidence-informed dialogs.

METHODS

This article reflects on how the Thanzi Programme cultivates an approach of research-to-policy engagement in health economics. The program is structured around 3 interrelated pillars comprising research evidence generation, capacity and capability building, and research-and-policy engagement. Each pillar is described and examples from the Thanzi Programme are given, including illustrating how each pillar informs the other. Limitations and challenges of the approach are discussed, with examples of a way forward.

RESULTS

This program supports health system strengthening through addressing gaps identified by program partners. This includes providing health economics training and research and strengthened partnerships between in-country researchers and health policymakers, as well as between national and international researchers. Platforms bringing together researchers and policymakers to shape the research agenda, disseminate evidence, and foster an evidence-based dialog are institutionalized at country and regional levels. Health Economics and Policy Units have been established, which sit between the Ministries of Health and Universities, to augment policymakers and health economics researchers' engagements on priority health policy matters and determine researchable policy questions. The establishment of the Health Economics Community of Practice as a substantive expert committee under the East Central and Southern Africa Health Community bolsters the contribution of health economics evidence in policy processes at the regional level.

CONCLUSIONS

The Thanzi Programme is an example of how a research-and-policy partnership framework is being used to support evidence-informed health resource allocation decisions in Africa. It uses a combination of high-quality multidisciplinary research, sustained research and policymakers' engagement and capacity strengthening to use research evidence to guide and support policy makers more effectively.

COVID-19, the environment and animal life in Malawi compared to other countries: A brief scooping review for a research agenda in the developing countries

The impact of COVID-19 on the human population in Malawi has been documented. However, its impact on the animal population and the environment has not been thoroughly researched. Because of the well-known inter-relationship between human and animal populations and the environment, a study based on a brief scooping review of previous related studies, media and survey reports, was conducted. The findings reveal that except for a few selected studies, the research gap on COVID-19's impact on the environment and animals in Malawi is wide compared to other countries. Nonetheless, from the few identified related studies, this study has revealed that as the restriction of movement and closure of borders disrupted the supply chain of forest resources in the country, the COVID-19 pandemic has led to increased pressure on forests as a coping strategy due to significant loss of jobs in the informal sector. Although the quality of water and air improved in most parts of the globe due to reduced human activity, there is no substantial literature on the same in Malawi partly due to ineffective monitoring systems. However, COVID-19 has exposed the deficiencies in water security in Malawi, thereby creating opportunities to address them. Conversely, increased demand for water at household levels due to restricted movements contributed to environmental pollution at suburb levels. In particular, the less developed and overpopulated countries suffered from land pollution due to poor disposal of plastic generated from hospitals and personal protection equipment. Elsewhere, studies show that minimal human interference with animals outside homes resulted in an increase of fish and bird biomasses. But, unemployment rates caused by the pandemic have seriously contributed to illegal poaching in developing countries. Therefore, a rapid assessment of the impact of the pandemic on environment in Malawi, to generate the evidence needed for policy makers to use in support of the affected and also plan for the recovery and sustainability of wildlife, is recommended.

Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi

INTRODUCTION

Understanding human mixing patterns relevant to infectious diseases spread through close contact is vital for modelling transmission dynamics and optimisation of disease control strategies. Mixing patterns in low-income countries like Malawi are not well known.

METHODOLOGY

We conducted a social mixing survey in urban Blantyre, Malawi between April and July 2021 (between the 2nd and 3rd wave of COVID-19 infections). Participants living in densely-populated neighbourhoods were randomly sampled and, if they consented, reported their physical and non-physical contacts within and outside homes lasting at least 5 min during the previous day. Age-specific mixing rates were calculated, and a negative binomial mixed effects model was used to estimate determinants of contact behaviour.

RESULTS

Of 1201 individuals enroled, 702 (58.5%) were female, the median age was 15 years (interquartile range [IQR] 5-32) and 127 (10.6%) were HIV-positive. On average, participants reported 10.3 contacts per day (range: 1-25). Mixing patterns were highly age-assortative, particularly those within the community and with skin-to-skin contact. Adults aged 20-49 y reported the most contacts (median:11, IQR: 8-15) of all age groups; 38% (95%CI: 16-63) more than infants (median: 8, IQR: 5-10), who had the least contacts. Household contact frequency increased by 3% (95%CI: 2-5) per additional household member. Unemployed participants had 15% (95%CI: 9-21) fewer contacts than other adults. Among long range (>30 m away from home) contacts, secondary school children had the largest median contact distance from home (257 m, IQR 78-761). HIV-positive status in adults >=18 years-old was not associated with changed contact patterns (rate ratio: 1.01, 95%CI: (0.91-1.12)). During this period of relatively low COVID-19 incidence in Malawi, 301 (25.1%) individuals stated that they had limited their contact with others due to COVID-19 precautions; however, their reported contacts were 8% (95%CI: 1-13) higher.

CONCLUSION

In urban Malawi, contact rates, are high and age-assortative, with little reported behavioural change due to either HIV-status or COVID-19 circulation. This highlights the limits of contact-restriction-based mitigation strategies in such settings and the need for pandemic preparedness to better understand how contact reductions can be enabled and motivated.