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Ebuenyi ID, Jamali MZ, Smith EM, Kafumba J, Chizala P, Munthali A, MacLachlan M. Age related increase in impairment across the life course: the use of Zomba curves to estimate assistive technology needs in Malawi. Disabil Rehabil Assist Technol 2024; 19:16-23. [PMID: 35426341 DOI: 10.1080/17483107.2022.2060352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. MATERIALS AND METHODS We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. RESULTS Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78-80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7-61.0) and 63.5% (63.3-63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0-99.0) and 98.4% (98.3-98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. CONCLUSION The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally.IMPLICATIONS FOR REHABILITATIONIt is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age.The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions.The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons.The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Monica Z Jamali
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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Kaunda-Khangamwa BN, Munthali A, Manderson L. Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi. Sex Reprod Health Matters 2023; 31:2209956. [PMID: 37224431 DOI: 10.1080/26410397.2023.2209956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Sexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis. Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.
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Affiliation(s)
- Blessings N Kaunda-Khangamwa
- Research Consultant, School of Global and Public Health, Kamuzu University of Health Sciences, MAC CDAC, Blantyre, Malawi
- Honorary Researcher, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alister Munthali
- Professor of Research, Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Lenore Manderson
- Distinguished Professor of Public Health and Medical Anthropology, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Adjunct Professor, School of Social Sciences, Monash University, Melbourne, Australia
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Kok M, Munthali A, Mvula P, Chisiza Z, Mat ML. Community bylaws concerning sexual and reproductive health and rights in Machinga District, Malawi: to what extent are they responsive to young people's needs? Int J Equity Health 2023; 22:237. [PMID: 37964291 PMCID: PMC10647080 DOI: 10.1186/s12939-023-02054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Community bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga District in southern Malawi are responsive to young people's realities and SRHR needs. METHODS In Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15-24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people's SRHR (Phase 2). The drama was performed in the community, after which young women (18-24 years), young men (17-24 years), female and male parents discussed on what they saw in the drama, focusing on young people's SRHR, in four focus group discussions (Phase 3). All transcripts were coded and thematically analysed and narratives were written on main themes. RESULTS Three community SRHR bylaws, related to teenage pregnancy, child marriage, and sexual harassment and rape were identified and commonly accepted in the community. While these bylaws intend to reduce SRHR-related issues among young people, they are often not involved in bylaw formulation. The bylaws were associated with protection of girls, and a good reputation for boys, young men and traditional leaders. Bylaw enforcement faced problems, as fines were not in line with national laws, and wealthy offenders could avoid them through bribes. Effects of bylaws on teenage pregnancy rates seemed limited, while some positive effects on school readmission, prevention of child marriage, and reporting sexual harassment were reported. CONCLUSIONS The study revealed that community bylaws were accepted but not owned by young people, and had different effects on the rich versus the poor, and girls versus young men. Bylaws were associated with punishment in terms of money, which seemed to overpower their potential to promote rights and address social norms underlying SRHR issues of the youth.
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Affiliation(s)
- Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands.
| | | | | | - Zindaba Chisiza
- Department of Drama and Theatre Studies, University of Malawi, Zomba, Malawi
| | - Marielle Le Mat
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
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Kabiru CW, Munthali A, Sawadogo N, Ajayi AI, Asego C, Ilboudo PG, Khisa AM, Kimemia G, Maina B, Mangwana J, Mbuthia M, Ouedraogo R, Thakwalakwa C, Wanambwa D, Tapsoba A, Alfonso WOT. Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers' schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol. Reprod Health 2023; 20:166. [PMID: 37946289 PMCID: PMC10634174 DOI: 10.1186/s12978-023-01706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Girls' and women's health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health. INTERVENTIONS The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers' clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months. METHODS We will conduct a baseline survey among adolescent mothers aged 10-19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers' clubs only); arm two (adolescent mothers' clubs + subsidized childcare), and arm three (adolescent mothers' clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions. DISCUSSION Our research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings. Trial registration number AEARCTR-0009115, May 15, 2022.
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Affiliation(s)
- Caroline W Kabiru
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya.
| | - Alister Munthali
- Centre for Social Research (CSR), University of Malawi, Zomba, Malawi
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Anthony Idowu Ajayi
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Catherine Asego
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Patrick G Ilboudo
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Anne M Khisa
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Grace Kimemia
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Beatrice Maina
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Jane Mangwana
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Michelle Mbuthia
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Ramatou Ouedraogo
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | | | - David Wanambwa
- African Population and Health Research Center (APHRC), APHRC Campus, Manga Close, Off Kirawa Road, Nairobi, Kenya
| | - Alexandra Tapsoba
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
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Ebuenyi ID, Smith EM, Jamali MZ, Munthali A, MacLachlan M. The IDEAL PROCESS for developing Assistive Technology policy. Assist Technol 2023:1-8. [PMID: 37725484 DOI: 10.1080/10400435.2023.2254359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
Policy development and implementation are key to improving access to Assistive Technology (AT). In this paper, we describe a strength-based framework for doing this at national level. We used an action research approach, with the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) as the primary frame of reference. Primary data were collected using the World Health Organisation's rapid Assistive Technology Assessment (rATA). We describe the process of applying our emergent framework and how our findings support it. We identified seven guiding principles for effective policy process: Participatory, Resource aware, Outcomes focused, Collaborative, Evidence-informed, supporting good practices, and System strengthening - which can be summarized by the acronym PROCESS. Five crucial building blocks for effective AT policy development emerged: Identification of the assistive technology ecosystem, Demography of disability and AT use, Evaluation of inclusion and participation in existing policy, Alignment with UNCRPD and Sustainable Development Goals (SDGs), and Locality of implementation - which can be summarized with the acronym IDEAL. The IDEAL PROCESS incorporates key content building blocks and core process principles, constituting a systematic framework for guiding the development of context sensitive AT policy and a strength-based pathway to improving access AT.
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Affiliation(s)
- Ikenna D Ebuenyi
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Monica Z Jamali
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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Chamdimba E, Kabiru CW, Ushie BA, Munthali A, Thakwalakwa C, Ajayi AI. Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi. Reprod Health 2023; 20:114. [PMID: 37544984 PMCID: PMC10404372 DOI: 10.1186/s12978-023-01655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy. METHODOLOGY The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data. FINDINGS The data revealed several interconnected and structural reasons for adolescents' vulnerability to early and unintended pregnancy. These include adolescents' limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies. CONCLUSION Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.
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Affiliation(s)
- Elita Chamdimba
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi.
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Alister Munthali
- Center for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | | | - Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Kok MC, Kakal T, Kassegne AB, Hidayana IM, Munthali A, Menon JA, Pires P, Gitau T, van der Kwaak A. Drivers of child marriage in specific settings of Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia - findings from the Yes I Do! baseline study. BMC Public Health 2023; 23:794. [PMID: 37118688 PMCID: PMC10141833 DOI: 10.1186/s12889-023-15697-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Child marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia. METHODS The study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum. RESULTS A lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambia. In all countries, teenage pregnancy was associated with child marriage. In Ethiopia, Kenya and Mozambique, fathers' education seemed a protective factor for child marriage. Narratives of study participants showed that in Ethiopia, Indonesia and (to a lesser extent) Kenya, child marriage was perceived as an 'appropriate practice' to avoid premarital sex or pregnancy, whether it involved sex with or without consent. In all countries, child marriage was driven by difficult economic circumstances, which were often intertwined with disapproved social circumstances, in particular teenage pregnancy, in case of Kenya, Malawi, Mozambique and Zambia. These circumstances made child marriage an 'acceptable practice'. Some youth, particularly in Indonesia, made their own choices to marry early, making child marriage a 'possible practice'. CONCLUSIONS Multiple intersecting drivers, which were present in different degrees in each country setting, influenced the occurrence of child marriage. We found that child marriage is a manifestation of social norms, particularly related to girls' sexuality, which are intersecting with other factors at individual, social, material, and institutional level - most prominently poverty or economic constraints. Child marriage was, in some cases, a result of girls' agentic choices. Efforts to prevent child marriage need to take these realities of girls and their families into account.
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Affiliation(s)
- Maryse C Kok
- KIT Royal Tropical Institute, Amsterdam, the Netherlands.
| | - Tasneem Kakal
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | | | - Irwan M Hidayana
- Center for Gender & Sexuality Studies, Universitas Indonesia, Depok, Indonesia
| | | | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
- American University of Sharjah, UAE, India
| | - Paulo Pires
- Faculdade de Ciências de Saúde, Universidade Lúrio, Nampula, Mozambique
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Rodríguez DC, Balaji LN, Chamdimba E, Kafumba J, Koon AD, Mazalale J, Mkombe D, Munywoki J, Mwase-Vuma T, Namakula J, Nambiar B, Neel AH, Nsabagasani X, Paina L, Rogers B, Tsoka M, Waweru E, Munthali A, Ssengooba F, Tsofa B. Political economy analysis of subnational health management in Kenya, Malawi and Uganda. Health Policy Plan 2023; 38:631-647. [PMID: 37084282 DOI: 10.1093/heapol/czad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/27/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Abstract
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management systems and power dynamics of actors can have a significant influence on health managers' ability to improve PHC access and quality. We conducted a problem-driven political economy analysis (PEA) in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. This PEA used document review and key informant interviews (N = 112) with government actors, development partners and civil societies in three districts or counties in each country (N = 9). We found that while decentralization should improve PHC by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. Emergent findings suggest that coronavirus disease 2019 (COVID-19) not only resulted in greater pressures on health teams and budgets but also improved relations with central government related to better communication and flexible funding, offering some lessons. Without addressing the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC and universal health coverage goals and the SDG agenda will remain out of reach.
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Affiliation(s)
- Daniela C Rodríguez
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | | | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Adam D Koon
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Jacob Mazalale
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Dadirai Mkombe
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Joshua Munywoki
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
| | - Tawonga Mwase-Vuma
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Justine Namakula
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Bejoy Nambiar
- UNICEF Malawi, PO Box 30375, Airtel Complex Area 40/31, Lilongwe, Malawi
| | - Abigail H Neel
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Xavier Nsabagasani
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Ligia Paina
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Braeden Rogers
- Health Section, UNICEF Eastern and Southern Africa Regional Office, United Nations Complex, Gigiri, P.O. Box 44145-00100, Nairobi, Kenya
| | - Maxton Tsoka
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Evelyn Waweru
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Freddie Ssengooba
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
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Ajayi AI, Chamdimba E, Sawadogo N, Gitahi N, Tarnagda AM, Ilboudo AK, Munthali A, Thakwalakwa C, Otukpa EO, Ushie BA, Kabiru CW. Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi. Reprod Health 2023; 20:38. [PMID: 36882850 PMCID: PMC9990966 DOI: 10.1186/s12978-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls. METHODS Our study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls. RESULTS The prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi. CONCLUSION Depressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya.
| | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Nyawira Gitahi
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Abdoul Moumini Tarnagda
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Abdoul Kader Ilboudo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | | | - Emmanuel Oloche Otukpa
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Ebuenyi ID, Kafumba J, Smith EM, Jamali-Phiri MZ, Munthali A, MacLachlan M. Empirical research and available data on assistive technology for persons with disabilities in Malawi: A review. Assist Technol 2023; 35:94-106. [PMID: 34292129 DOI: 10.1080/10400435.2021.1956641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Empirical research and data are necessary for policy, planning and provision of services for persons with disabilities. Research data may be available but still not used by researchers and policy makers. The aim of this study is to explore existing empirical research and sources of data on Assistive Technology (AT) in Malawi in order to facilitate the development of an AT policy and Assistive Product List (APL). A two-stage process using a scoping review methodology was adopted to identify (1) empirical research on AT in Malawi and (2) sources of existing data on AT in Malawi. Following a narrative synthesis, 12 heterogenous studies that reported on the use, availability, sources and knowledge about AT in Malawi were identified. Identified studies suggest that there is high unmet need for AT and services in Malawi. Five major sources of data on disability and AT were Identified. Only 2 out of the 12 studies had used existing sources of data. The high unmet need for AT and services in Malawi have substantial implications for persons with disabilities. Developing mechanisms that will improve the use of existing data on AT in all countries is pivotal for the efficient and effective development of AT ecosystems.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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11
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Abstract
Background Assistive technologies promote participation and quality of life for people with disabilities and other functional limitations. There is a global call to develop and implement policies to improve access to assistive technologies. In response, a stakeholder led initiative in Malawi is working towards the development of such a policy. Objective The objective of this study was to assess the existing network of stakeholders, and the strength of relationship between organizations who deliver assistive products and related services. Method We conducted a survey-based network analysis of assistive technology stakeholder organizations in Malawi. Results Stakeholders (n = 19) reported a range of connections, from no awareness to collaboration with organizations within the assistive technology network. No single organization or government ministry was most central to the network. International NGOs were less central to the network than local organizations for disabled people, service providers, and ministries. Conclusion The assistive technology stakeholder network in Malawi is distributed, with a range of responsibility across a variety of stakeholders, including three government ministries. An effective assistive technology policy must engage all stakeholders and may benefit from a collective leadership approach that spans the inter-sectoral need for a cohesive assistive technology system.
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Affiliation(s)
- Emma M Smith
- Assisting Living and Learning Institute, John Hume Building, Maynooth University, Maynooth, Ireland
| | - Ikenna D Ebuenyi
- Assisting Living and Learning Institute, John Hume Building, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, Chancellor's College, University of Malawi, Zomba, Malawi
| | - Monica Jamali-Phiri
- Centre for Social Research, Chancellor's College, University of Malawi, Zomba, Malawi
| | - Alister Munthali
- Centre for Social Research, Chancellor's College, University of Malawi, Zomba, Malawi
| | - Malcolm MacLachlan
- Assisting Living and Learning Institute, John Hume Building, Maynooth University, Maynooth, Ireland
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Smith EM, Ebuenyi ID, Kafumba JA, Jamali-Phiri M, Munthali A, MacLachlan M. Relevance of assistive technology and the sustainable development goals to stakeholder organizations in Malawi. Glob Health Action 2022; 15:2133381. [PMID: 36351296 PMCID: PMC9661997 DOI: 10.1080/16549716.2022.2133381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Assistive technologies are critical to supporting the participation and engagement of persons with disabilities and others who experience functional difficulties in daily life. Assistive products have been demonstrated to be related to the achievement of the Sustainable Development Goals (SDGs); however, no previous research has explored the relationship between assistive technology (AT) and the SDGs from the perspective of stakeholder organisations working in the field of AT provision. In this study, we evaluated the relevance of AT and the SDGs to achieving the organisational missions of key stakeholders in AT ecosystem in Malawi. Key stakeholders (n = 36) in the AT field in Malawi were asked to rate the relevance of AT to achieving their organisational missions, and the relevance of AT to each of the 17 SDGs on a 5-point Likert scale. Stakeholders who participated were engaged in consultative meetings with the government and an action research team as part of a larger policy development project, and represented ministries and government agencies, organisations of persons with disabilities, and local and international non-governmental organisations. AT was rated as being relevant to all of the SDGs, albeit to varying degrees, and not surprisingly to achieving AT stakeholders' organisational missions. The cross-cutting nature of the relevance of AT underscores the importance of cross-ministerial cooperation and shared leadership in provision AT.
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Affiliation(s)
- Emma M. Smith
- Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland,CONTACT Emma M. Smith Assisting Living and Learning Institute, Department of Psychology, Maynooth University, Main Street Maynooth, Co. Kildare, Maynooth, Ireland
| | - Ikenna D. Ebuenyi
- Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - Juba A. Kafumba
- Centre for Social Research, Olomouc University Social Health Institute (OUSHI), Palacky University, Olomouc, Czech Republic
| | - Monica Jamali-Phiri
- Centre for Social Research, Olomouc University Social Health Institute (OUSHI), Palacky University, Olomouc, Czech Republic
| | - Alister Munthali
- Centre for Social Research, Olomouc University Social Health Institute (OUSHI), Palacky University, Olomouc, Czech Republic
| | - Mac MacLachlan
- Centre for Social Research, Olomouc University Social Health Institute (OUSHI), Palacky University, Olomouc, Czech Republic
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Kok MC, van Eldik Z, Kakal T, Munthali A, Menon JA, Pires P, Baatsen P, van der Kwaak A. Being dragged into adulthood? Young people's agency concerning sex, relationships and marriage in Malawi, Mozambique and Zambia. Cult Health Sex 2022; 24:767-781. [PMID: 33630727 DOI: 10.1080/13691058.2021.1881618] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to explore how young people exercise agency in rural Malawi, Mozambique and Zambia in relation to sex, relationships and marriage, to inform local programmes aiming to prevent teenage pregnancy and child marriage. In each country, focus group discussions with young people and parents, in-depth interviews with young people and a variety of other participants, and a household survey with young people (15-24 years) were conducted. We found that (child) marriage was often a response to teenage pregnancy, which was highly prevalent in all study areas. Young people's aspirations to enter adulthood were influenced by their life circumstances. Initiation ceremonies symbolised the transition to adulthood and gave social endorsement to young people to start engaging in (often unprotected) sexual activity. Given the uncertain socio-economic context, resource constraints led families to marry off their daughters; or girls themselves to marry early to relieve the burden on their families, but also to get pregnant as a 'next step' towards adulthood. Transactional sex was common. These intersecting cultural, social and economic contextual factors constrained young women's agency, more as compared to young men. However, young women did manoeuvre within contextual constraints to exercise a degree of agency.
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Affiliation(s)
- Maryse C Kok
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Zoe van Eldik
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
- Wageningen Environmental Research, Wageningen, the Netherlands
| | - Tasneem Kakal
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | | | - J Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Paulo Pires
- Faculdade de Ciências de Saúde, Universidade Lúrio, Nampula, Mozambique
| | - Pam Baatsen
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
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Hampshire K, Mwase-Vuma T, Alemu K, Abane A, Munthali A, Awoke T, Mariwah S, Chamdimba E, Owusu SA, Robson E, Castelli M, Shkedy Z, Shawa N, Abel J, Kasim A. Informal mhealth at scale in Africa: Opportunities and challenges. World Dev 2021; 140:105257. [PMID: 33814676 PMCID: PMC7903241 DOI: 10.1016/j.worlddev.2020.105257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with 'mobile health' (mhealth) being a key component of this. However, while 'formal' (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers' (CHWs') 'informal mhealth' practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of 'formal' compared with 'informal' mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this 'informal health' usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
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Affiliation(s)
- Kate Hampshire
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
- Corresponding author.
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Jamali-Phiri M, Ebuenyi ID, Smith EM, Kafumba JA, MacLachlan M, Munthali A. Socio-Demographic Factors Influencing the Use of Assistive Technology among Children with Disabilities in Malawi. Int J Environ Res Public Health 2021; 18:ijerph18063062. [PMID: 33809690 PMCID: PMC8002356 DOI: 10.3390/ijerph18063062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
This paper aims to address the information gap on the influence of socio-demographic factors on access and utilization of Assistive Technology (AT) among children with disabilities in Malawi. Thus, it contributes towards the realization of the recommendations of the UN Convention on the Rights of Persons with disabilities and the development of a framework for creating an effective national AT policy. The paper used two statistically matched datasets, namely, the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey. Logistic regression and structural equation modeling techniques were utilized to assess the influence of socio-demographic factors on the use of AT among children with disabilities. The results indicate that there is a high level of unmet need for AT among young children aged 2 to 9 and those living in urban areas. The results further indicate that children with multiple disabilities have lower odds (OR = 0.924) of using AT for personal mobility compared to children with a single functional difficulty. These results entail that AT needs for children with multiple disabilities are not adequately addressed. Therefore, when developing policies on AT, younger children and those with multiple disabilities need to be specifically targeted.
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Affiliation(s)
- Monica Jamali-Phiri
- Centre for Social Research, University of Malawi, Zomba, Malawi; (J.A.K.); (A.M.)
- Correspondence:
| | - Ikenna D. Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, W23 F2K8 Maynooth, Ireland; (I.D.E.); (E.M.S.); (M.M.)
| | - Emma M. Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, W23 F2K8 Maynooth, Ireland; (I.D.E.); (E.M.S.); (M.M.)
| | - Juba Alyce Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi; (J.A.K.); (A.M.)
| | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, W23 F2K8 Maynooth, Ireland; (I.D.E.); (E.M.S.); (M.M.)
- Olomouc University Social Health Institute (OUSHI), Palacký University, 779 00 Olomouc, Czech Republic
| | - Alister Munthali
- Centre for Social Research, University of Malawi, Zomba, Malawi; (J.A.K.); (A.M.)
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16
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Ebuenyi ID, Smith EM, Munthali A, Msowoya SW, Kafumba J, Jamali MZ, MacLachlan M. Exploring equity and inclusion in Malawi's National Disability Mainstreaming Strategy and Implementation Plan. Int J Equity Health 2021; 20:18. [PMID: 33413443 PMCID: PMC7788888 DOI: 10.1186/s12939-020-01378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi’s National Disability Mainstreaming Strategy and Implementation Plan. Methods We applied an analytical methodology to review the Malawi’s National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion. Results The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process. Conclusions The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production – co-implementation – co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland.
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | - Steven W Msowoya
- Independent Consultant in Disability and Development, Blantyre, Malawi
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Monica Z Jamali
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland.,Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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Jamali-Phiri M, Kafumba JA, MacLachlan M, Smith EM, Ebuenyi ID, Eide AH, Munthali A. Addressing data deficiencies in assistive technology by using statistical matching methodology: a case study from Malawi. Disabil Rehabil Assist Technol 2020; 18:415-422. [PMID: 33369500 DOI: 10.1080/17483107.2020.1861118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa. MATERIALS AND METHODS The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors. RESULTS Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997). CONCLUSIONS The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings.Implications for RehabilitationIn resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities.The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers.
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Affiliation(s)
- Monica Jamali-Phiri
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Juba Alyce Kafumba
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of psychology, Maynooth University, Maynooth, Ireland.,Olomouc University Social Health Institute(OUSHI), Palacky University Olomouc, Czech Republic
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of psychology, Maynooth University, Maynooth, Ireland
| | - Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of psychology, Maynooth University, Maynooth, Ireland
| | | | - Alister Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
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Smith EM, Ebuenyi ID, Kafumba J, Jamali-Phiri M, MacLachlan M, Munthali A. An overview of assistive technology products and services provided in Malawi. Disabil Rehabil Assist Technol 2020; 18:387-391. [PMID: 33301351 DOI: 10.1080/17483107.2020.1854356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. OBJECTIVE To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. STUDY DESIGN Online survey of representatives from key stakeholder organisations. METHODS We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. RESULTS A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. CONCLUSION A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population.Implications for rehabilitationPolicies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented.Coordination is required for assistive product and service provision at the national and subnational level.Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.
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Affiliation(s)
- Emma M Smith
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Ikenna D Ebuenyi
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | - Malcolm MacLachlan
- Assisting Living and Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland.,Olomouc University Social Health Institute (OUSHI), Palacki University, Olomouc, Czech Republic
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Ebuenyi ID, Smith EM, Kafumba J, Jamali MZ, Munthali A, MacLachlan M. Implementation of the Assistive Product List (APL) in Malawi through development of appropriate policy and systems: an action research protocol. BMJ Open 2020; 10:e040281. [PMID: 33158833 PMCID: PMC7651723 DOI: 10.1136/bmjopen-2020-040281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Assistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi. METHOD AND ANALYSIS We propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice-and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations. ETHICS AND DISSEMINATION The study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences.
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Affiliation(s)
- Ikenna D Ebuenyi
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Emma M Smith
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Monica Z Jamali
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | | | - Malcolm MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic
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Kaunda-Khangamwa BN, Maposa I, Dambe R, Malisita K, Mtagalume E, Chigaru L, Munthali A, Chipeta E, Phiri S, Manderson L. Validating a Child Youth Resilience Measurement (CYRM-28) for Adolescents Living With HIV (ALHIV) in Urban Malawi. Front Psychol 2020; 11:1896. [PMID: 32982826 PMCID: PMC7488208 DOI: 10.3389/fpsyg.2020.01896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
Resilience as a strength-based notion, measured across cultures, age groups, and sub-populations, contributes to understanding health and well-being. Yet, there is limited evidence of how the construct performs in resource-limited countries. We explored the psychometric properties of the CYRM-28 and validated the scale with adolescents living with HIV (ALHIV), a key sub-population. The participants included members of an advisory panel and 406 ALHIV, aged 15–19 years, attending an antiretroviral therapy and teen-club clinic in Blantyre, Malawi. This study employed a mixed-method study using an exploratory sequential design. The advisory panel discussed the CYRM-28, and select ALHIV then translated it into Chichewa, pilot-tested it using cognitive interviews, and back-translated it for clarity and appropriateness. The resultant CYRM-28 was tested using a survey with purposefully selected ALHIV. The overall median score was 123, with an interquartile range of 110–130. Minimum and maximum scores were 53 and 140. Cronbach’s alpha of 0.863 and Kaiser–Meyer–Olkin measure (0.866) confirmed internal consistency and the sample size adequacy, respectively. Bartlett’s tests of sphericity (p < 0.001) informed factor analysis. Exploratory factor analysis determined possible dimensions of resilience and the sub-scales. The confirmatory factor analysis (CFA) confirmed the construct validity and supported a three-factor model consistent with the conceptualization of resilience as a multi-dimensional construct. Structural equation modeling was applied to perform CFA to measure model of resilience. Multiple fit indices showed a good fit for the model. The CYRM-28 has good internal consistency, test and re-test reliability, and moderate convergent validity which render it useful as a self-report resilience measure to inform and evaluate interventions for the health and well-being of adolescents in Malawi.
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Affiliation(s)
- Blessings N Kaunda-Khangamwa
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Malaria Alert Centre, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Innocent Maposa
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | | | | | | | | | - Alister Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sam Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Lighthouse Trust, Lilongwe, Malawi
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,School of Social Sciences, Monash University, Clayton, VIC, Australia.,Institute at Brown for Environment and Society, Brown University, Providence, RI, United States
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Kaunda-Khangamwa BN, Kapwata P, Malisita K, Munthali A, Chipeta E, Phiri S, Manderson L. Adolescents living with HIV, complex needs and resilience in Blantyre, Malawi. AIDS Res Ther 2020; 17:35. [PMID: 32571375 PMCID: PMC7310029 DOI: 10.1186/s12981-020-00292-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their illness and various social, environmental, economic and cultural factors. In exploring their various medical concerns and social vulnerabilities, we consider the role of multiple services in creating a pathway for resilience. METHODS Multiple methods and case studies allowed for triangulation of evidence and provided a holistic understanding of resilience among adolescents with complex needs. The research methods included: (1) a survey to identify examples of young people with complex needs, (2) qualitative interviews and field notes to further explore these needs, (3) patient files and health passports to identify clinical challenges, and (4) ecomapping exercises to personalize cases and identify resilience-enabling resources and supports. We present four case studies to highlight the complex experiences and access to services of ALHIV, and to illustrate their growing power and decision-making capacity over time. RESULTS Adversity experienced by ALHIV varied by gender, family situation, years of schooling, and use of teen-clubs for support. The two female adolescents emphasised their need to be accepted and how this impacted sexuality and reproduction. The two males illustrated how ideas of masculinity influenced their sexual practice and involvement with health services and the correctional justice system. Multiple risks (alcohol use, sexual activities) and complex needs (belonging, having a purpose in life/productive activities, autonomy, desire for offspring) influence pathways to resilience. ALHIV were able to strengthen their own wellbeing by resisting negative behaviours and peer pressure and caregiver interactions through 'strategic silence'. CONCLUSION ALHIV experienced self-transformation as a result of taking ART, with fewer severe episodes of illness and distressing skin conditions. Continuous engagement at the teen-club clinic transformed both productive activities and social relationships among ALHIV as they set life goals, gained a sense of empowerment, requested SRH services, and formed intimate relationships. These transformative opportunities allowed them to learn ways of minimizing risk of reinfection and violence, and of navigating health worker-caregiver-adolescent interactions.
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22
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Fleming JA, Munthali A, Ngwira B, Kadzandira J, Jamili-Phiri M, Ortiz JR, Lambach P, Hombach J, Neuzil KM, Stepanchak M, Bhat N. Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning. Vaccine 2019; 37:4568-4575. [PMID: 31319932 PMCID: PMC6642336 DOI: 10.1016/j.vaccine.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Safe, effective vaccines are given to pregnant women to protect their infants and/or themselves against certain infectious agents; however, apart from tetanus vaccination, maternal immunization in low- and middle-income countries (LMICs) remains low. Tetanus toxoid vaccine is integrated into antenatal care services in Malawi with high coverage and provides an opportunity to identify factors that facilitate successful immunization delivery to pregnant women in LMICs. METHODS PATH and the University of Malawi's Centre for Social Research conducted a mixed-methods study in 2015 to document community perceptions of maternal immunization, using tetanus vaccine as an example, and to identify factors perceived to be important to successfully introducing other maternal vaccines, such as influenza vaccine, in Malawi. We conducted 18 focus group discussions with pregnant and recently pregnant women and their family members and 76 semi-structured interviews with pregnant and recently pregnant women, community leaders, health workers, public health program managers, non-governmental partners, and policy makers. RESULTS We identified factors perceived to support the introduction of new maternal vaccines, including strong maternal vaccine acceptance in the community, an existing strategy for maternal tetanus vaccine delivery, and positive health workers' views about the introduction of additional maternal vaccines. Potential challenges to adoption and acceptance included identifying and tracking the target population and monitoring adverse events, and the need to ensure operational capacity of the health system to support the introduction and wide-scale use of an additional vaccine. For influenza vaccine specifically, additional challenges included limited awareness of influenza disease and its low prioritization among health needs. CONCLUSIONS Lessons from the successful delivery of maternal tetanus immunization in Malawi may be informative for similar countries considering new vaccines for pregnant women or striving to optimize the delivery of those currently provided.
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Affiliation(s)
- Jessica A Fleming
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
| | - Alister Munthali
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi.
| | - Bagrey Ngwira
- Malawi Polytechnic, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - John Kadzandira
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi
| | - Monica Jamili-Phiri
- The Centre for Social Research, University of Malawi, PO Box 280, Zomba, Malawi.
| | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization, Appia 20, 1211, Geneva 27, Switzerland.
| | - Kathleen M Neuzil
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
| | - Maria Stepanchak
- Global Alliance to Prevent Prematurity and Stillbirth, 19009 33rd Ave W #200, Lynnwood, WA 98036, USA.
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
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Kumwenda MK, Corbett EL, Choko AT, Chikovore J, Kaswaswa K, Mwapasa M, Sambakunsi R, Gutteberg TJ, Gordon S, Munthali A, Desmond N. Post-test adverse psychological effects and coping mechanisms amongst HIV self-tested individuals living in couples in urban Blantyre, Malawi. PLoS One 2019; 14:e0217534. [PMID: 31188865 PMCID: PMC6561556 DOI: 10.1371/journal.pone.0217534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Mandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing. We investigated adverse psychological effects and coping mechanisms following HIV-positive and HIV-discordant test results amongst self-tested individuals living in couples in urban Blantyre, Malawi. Methods Qualitative data from 35 in-depth interviews with self-tested individuals living in couples for more than 3 months were collected and analysed using thematic content analysis. Results Adverse psychological effects seemed to mostly occur among individuals learning for the first-time that they were HIV-positive or living in HIV-discordant relationship. Irrespective of test outcomes, women living in couples expressed difficulty making important decisions about the future of their relationships while men seemed to shoulder the emotional burden associated with feeling or being seen as responsible for introducing HIV into the relationship. Post-test psychosocial support and ascertained positive behaviour change of the perceived index partner allowed some couples to overcome adverse psychological effects linked to test results. Conclusion Self-tested individuals living in couples may lack collective coping capability to collaboratively manage post-test adverse events after new HIV-positive or HIV-discordant results. Psychosocial support seemed to enable couples to foster both an individual and a collective ability to manage adverse psychological effects within the context of a couple. More research is needed to ascertain the magnitude of the deficiency of collective coping competency in couples following an HIV test.
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Affiliation(s)
- Moses Kelly Kumwenda
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Elizabeth Lucy Corbett
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Augustine Talumba Choko
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeremiah Chikovore
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, Durban, South Africa
| | - Kruger Kaswaswa
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
| | - Mphatso Mwapasa
- Helse Nord TB initiative, College of Medicine, Blantyre, Malawi
- Population Health Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tore Jarl Gutteberg
- University of Tromso, The Arctic University of Norway, Tromsø, Norway
- University Hospital of North Norway, Tromsø, Norway
| | - Stephen Gordon
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Nicola Desmond
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Hjertholm KG, Holmboe-Ottesen G, Iversen PO, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Seasonality in associations between dietary diversity scores and nutrient adequacy ratios among pregnant women in rural Malawi - a cross-sectional study. Food Nutr Res 2019; 63:2712. [PMID: 30837821 PMCID: PMC6397333 DOI: 10.29219/fnr.v63.2712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background Dietary diversity scores (DDS) are simple indicators often used as proxies for nutrient adequacy. A 10-food group indicator is proposed by the Food and Agriculture Organization of the United Nations as a global standard for measuring dietary diversity among women in low-resource settings. However, its validity as a proxy for nutrient adequacy across different agricultural seasons for pregnant women has not been determined. Objective We studied associations between DDS and nutrient adequacy ratios (NAR) across two different agricultural seasons (pre- and post-harvest seasons) for pregnant women in rural Malawi and assessed whether a 1-day DDS or a 3-day DDS would be the best indicator of nutrient adequacy. Design Dietary intakes of 330 pregnant women were assessed between gestational weeks 28 and 35. Intakes of energy, macronutrients, and 11 micronutrients were estimated using three repeated interactive 24-h diet recalls, and DDS were also calculated from these days. Correlation coefficients (r) between DDS, NAR, and mean adequacy ratio (MAR) of the 11 micronutrients were determined. Results After energy adjustments, we found significant correlations between DDS and MAR with both DDS indicators in the preharvest season (r = 0.22–0.23; p < 0.001) but not in the post-harvest season (p > 0.05). For individual energy-adjusted NARs, correlations were not consistently significant across the two seasons and the two DDS indicators. Conclusions Our results suggest that DDS could be used to predict overall nutrient adequacy during the preharvest season. As similar correlations were found using both the 1- and 3-day indicators, we recommend using a 1-day DDS, for simplicity. However, as the indicators are sensitive to seasonality they should be used with care in this study setting.
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Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Ibrahimu Mdala
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Penjani Kamudoni
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Kumwenda MK, Corbett EL, Chikovore J, Phiri M, Mwale D, Choko AT, Nliwasa M, Sambakunsi R, Taegtmeyer M, Gutteberg TJ, Munthali A, Desmond N. Discordance, Disclosure and Normative Gender Roles: Barriers to Couple Testing Within a Community-Level HIV Self-Testing Intervention in Urban Blantyre, Malawi. AIDS Behav 2018; 22:2491-2499. [PMID: 29411227 PMCID: PMC6097721 DOI: 10.1007/s10461-018-2038-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A community-based HIV self-testing study in Blantyre, Malawi demonstrated that not all individuals living in couples tested with their partner. We describe factors dissuading individuals in couples from self-testing with their partner. Data were drawn from qualitative study exploring consequences of HIV self-testing within couples. In-depth interviews were conducted with 33 individuals living in couples who tested alone. Participants expressed fear of dealing with HIV-discordant relationships. Failure to self-test with a partner was correlated with gender, with more men than women overtly declining or unconsciously unable to have joint HIV self-test. Men feared exposure of infidelity and were often not available at home for economic reasons. Barriers to uptake of couple HIV self-testing seemed to be shaped by gendered dichotomies of social-relationships. To help achieve the first 90% of the UNAIDS 90:90:90 goals, it is important to overcome structural barriers to realise the full potential of HIV self-testing.
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Affiliation(s)
- Moses Kelly Kumwenda
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi.
- College of Medicine, Helse Nord TB Initiative, Blantyre 3, Private Bag 360, Chichiri, Malawi.
| | - Elizabeth Lucy Corbett
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jeremiah Chikovore
- HIV/AIDS, STIs and TB (HAST), Human Sciences Research Council, Private Bag X07, Dalbridge, 4014, South Africa
| | - Mackwellings Phiri
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi
| | - Daniel Mwale
- College of Medicine, Helse Nord TB Initiative, Blantyre 3, Private Bag 360, Chichiri, Malawi
| | - Augustine Talumba Choko
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Marriot Nliwasa
- College of Medicine, Helse Nord TB Initiative, Blantyre 3, Private Bag 360, Chichiri, Malawi
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Rodrick Sambakunsi
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi
| | - Miriam Taegtmeyer
- International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Tore Jarl Gutteberg
- Department of Medical Biology, University of Tromsø, Postboks 6050, Langnes 9037, Tromsø, Norway
- Department of Microbiology and Infection Control, University Hospital, UNN Tromsø, Klinikk/avdeling, 9038, Tromsø, Norway
| | - Alister Munthali
- Centre for Social Research, Chancellor College, P.O. Box 280, Zomba, Malawi
| | - Nicola Desmond
- Behaviour and Health Group, Malawi Liverpool Wellcome Trust, Blantyre 3, P.O. Box 30096, Chichiri, Malawi
- International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Eide AH, Dyrstad K, Munthali A, Van Rooy G, Braathen SH, Halvorsen T, Persendt F, Mvula P, Rød JK. Combining survey data, GIS and qualitative interviews in the analysis of health service access for persons with disabilities. BMC Int Health Hum Rights 2018; 18:26. [PMID: 29940955 PMCID: PMC6019232 DOI: 10.1186/s12914-018-0166-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022]
Abstract
Background Equitable access to health services is a key ingredient in reaching health for persons with disabilities and other vulnerable groups. So far, research on access to health services in low- and middle-income countries has largely relied on self-reported survey data. Realizing that there may be substantial discrepancies between perceived and actual access, other methods are needed for more precise knowledge to guide health policy and planning. The objective of this article is to describe and discuss an innovative methodological triangulation where statistical and spatial analysis of perceived distance and objective measures of access is combined with qualitative evidence. Methods The data for the study was drawn from a large household and individual questionnaire based survey carried out in Namibia and Malawi. The survey data was combined with spatial data of respondents and health facilities, key informant interviews and focus group discussions. To analyse access and barriers to access, a model is developed that takes into account both measured and perceived access. The geo-referenced survey data is used to establish four outcome categories of perceived and measured access as either good or poor. Combined with analyses of the terrain and the actual distance from where the respondents live to the health facility they go to, the data allows for categorising areas and respondents according to the four outcome categories. The four groups are subsequently analysed with respect to variation in individual characteristics and vulnerability factors. The qualitative component includes participatory map drawing and is used to gain further insight into the mechanisms behind the different combinations of perceived and actual access. Results Preliminary results show that there are substantial discrepancies between perceived and actual access to health services and the qualitative study provides insight into mechanisms behind such divergences. Conclusion The novel combination of survey data, geographical data and qualitative data will generate a model on access to health services in poor contexts that will feed into efforts to improve access for the most vulnerable people in underserved areas.
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Affiliation(s)
- Arne H Eide
- SINTEF, Department of Health, P.B.124, N-0314, Oslo, Norway.
| | - Karin Dyrstad
- Department of Sociology and Political Science, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Gert Van Rooy
- Multidisciplinary Research Centre, University of Namibia, P. B. 13301, Windhoek, Namibia
| | | | - Thomas Halvorsen
- SINTEF, Department of Health, P.B. 4760, Torgarden, N-7465, Trondheim, Norway
| | - Frans Persendt
- Department of Geography, History and Environmental Studies, University of Namibia, P.B. 13301, Windhoek, Namibia
| | - Peter Mvula
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Jan Ketil Rød
- Department of Geography, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
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Flick RJ, Kim MH, Simon K, Munthali A, Hosseinipour MC, Rosenberg NE, Kazembe PN, Mpunga J, Ahmed S. Burden of disease and risk factors for death among children treated for tuberculosis in Malawi. Int J Tuberc Lung Dis 2018; 20:1046-54. [PMID: 27393538 DOI: 10.5588/ijtld.15.0928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is a leading cause of childhood death. Patient-level data on pediatric TB in Malawi that can be used to guide programmatic interventions are limited. OBJECTIVE To describe pediatric TB case burden, disease patterns, treatment outcomes, and risk factors for death and poor outcome. DESIGN We conducted a retrospective cohort study utilizing routine data. Odds ratios (ORs) for factors associated with poor outcome and death were calculated using generalized estimating equations. RESULTS Children represented 8% (371/4642) of TB diagnoses. The median age was 7 years (interquartile range 2.8-11); 32.8% (113/345) were human immunodeficiency virus (HIV) infected. Of these, 54.0% were on antiretroviral therapy (ART) at the time of anti-tuberculosis treatment (ATT) initiation, 21.2% started ART during ATT, and 24.8% had no documented ART. The treatment success rate was 77.3% (11.2% cured, 66.1% completed treatment), with 22.7% experiencing poor outcomes (9.5% died, 13.2% were lost to follow-up). Being on ART at the time of ATT initiation was associated with increased odds of death compared to beginning ART during treatment (adjusted OR 2.75, 95%CI 1.27-5.96). CONCLUSION Children represent a small proportion of diagnosed TB cases and experience poor outcomes. Higher odds of death among children already on ART raises concerns over the management of these children. Further discussion of and research into pediatric-specific strategies is required to improve case finding and outcomes.
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Affiliation(s)
- R J Flick
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; University of North Carolina Project-Malawi, Lilongwe, Malawi; University of Colorado School of Medicine, Denver, Colorado, USA
| | - M H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - K Simon
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi, Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - A Munthali
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - M C Hosseinipour
- University of North Carolina Project-Malawi, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - N E Rosenberg
- University of North Carolina Project-Malawi, Lilongwe, Malawi, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - P N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - J Mpunga
- Malawi Ministry of Health National Tuberculosis Programme, Lilongwe, Malawi
| | - S Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Gondwe A, Munthali A, Ashorn P, Ashorn U. Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi. Matern Child Health J 2017; 20:1441-7. [PMID: 26976282 DOI: 10.1007/s10995-016-1942-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility's preterm unit.
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Affiliation(s)
- Austrida Gondwe
- iLiNS Project, College of Medicine-Mangochi, University of Malawi, Zomba, Malawi. .,Department of International Health, University of Tampere, Tampere, Finland.
| | - Alister Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | - Per Ashorn
- Department for International Health, University of Tampere and Department of Paediatrics, Tampere University Hospital, University of Tampere School of Medicine, Tampere, Finland
| | - Ulla Ashorn
- Department for International Health, University of Tampere and Department of Paediatrics, Tampere University Hospital, University of Tampere School of Medicine, Tampere, Finland
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Visagie S, Eide AH, Dyrstad K, Mannan H, Swartz L, Schneider M, Mji G, Munthali A, Khogali M, van Rooy G, Hem KG, MacLachlan M. Factors related to environmental barriers experienced by persons with and without disabilities in diverse African settings. PLoS One 2017; 12:e0186342. [PMID: 29023578 PMCID: PMC5638520 DOI: 10.1371/journal.pone.0186342] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 10/01/2017] [Indexed: 11/18/2022] Open
Abstract
This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011–2012 by means of a two-stage cluster sampling and comprised 400–500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.
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Affiliation(s)
- Surona Visagie
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
| | - Arne H. Eide
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
- SINTEF Technology and Society, Oslo, Norway
- * E-mail:
| | | | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Leslie Swartz
- Stellenbosch University, Department of Psychology, Stellenbosch, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
| | | | | | | | | | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
- Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
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Hjertholm KG, Iversen PO, Holmboe-Ottesen G, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Maternal dietary intake during pregnancy and its association to birth size in rural Malawi: A cross-sectional study. Matern Child Nutr 2017; 14. [PMID: 28217860 DOI: 10.1111/mcn.12433] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Abstract
In low-resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low-birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3-day interactive 24-hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: -0.1; 95% CI: -0.2, 0.0 cm/E%) and abdominal circumference (β: -0.1, 95% CI: -0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food-based interventions in the study area to promote inclusion of fat, vitamin C-rich foods, and milk in pregnancy.
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Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Penjani Kamudoni
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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31
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Visagie S, Eide AH, Mannan H, Schneider M, Swartz L, Mji G, Munthali A, Khogali M, van Rooy G, Hem KG, MacLachlan M. A description of assistive technology sources, services and outcomes of use in a number of African settings. Disabil Rehabil Assist Technol 2016; 12:705-712. [DOI: 10.1080/17483107.2016.1244293] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Surona Visagie
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | - Arne H. Eide
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
- SINTEF Technology and Society, Oslo, Norway
| | - Hasheem Mannan
- Centre for Global Health, Trinity University College, Dublin, Ireland
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - Leslie Swartz
- Department of Psycology, Stellenbosch University, Stellenbosch, South Africa
| | - Gubela Mji
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | | | - Mustafa Khogali
- School of Medicine, Afhad University for Women, Omdurman, Sudan
| | - Gert van Rooy
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
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Hampshire K, Porter G, Mariwah S, Munthali A, Robson E, Owusu SA, Abane A, Milner J. Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi. Health Policy Plan 2016; 32:34-42. [PMID: 27476501 PMCID: PMC5886236 DOI: 10.1093/heapol/czw095] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/13/2022] Open
Abstract
Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to 'care' even at substantial personal cost. Although there is significant potential for 'informal mhealth' to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.
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Affiliation(s)
- Kate Hampshire
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - Gina Porter
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast, Ghana
| | | | - Elsbeth Robson
- Department of Geography, Environment and Earth Sciences, University of Hull, UK
| | | | - Albert Abane
- Department of Geography and Regional Planning, University of Cape Coast, Ghana
| | - James Milner
- Centre for Social Research, University of Malawi.,Deceased author
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Nyasulu P, Kambale S, Chirwa T, Umanah T, Singini I, Sikwese S, Banda HT, Banda RP, Chimbali H, Ngwira B, Munthali A. Knowledge and perception about tuberculosis among children attending primary school in Ntcheu District, Malawi. J Multidiscip Healthc 2016; 9:121-31. [PMID: 27069367 PMCID: PMC4818047 DOI: 10.2147/jmdh.s97409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Knowledge and perceptions about tuberculosis (TB) can influence care-seeking behavior and adherence to treatment. Previous studies in Malawi were conducted to assess knowledge and attitudes regarding TB in adults, with limited data on knowledge in children. OBJECTIVES This study assessed knowledge and perceptions about TB in children aged 10-14 years attending primary school in Ntcheu District, Malawi. DESIGN A cross-sectional study was conducted in four primary schools in Ntcheu District. Data on knowledge and perception of TB were collected using a structured questionnaire. Pearson chi-square test was used to determine the association between socioeconomic factors and TB knowledge and perception. A P<0.05 was considered significant. RESULTS The study found that the learners had high knowledge regarding the cause, spread, and TB preventive measures. Almost 90% of learners knew that TB is caused by a germ, however, a lower proportion knew about TB symptoms ie, night sweats (49%) and enlarged cervical lymph nodes (40%). We found that 68% of learners did not know the duration of anti-TB treatment. No association was found between age, learners' grade, and knowledge (P>0.05). CONCLUSION Lack of knowledge regarding TB and gaps identified, may be due to a deficiency in the content of the school curriculum or the availability of information, education, and communication materials. This is the first study to report on knowledge and perceptions of TB among primary school learners in Malawi. These results will inform the development of relevant information, education, and communication materials to enhance awareness about TB among school going children.
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Affiliation(s)
- Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Susan Kambale
- World Health Organization, Country Office, Lilongwe, Malawi
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Teye Umanah
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Isaac Singini
- Johns Hopkins Research Project, College of Medicine, University of Malawi, Malawi
| | - Simon Sikwese
- Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Hastings T Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Rhoda P Banda
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - Henry Chimbali
- Health Promotion Section, Ministry of Health, Lilongwe, Malawi
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
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MacLachlan M, Mannan H, Huss T, Munthali A, Amin M. Policies and Processes for Social Inclusion: Using EquiFrame and EquIPP for Policy Dialogue Comment on "Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development". Int J Health Policy Manag 2015; 5:193-6. [PMID: 26927591 DOI: 10.15171/ijhpm.2015.200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/13/2015] [Indexed: 11/09/2022] Open
Abstract
The application of EquiFrame in the analysis of sexual and reproductive health policies by Ivanova et al to a new thematic area, their selection of only some of the Core Concepts of human rights in health service provision and the addition of new vulnerable groups relevant to the purpose of their analysis, are all very welcome developments. We also applaud their application of EquiFrame to policies in countries where it has not previously been used, along with their use of interviews with policy-makers to produce a deeper understanding of policy processes. We argue that clear justification for the inclusion of additional, or replacement of some exiting vulnerable groups within EquiFrame should be accompanied by clear definitions of such groups, along with the evidence-base that justifies their classification as a vulnerable or marginalised group. To illustrate the versatility of EquiFrame, we summarise a range of ways in which it has been used across a number of regions; including a brief Case Study of its use to develop the National Health Policy of Malawi. While EquiFrame focuses on policy content, we preview a new policy analysis tool - Equity and Inclusion in Policy Processes (EquIPP) - which assesses the extent of equity and inclusion in broader policy processes. Together, EquiFrame and EquIPP can be used to help governments and civil society ensure that policies are addressing the much stronger emphasis on social inclusion, now apparent in the Sustainable Development Goals (SDGs).
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Affiliation(s)
- Malcolm MacLachlan
- Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland.,Stellenbosch University, Stellenbosch, South Africa
| | - Hasheem Mannan
- Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland.,University College Dublin, Dublin 4, Ireland
| | - Tessy Huss
- Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
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Eide AH, Mannan H, Khogali M, van Rooy G, Swartz L, Munthali A, Hem KG, MacLachlan M, Dyrstad K. Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries. PLoS One 2015; 10:e0125915. [PMID: 25993307 PMCID: PMC4489521 DOI: 10.1371/journal.pone.0125915] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/21/2015] [Indexed: 11/19/2022] Open
Abstract
There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.
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Affiliation(s)
- Arne H. Eide
- SINTEF Technology and Society, Oslo, Norway
- Stellenbosch University, Stellenbosch, South Africa
- * E-mail:
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Chizimba R, Christofides N, Chirwa T, Singini I, Ozumba C, Sikwese S, Banda HT, Banda R, Chimbali H, Ngwira B, Munthali A, Nyasulu P. The association between multiple sources of information and risk perceptions of tuberculosis, Ntcheu district, Malawi. PLoS One 2015; 10:e0122998. [PMID: 25885532 PMCID: PMC4401750 DOI: 10.1371/journal.pone.0122998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) is one of the main causes of death in developing countries. Awareness and perception of risk of TB could influence early detection, diagnosis and care seeking at treatment centers. However, perceptions about TB are influenced by sources of information. Aim This study aimed to determine the association between multiple sources of information, and perceptions of risk of TB among adults aged 18–49 years. Methods A cross-sectional study was conducted in Ntcheu district in Malawi. A total of 121 adults were sampled in a three-stage simple random sampling technique. Data were collected using a structured questionnaire. Perceptions of risk were measured using specific statements that reflected common myths and misconceptions. Low risk perception implied a person having strong belief in myths and misconceptions about TB and high risk perception meant a person having no belief in myths or misconceptions and demonstrated understanding of the disease. Results Females were more likely to have low risk perceptions about TB compared to males (67.7% vs. 32.5%, p = 0.01). The higher the household asset index the more likely an individual had higher risk perceptions about TB (p = 0.006). The perception of risk of TB was associated with sources of information (p = 0.03). Use of both interpersonal communication and mass media was 2.8 times more likely to be associated with increased perception of risk of TB (Odds Ratio [OR] = 2.8; 95% Confidence interva1[CI]: 3.1–15. 6; p = 0.01). After adjusting for sex and asset ownership, use of interpersonal communication and mass media were more likely to be associated with higher perception of risk of TB (OR, 2.0; 95% CI: 1.65–10.72; p = 0.003) compared with interpersonal communication only (OR 1.6, 95%; CI: 1.13–8.98, p = 0.027). Conclusion The study found that there was association between multiple sources of information, and higher perceptions of risk of TB among adults aged 18–49 years.
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Affiliation(s)
- Robert Chizimba
- Health Department, Save the Children International, Lilongwe, Malawi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Singini
- Johns Hopkins Research Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Chineme Ozumba
- Department of Public Health, School of Health Sciences, Monash, South Africa
| | - Simon Sikwese
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Hastings T. Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Rhoda Banda
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - Henry Chimbali
- Health Promotion Services, Ministry of Health, Lilongwe, Malawi
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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MacLachlan M, Amin M, Mji G, Mannan H, McVeigh J, McAuliffe E, Amadhila E, Munthali A, Eide AH, Dube AK. Learning from doing the EquitAble project: Content, context, process, and impact of a multi-country research project on vulnerable populations in Africa. Afr J Disabil 2014; 3:89. [PMID: 28730013 PMCID: PMC5442513 DOI: 10.4102/ajod.v3i2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 05/28/2014] [Indexed: 11/04/2022] Open
Abstract
Background The ‘EquitAble’ project carried out content analyses of policies and collected and analysed qualitative and quantitative data concerning access to health services in Sudan, Malawi, Namibia and South Africa. Our particular concern was to address the situation of people with disabilities, although not in isolation from other marginalised or vulnerable groups. Objectives This article reports on the content, context, process and impact of project EquitAble, funded by the European Commission Seventh Research Framework Programme, which brought together researchers from Ireland, Norway, South Africa, Namibia, Sudan and Malawi. Method After the 4-year project ended in February 2013, all members of the consortium were asked to anonymously complete a bespoke questionnaire designed by the coordinating team. The purpose of the questionnaire was to capture the views of those who collaborated on the research project in relation to issues of content, context, process and impact of the EquitAble project. Results Our results indicated some of the successes and challenges encountered by our consortium. Conclusion We identified contextual and process learning points, factors often not discussed in papers, which typically focus on the reporting of the ‘content’ of results.
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Affiliation(s)
- Mac MacLachlan
- Centre for Global Health and School of Psychology, Trinity College Dublin, Ireland.,Centre for Rehabilitation Studies, Stellenbosch University, South Africa
| | - Mutamad Amin
- Research & Grants, Ahfad University for Women, Omdurman, Sudan
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, South Africa
| | - Hasheem Mannan
- Centre for Global Health and School of Psychology, Trinity College Dublin, Ireland.,Nossal Institute for Global Health, University of Melbourne, Australia
| | - Joanne McVeigh
- Centre for Global Health and School of Psychology, Trinity College Dublin, Ireland
| | - Eilish McAuliffe
- Centre for Global Health and School of Psychology, Trinity College Dublin, Ireland
| | - Elina Amadhila
- Multidisciplinary Research Centre, University of Namibia, Namibia
| | | | | | - A Kudakwashe Dube
- Secretariat of the African Decade of Persons with Disabilities, Pretoria, South Africa
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Kumwenda M, Munthali A, Phiri M, Mwale D, Gutteberg T, MacPherson E, Theobald S, Corbett L, Desmond N. Factors shaping initial decision-making to self-test amongst cohabiting couples in urban Blantyre, Malawi. AIDS Behav 2014; 18 Suppl 4:S396-404. [PMID: 24929834 PMCID: PMC4102820 DOI: 10.1007/s10461-014-0817-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.
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Affiliation(s)
- Moses Kumwenda
- Pathology and Medical Laboratory Sciences, College of Medicine, University of Malawi, Private Bag 360 Chichiri, Blantyre 3, Malawi,
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Buck WC, Olson D, Kabue MM, Ahmed S, Nchama LK, Munthali A, Hosseinipour MC, Kazembe PN. Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection. Int J Tuberc Lung Dis 2013; 17:1389-95. [PMID: 24125439 PMCID: PMC5523939 DOI: 10.5588/ijtld.13.0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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 co-infected 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 antiretroviral 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 anti-tuberculosis treatment (adjusted OR 8.83, 95%CI 4.42-17.63). Severe immunosuppression and World Health Organization Stage IV were also associated with mortality. CONCLUSIONS Pediatric TB-HIV co-infection is common and mortality is high in this cohort of Malawian children. Prompt initiation of ART should be emphasized in this high-risk patient population.
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Affiliation(s)
- W C Buck
- Abbott Fund Children's Clinical Centre of Excellence, Baylor College of Medicine, Lilongwe, Malawi; Baylor College of Medicine International Pediatric AIDS Initiative, Houston, Texas, USA; Department of Pediatrics, Denver Health/University of Colorado, Denver, Colorado, USA
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Munthali A, Braathen SH, Grut L, Kamaleri Y, Ingstad B. Seeking care for epilepsy and its impacts on households in a rural district in southern Malawi. Afr J Disabil 2013; 2:54. [PMID: 28729991 PMCID: PMC5442585 DOI: 10.4102/ajod.v2i1.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/30/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Epilepsy is a disability as defined in the 2012 Disability Act of the Government of Malawi. OBJECTIVES This article explores the health-seeking behaviour of people with epilepsy in a rural town in southern Malawi and how having a person with epilepsy impacts on the households' productivity. METHOD A snowball approach was used to identify persons with various forms of disabilities. The article is based on a bigger study carried out in Malawi which explored how persons with disabilities seek health care. In this bigger study, a total of 63 interviews were done with persons with disabilities or their guardians. Eight of the 63 interviews were with persons with epilepsy and this article is based on these interviews. RESULTS The study found that persons with epilepsy seek both traditional and modern medicines to treat the condition. Informants mentioned that barriers to accessing western treatment include lack of medicines, congestion at health facilities, lack of knowledge about epilepsy, misdiagnosis by health workers and the belief that epilepsy caused by witchcraft cannot be treated by western medicine. The study also highlights the wider impacts of epilepsy on the household such as the failure of children to attend school, children dropping out of school, stigma and discrimination and households being driven deeper into poverty as a result of seeking care for members with epilepsy. CONCLUSION The existing barriers to accessing treatment for epilepsy can be addressed by using a combination of public education, simple treatments and regular reviews. Ensuring constant availability of drugs for the treatment of epilepsy is key to effective treatment of the condition. This would contribute to closing the treatment gap for epilepsy as advocated by the Global Campaign against Epilepsy.
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Mannan H, ElTayeb S, MacLachlan M, Amin M, McVeigh J, Munthali A, Van Rooy G. Core concepts of human rights and inclusion of vulnerable groups in the mental health policies of Malawi, Namibia, and Sudan. Int J Ment Health Syst 2013; 7:7. [PMID: 23406583 PMCID: PMC3620687 DOI: 10.1186/1752-4458-7-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most crucial steps towards delivering judicious and comprehensive mental health care is the formulation of a policy and plan that will navigate mental health systems. For policy-makers, the challenges of a high-quality mental health system are considerable: the provision of mental health services to all who need them, in an equitable way, in a mode that promotes human rights and health outcomes. METHOD EquiFrame, a novel policy analysis framework, was used to evaluate the mental health policies of Malawi, Namibia, and Sudan. The health policies were assessed in terms of their coverage of 21 predefined Core Concepts of human rights (Core Concept Coverage), their stated quality of commitment to said Core Concepts (Core Concept Quality), and their inclusion of 12 Vulnerable Groups (Vulnerable Group Coverage). In relation to these summary indices, each policy was also assigned an Overall Summary Ranking, in terms of it being of High, Moderate, or Low quality. RESULTS Substantial variability was identified across EquiFrame's summary indices for the mental health policies of Malawi, Namibia, and Sudan. However, all three mental health policies scored high on Core Concept Coverage. Particularly noteworthy was the Sudanese policy, which scored 86% on Core Concept Coverage, and 92% on Vulnerable Group Coverage. Particular deficits were evident in the Malawian mental health policy, which scored 33% on Vulnerable Group Coverage and 47% on Core Concept Quality, and was assigned an Overall Summary Ranking of Low accordingly. The Overall Summary Ranking for the Namibian Mental Health Policy was High; for the Sudanese Mental Health Policy was Moderate; and for the Malawian Mental Health Policy was Low. CONCLUSIONS If human rights and equity underpin policy formation, it is more likely that they will be inculcated in health service delivery. EquiFrame may provide a novel and valuable tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, a key practical step in the successful realization of the Millennium Development Goals.
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Affiliation(s)
- Hasheem Mannan
- Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Shahla ElTayeb
- School of Psychology at Ahfad University for Women, Omdurman, Sudan
| | - Malcolm MacLachlan
- Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland, and Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa
| | | | - Joanne McVeigh
- Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | | | - Gert Van Rooy
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
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Mannan H, McVeigh J, Amin M, MacLachlan M, Swartz L, Munthali A, Van Rooy G. Core Concepts of Human Rights and Inclusion of Vulnerable Groups in the Disability and Rehabilitation Policies of Malawi, Namibia, Sudan, and South Africa. Journal of Disability Policy Studies 2012. [DOI: 10.1177/1044207312439103] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent decades, there has been a push to incorporate the World Health Organization “Health for All” principles in national, regional, and local health policy documents. However, there is still no methodology guiding the appraisal of such policies with regard to the extent that they address social inclusion. In this article, the authors report on the development of EquiFrame, a novel policy analysis framework that was used to evaluate the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. The policies were assessed in terms of their commitment to 21 predefined core concepts of human rights and inclusion of 12 vulnerable groups. Substantial variability was identified in the degree to which the core concepts and vulnerable groups were featured in these policy documents. The overall summary rankings for the disability policies of the countries studied were as follows: Namibia–High, Malawi–Low, and Sudan–Low. The rehabilitation policy of South Africa was ranked as Low. The results support the idea that adequate disability and rehabilitation policies remain mostly undefined. EquiFrame may offer a useful methodology for evaluating and comparing human rights and social inclusion across policy documents.
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Affiliation(s)
| | | | | | - Malcolm MacLachlan
- Trinity College, Dublin, Ireland
- Stellenbosch University, Matieland, South Africa
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MacLachlan M, Amin M, Mannan H, El Tayeb S, Bedri N, Swartz L, Munthali A, Van Rooy G, McVeigh J. Inclusion and human rights in health policies: comparative and benchmarking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia. PLoS One 2012; 7:e35864. [PMID: 22649488 PMCID: PMC3359320 DOI: 10.1371/journal.pone.0035864] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 03/27/2012] [Indexed: 11/19/2022] Open
Abstract
While many health services strive to be equitable, accessible and inclusive, peoples' right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed--EquiFrame--to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development.
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Affiliation(s)
- Malcolm MacLachlan
- Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland.
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Amin M, MacLachlan M, Mannan H, El Tayeb S, El Khatim A, Swartz L, Munthali A, Van Rooy G, McVeigh J, Eide A, Schneider M. EquiFrame: a framework for analysis of the inclusion of human rights and vulnerable groups in health policies. Health Hum Rights 2011; 13:1-20. [PMID: 22957368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Ensuring that health policies uphold core concepts of human rights and are inclusive of vulnerable groups are imperative aspects of providing equity in health care, and of realizing the United Nations’ call for Health for All. We outline the process of extensive consultation undertaken across countries and stakeholders culminating in the development of EquiFrame, in conjunction with its associated definitions of core concepts of human rights and vulnerability. EquiFrame is a systematic policy analysis framework that assesses the degree to which 21 core concepts of human rights and 12 vulnerable groups are mentioned and endorsed in health policy documents. We illustrate the scope of the framework by reporting the results of its application to two health policy documents from (Northern) Sudan: the rather generalist Health Policy of (Northern) Sudan, and the more specific National Drug Policy of (Northern) Sudan. We outline some limitations of the framework and highlight issues for considerationin its interpretation. EquiFrame offers a systematic approach to analyzing andfacilitating the inclusion of core concepts of human rights and vulnerability in existing or developing health policies and ultimately to promoting greater equity in health care.
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Affiliation(s)
- Mutamad Amin
- School of Psychology, Ahfad University for Women, Omdurman, Sudan
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Abstract
Although the original study of remuneration differences between local and expatriate development workers took place in the landlocked economy of Malaŵi, the study has never been replicated outside of one sector and organization (the National University), and took place prior to the 2000 Millennium Development Goals. Participating in the present studies were 458 aid and development professionals, working across a range of sectors in Malaŵi (n = 241, response rate = 50%) and Uganda (n = 217, response rate = 51%). The size of the gap between local and international workers, measured using the World Bank's purchasing power parity, was higher in Malaŵi (4.04:1) than in Uganda (1.97:1). The ratio was more clearly within tolerance levels in Uganda than in Malaŵi. Consistent with these differences, and controlling for organization, cultural, and demographic factors, locally remunerated workers reported more and expatriate workers less injustice and demotivation in Malaŵi than in Uganda. Although sample sizes for the internationally remunerated are small, the findings suggest that wider disparities may (1) hinder perspective-taking and (2) decrease motivation. In-country workshops with stakeholders and subject-matter experts considered the findings, and potential solutions offered through the survey form. They recommended the implementation of performance-based remuneration, including competency-based job analysis and evaluation. Competencies in such functions can be provided by humanitarian work psychology.
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Porter G, Hampshire K, Bourdillon M, Robson E, Munthali A, Abane A, Mashiri M. Children as research collaborators: issues and reflections from a mobility study in sub-Saharan Africa. Am J Community Psychol 2010; 46:215-227. [PMID: 20532615 DOI: 10.1007/s10464-010-9317-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper reflects on issues raised by work with children in an ongoing child mobility study in three sub-Saharan African countries: Ghana, Malawi and South Africa. There are now 70 school pupils of varying ages involved in the project, but the paper is particularly concerned with the participation of those children 14 years and under. We examine the significant ethical issues associated with working with younger child researchers, and linked questions concerning the spaces open to them in African contexts where local cultural constructions of childhood and associated economic imperatives (which commonly drive family and household endeavour) help shape the attitudes of adults to children's rights and responsibilities and inter-generational power relations.
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Affiliation(s)
- Gina Porter
- Department of Anthropoloogy, Durham University, Science Site, South Road, Durham, UK.
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Biddlecom AE, Munthali A, Singh S, Woog V. Adolescents' views of and preferences for sexual and reproductive health services in Burkina Faso, Ghana, Malawi and Uganda. Afr J Reprod Health 2007; 11:99-110. [PMID: 18458737 PMCID: PMC2367115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Adolescents' views of and preferences for sexual and reproductive health services highlight promising directions and persistent challenges in preventing pregnancy and HIV and treating sexually-transmitted infections (STIs) in this population. Results from nationally-representative surveys of 12-19 year-olds in Burkina Faso, Ghana, Malawi and Uganda in 2004 show that contraceptive and STI services and HIV testing are still under-utilized. A substantial proportion of sexually-active adolescents do not know of any source to obtain contraception or get STI treatment, and social-psychological reasons (e.g., embarrassment or fear) and financial cost remain common barriers to getting services. Adolescents' preferences are overwhelmingly for public clinics, with strongly positive perceptions of confidentiality, accessibility and cost. Some gender and country differences exist, yet overall females and males' views are similar. Results highlight the need to inform youth about sources, increase availability of government health facilities and improve youth's access to them, especially by reducing social barriers.
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Biddlecom AE, Munthali A, Singh S, Woog V. Adolescents' Views of and Preferences for Sexual and Reproductive Health Services in Burkina Faso, Ghana, Malawi and Uganda. Afr J Reprod Health 2007. [DOI: 10.2307/25549734] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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