Community, social group, and individual level correlates of rural Malawian men's and women's reproductive health intentions and practices.

Using a sample of 656 men and 930 women from rural Malawi in 2000, the authors examined the association between various individual and community level factors, as well as participation in social groups, and four reproductive health outcomes: intentions to use any contraceptives in the next six months, current use of modem contraceptives, wanting an HIV test, and having had an HIV test. Women in social groups have higher odds of reporting intentions to use contraceptives, wanting an HIV test, and of having had an HIV test than those not in groups. Among men, social group participation is only slightly associated with having had an HIV test. For all, education is positively associated with all four outcomes, and number of children is associated with intentions to use and actual use of contraceptives. At a community level, proximity to a health center or school is positively associated with three outcomes for women and with use of modern contraceptive methods for men.

Health systems strengthening in conflict situations.

Many people in Africa live in fragile states where conflicts are common. These countries are under pressure to deliver health services within their limited capacity. This paper looks at ways of strengthening health systems in conflict and post-conflict situations at a time when many African countries are emerging from conflict. The paper concludes that health systems strengthening in post-conflict situations should focus on the delivery of primary health care services using existing human resources for health, community structures, NGOs and mobile clinics while pursuing renovation of health facilities and human resources for health development in the medium and long term.

Potential acceptability of microbicides in HIV prevention in stable marital relationships in Malawi.

BACKGROUND: The XVII International Conference on AIDS held in Mexico City in August 2008 emphasised the importance of dual prevention using both vaccines and microbicides in the fight against HIV and AIDS. Microbicides are important because they constitute one of the potentially important female-controlled methods of HIV and sexually transmitted infection prevention, especially in Malawi where the use of the female condom has not yet been fully embraced. METHODS: A qualitative study utilising focus group discussions was used to assess the acceptability of the microbicide nonoxynol-9 (N-9) as part of the ongoing Preparatory AIDS Vaccine Evaluation (PAVE) studies. RESULTS: The study observed that men oppose the use of N-9, and that although women consider themselves at risk for HIV they caution against the unintended consequence of altering the vaginal environment with the use of microbicides, which can interfere with the men's preference for dry sex. DISCUSSION AND CONCLUSIONS: Although N-9 did not produce the desired results, these can inform the development of other promising microbicide candidates. The study concludes that it is important to pay attention to how new microbicides are formulated rather than just concentrating solely on an individual product's effectiveness.

A pilot study to evaluate the diagnostic accuracy of local terminology for malaria screening among children in rural Malawi.

BACKGROUND: Malaria is a serious health problem in Malawi. It is responsible for 43% of all out patient visits and 19% of all deaths occurring to children under five years of age. Rapid diagnosis and appropriate treatment can avert most malaria deaths. However this is not always possible in resource limited settings where functioning laboratories are almost nonexistent. METHODS: This paper assesses the accuracy of local terminology in detecting parasitemia in children using blood smears as the reference standard. RESULTS: The study observes that there are local terms that can be used as an inexpensive, readily available and easily implementable malaria screening test in Malawian children in rural areas. These terms include "malungo" (official name for malaria), "kutentha thupi" (hot body), "kutsegula m'mimba" (official term for diarrhoea) and "kukhosomola" (coughing). The local terms "malungo" and "kutentha thupi" yielded better results. CONCLUSION: Although the local terminology produced results that are less than optimal, the study concludes that the knowledge of sensitivity and specificity of local terminology can be used by local healthcare practitioners to identify children who could benefit from malaria confirmation testing and presumptive treatment. The study, however, cautions that these terms should be used as an entry point to malaria case management as they do not distinguish the severity of the malaria infection and all of them produced a sensitivity of less than 50%.

Sexual and reproductive health and HIV/AIDS risk perception in the Malawi tourism industry.

Malawi has for a long time relied on agriculture for the generation of foreign exchange. Due to varied reasons like climate change, the Malawi government has, therefore, identified tourism as one way of boosting foreign exchange earnings and is already in the process of developing the sector especially in the area of ecotourism. However, tourism is associated with increasing prostitution, drug abuse and a whole range of other sexual and reproductive health (SRH) problems such as teenage pregnancies, HIV/AIDS and sexually transmitted infections (STIs). This paper examines the knowledge, attitudes, practices and behaviour as well as risk perceptions associated with HIV/AIDS, sexually transmitted infections and unwanted pregnancies among staff in the tourism industry and communities around tourist facilities in Malawi. The study was descriptive in nature and used both qualitative and quantitative research methods. The qualitative methods involved in-depth interviews and focus group discussions. The quantitative technique employed a survey of 205 purposively selected subjects from the tourism sector. The study concludes that people in the tourism sector are at high risk of HIV/AIDS, sexually transmitted infections and unwanted pregnancies and should be considered as a vulnerable group. The study further observes that this group of people has not adopted behaviours that can protect them from HIV/AIDS, sexually transmitted infections and unwanted pregnancies although there is high demand for voluntary counselling and testing (VCT) which offers a very good entry point for HIV prevention and treatment in the tourism sector. The study recommends that a comprehensive tourism policy covering tourists, employees and communities around tourist facilities is required. Such a policy should address the rights of HIV infected employees and the provision of prevention and treatment services for HIV/AIDS and STIs as well as a broad range of SRH and family planning services especially the condom which offers dual protection for pregnancy and STIs including HIV.

The effectiveness of the TBA programme in reducing maternal mortality and morbidity in Malawi.

OBJECTIVE: The main objective of this study was to assess the role of TBAs and the quality of their services in contributing to the reduction of maternal deaths in Malawi. METHODS: This study used a qualitative research methodology involving key informant and in-depth interviews, observation and focus group interviews. RESULTS: The study found that most of the people rely on traditional birth attendants although the quality of their services is poor due to illiteracy, their ailing age, lack of supplies and equipment and general absence of supervision. The study fiuther observed that although the hospital sees many pregnant women during antenatal care, very few women actually come back to the hospital for delivery. The study also found that there was high awareness among TBAs about what they were supposed to do but that their actual practices did not reflect compliance with their roles as assigned by the formal health system. CONCLUSION: The study concludes that TBAs are an important source of maternal care especially in rural areas and that they need to be empowered to comply with the requirement of ensuring infection free deliveries. This entails adequate supervision and provision of supplies. The study further observed that the utilization levels of TBAs is far much greater that presently acknowledged suggesting severe inadequacies within the formal health system.

Self treatment of eye diseases in Malawi.

Self-treatment for eye diseases is very common in most developing countries yet there has been little investigation of such attitudes and practices. In many settings, people do not proceed beyond self-treatment and do not receive care from either traditional healers or Western eye care providers. Visual impairment and blindness can be the result. We conducted population-based survey of use of eye care services and self-treatment in two districts of Malawi. Adults were administered a detailed interview regarding their use of eye care services (Western and traditional as well as self-treatment) and their knowledge and use of traditional eye medicines. Self-treatment was defined as use of either Western or traditional medicines by the individual for their most recent eye condition. Only eye conditions that were considered severe by the study subjects were correlated with treatment options. Interviews were carried out among 800 adults in the study areas. Self-treatment was reported for the last episode of eye disease by 39.8% of the study population. Factors associated with self-treatment included sex, religion and socioeconomic status. Even though 76.8% of the respondents reported treatment from the health center or hospital to be the least expensive option, many opted for self-treatment first. Among those opting for self-treatment 72% used traditional eye medicines. Even among cases that individuals considered to be quite severe (these included cataract, trachoma and conjunctivitis), self-treatment was the option of choice in 22.2% of cases.

Social, economic and demographic determinants of sexual risk behaviors among men in rural Malawi: A district-level study.

Data from a survey of 715 men aged 20-44 from Mangochi district of Malawi were used to assess the sociodemographic and economic determinants of (1) having ever paid for sex, (2) total number of sex partners in the past year, and (3) having ever used condoms. Different individual characteristics were associated with each of these sexual behaviors. Polygamy and being a fisherman who has left home for over a month in the past year for work reasons were both positively associated with having ever paid for sex, whereas those with more household wealth were less likely to have paid for sex. The influence of education, age, age at sexual initiation, Muslim religion, polygamy, occupation, and having ever paid for sex on total number of sexual partners in the past year are all evident. Finally, secondary education, work-related migration, and having ever paid for sex were significantly associated with having used condoms.

Factors associated with HIV/AIDS knowledge and risk perception in rural Malawi.

Measures of HIV/AIDS knowledge and risk perception are important because they are often linked to behavioral change both in theory and in practice. This study examines knowledge and risk perception by assessing their relationship with demographic characteristics, first source of HIV/AIDS information, and behavioral and cognitive risk exposures among men and women in a rural district of Malawi. The data come from a panel study of 940 women aged 15-34 years and 661 men aged 20-44 years. Descriptive statistics and multivariate regression models are used for the analysis. The results indicate that knowledge of HIV/AIDS does not necessarily translate into perceived risk. In addition, there appears to be a gender difference in the influence of cognitive and behavioral factors on perceived risk.