Development of a framework to facilitate malaria research utilisation for policy development in Malawi

Background: Malaria has remained a major public health burden in Malawi despite recent global progress in its control. Children under the age of five and pregnant women are among the groups most affected by the disease. Malaria research has been identified to provide vital evidence that contributes to addressing this burden through the development of evidence-based policies. One of the challenges however, is the lack of a systematic mechanism through which malaria research can be fully utilised for policy development. Unless research is commissioned by the government, individual researchers often do not know the pathway through which they can engage with policymakers. While some institutions or elements that promote health research in policy development exist, they remain fragmented and overwhelmed by the totality of health research in the country. This study aimed at developing a framework for promoting the utilisation of malaria research for policy development in Malawi. The framework seeks to encourage the engagement of researchers and policymakers, and to increase visibility and coordination of the existing elements presently promoting research utilisation for policy development. Methods: The study utilised both quantitative and qualitative methods depending on the study objectives. Several specific approaches were employed towards the development of the framework. The first step described the type and amount of malaria research conducted in Malawi, and its related sources of funding from 1984 to 2016. Its approach included an online systematic literature review in the Medline/PubMed database for Malawian publications, and the extraction of approved malaria studies from two Ethical Committees. The second approach assessed the research contribution to malaria policy development and the understanding of policy formulation process in Malawi. This step was done through case studies that adopted systematic literature search, in-depth interviews with key informants and relevant stakeholders, and record review. The third step examined the facilitating factors and barriers to utilisation of malaria research in the policy development process and involved in-depth interview with key informants, and review of records. In addition, the assessment of challenges to the implementation of malaria policies in Malawi was conducted through in-depth interviews with key informants and key stakeholders. The development of the framework was then guided by the lessons from the case studies and findings from the assessment of facilitating factors and barriers while being informed by literature of existing research-to-policy frameworks. In addition, a rigorous iterative approach with stakeholders was conducted for validation and applicability of the framework. Findings: The research revealed that clinical and basic research in the fields of malaria in pregnancy, severe malaria, and vector and/or agent dynamics dominated the publications while morbidity studies, severe malaria, and health policy and systems research dominated the approved studies. The results show that malaria research output increased steadily from 1996 to 2016 and this was attributed to the establishment of the College of Medicine and its research affiliates. However, the major malaria research funding came from external sources. The case studies showed that primary research was instrumental in changing the malaria treatment policies and in some cases Malawi was the first country to adopt these changes. Policy development process was found to follow the established process that involves agenda setting, policy formulation, and policy implementation. Many factors were identified as facilitating the utilisation of malaria research in policy development and these included the government commitment through the ministry of health, by reviving the policy development unit and the establishment of the office for the director of research, the knowledge translation unit, and academic and non-academic research institutions. Specific tools that support these institutions are the national health research agenda, guidelines for policy development and analysis, and guidelines for evidence use in policy-making. Barriers to the utilisation of malaria research included, the lack of knowledge by researchers to involve, collaborate and communicate their research findings to policy makers. Other barriers included lack of platforms for researcher-public engagement, politics, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository. Challenges to the implementation of malaria policies included inadequate resources, unavailability of trained staff, poor supervision and mentorship, politics, parallel implementation of policies, lack of a platform for engagement with communities, top-down approach in policy development, lack of understanding of socio-cultural factors affecting policy uptake by communities, and incomplete stakeholder analysis during policy development. Lessons from the case studies and the assessment of facilitating factors and barriers contributed to the development of a contextual knowledge-to-policy framework which proposes an integrated approach to knowledge translation between malaria researchers and the government, through the Ministry of Health (MOH) and the National Malaria Control Programme (NMCP), which is considered as the main user of research knowledge. Conclusion: Malaria research provides the relevant evidence for policy decision-making to address the malaria burden in Malawi. The developed framework offers a basis for the identified factors and their linkages to promote a coordinated approach to malaria research utilisation in policy making. Its applicability and success would, however, hinge on its wider dissemination and ownership by the government through the NMCP. It is important for the government to support health policy and systems research that seeks to explore bottlenecks in the delivery of health services within the health system. This evidence should provide solutions to challenges of policy implementation.Thesis (PhD)--University of Pretoria, 2017.University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) and MRC Collaborating Centre for malaria researchSchool of Health Systems and Public Health (SHSPH)PhDUnrestricte

Assessment of water governance institutions and their roles in smallholder irrigation schemes of Nzhelele Area, Limpopo Province

Smallholder irrigation schemes have been a significant strategy to ensure food security and poverty reduction in rural areas worldwide. Despite the efforts by the South African government to rehabilitate and revitalise smallholder irrigation schemes, the schemes have been performing below expectations. This follows the failure of water governance institutions to execute their roles within the schemes, thus affecting optimum agricultural production. Therefore, it is against this background that this study sought to assess water governance institutions and their related roles at Nzhelele area of Vhembe District, South Africa. A mixed-methods research design was adopted. Fifty-six farmers were selected through a census sampling method to participate in qualitative and quantitative data collection using a semi-structured interview guide and a questionnaire. Qualitative data were analysed using Atlas.ti, Version 8.0 software to perform thematic content analysis. Quantitative data were analysed using SPSS version 28 for descriptive statistics. The study revealed that there are various water governance institutions within the schemes, namely, the scheme committee, the Water Users Association, and the Informal water institutions. These water governance institutions have varied roles regarding irrigation water governance within the schemes. Based on the findings, this study recommends that water governance institutions should be active in performing their roles and responsibilities in irrigation schemes to foster improvement in adherence to the water rules and regulations in place

What do Malawi Polytechnic first year students know and do about HIV and AIDS?

Background: The Polytechnic introduced a “WHY WAIT?” course to equip first year students with skills to help reduce transmission of Human Immune-deficiency Virus (HIV). Training is conducted during the first week of arrival at college. The study aimed to explore existing knowledge, beliefs and attitudes in order to tailor the training programme to students’ needs.Methods: This was a cross sectional study. During first day of arrival, first year students available on campus were given a structured self-administered questionnaire which was filled and submitted before the course. Out of 320 questionnaires distributed, 295 were returned representing 92% response rate.Results: Ten percent (30) had more than one girlfriend or boyfriend. Ninety-seven percent (286) indicated that condoms are not 100% effective towards prevention of HIV while 72% (169) reported that they had never had sexual intercourse before. Of 66 students who had had sexual intercourse before, 30% indicated that they used condoms always during sexual intercourse, 40% used it occasionally while 30% never used condoms. Thirty-two percent (94) reported having an HIV test before and 19% (56) would feel uncomfortable to share a room with an HIV infected person.Conclusion: The Polytechnic first year students have varying knowledge and practices about HIV and AIDS. There is need to intensify “WHY WAIT?” course to first years during first week at College to help equip them with necessary knowledge and skills to protect themselves against HIV and AIDS

Water quality assessment in Bangwe Township, Blantyre City, Malawi

This study assessed microbial contamination of water in sources (boreholes and open wells) and selected households in four Malawian villages (situated in Bangwe Township, Blantyre city) by analyzing the presence of faecal coliforms using membrane filtration. Additionally, pH, conductivity and temperature of the water sources were also determined. Conductivity ranged from 150.5 to 1575 μS/cm. About 70% of all water sources were above World Health Organization (WHO) and Malawi Bureau of Standards (MBS) limits for conductivity (indicating salty water in the area). Water temperature ranged from 21.5 to 24.7°C and pH from 5.28 to 6.95 with no significant difference (p > 0.05) for these physical parameters among the sampling points. Water pH was within MBS range while 60% of water sources were below WHO range. Faecal coliform levels exceeding WHO and MBS safe standards were observed in 79% of all samples analysed in this study. Mean household faecal coliform levels were as follows (village (mean)); Nalivata (437 CFU/100 mL), Mpingwe 1 (172 CFU/100 mL), Mpingwe (266 CFU/100 mL) and Salvation Army (15 CFU/100 mL). All mean faecal coliform counts were above WHO (0  CFU/100 mL) and MBS (0 CFU/100 mL) safe values. The results suggest that the quality of water in the villages often fails to meet one or more WHO and MBS recommended safe levels as such, poses a potential risk to the health of those individuals living in such villages. Local and National Governments should therefore target the provision of safe water to such populations. The findings of this study also highlight the need for improved dissemination of good hygienic practices amongst such communities.Key words: Boreholes, drinking water, faecal coliforms, health, pollution

Impact of soil and water conservation measuren on catchment hydrological response: a case in north Ethiopia

Impact studies of catchment management in the developing world rarely include detailed hydrological components. Here, changes in the hydrological response of a 200-ha catchment in north Ethiopia are investigated. The management included various soil and water conservation measures such as the construction of dry masonry stone bunds and check dams, the abandonment of post-harvest grazing, and the establishment of woody vegetation. Measurements at the catchment outlet indicated a runoff depth of 5 mm or a runoff coefficient (RC) of 1·6% in the rainy season of 2006. Combined with runoff measurements at plot scale, this allowed calculating the runoff curve number (CN) for various land uses and land management techniques. The pre-implementation runoff depth was then predicted using the CN values and a ponding adjustment factor, representing the abstraction of runoff induced by the 242 check dams in gullies. Using the 2006 rainfall depths, the runoff depth for the 2000 land management situation was predicted to be 26·5mm(RCD 8%), in line with current RCs of nearby catchments. Monitoring of the ground water level indicated a rise after catchment management. The yearly rise in water table after the onset of the rains (ΔT) relative to the water surplus (WS) over the same period increased between 2002-2003 (ΔT/WS D 3·4) and 2006 (ΔT/WS >11·1). Emerging wells and irrigation are other indicators for improved water supply in the managed catchment. Cropped fields in the gullies indicate that farmers are less frightened for the destructive effects of flash floods. Due to increased soil water content, the crop growing period is prolonged. It can be concluded that this catchment management has resulted in a higher infiltration rate and a reduction of direct runoff volume by 81% which has had a positive influence on the catchment water balance. © 2010 John Wiley & Sons, Ltd

Assessment of water governance institutions and their roles in smallholder irrigation schemes of Nzhelele Area, Limpopo Province

Smallholder irrigation schemes have been a significant strategy to ensure food security and poverty reduction in rural areas worldwide. Despite the efforts by the South African government to rehabilitate and revitalise smallholder irrigation schemes, the schemes have been performing below expectations. This follows the failure of water governance institutions to execute their roles within the schemes, thus affecting optimum agricultural production. Therefore, it is against this background that this study sought to assess water governance institutions and their related roles at Nzhelele area of Vhembe District, South Africa. A mixed-methods research design was adopted. Fifty-six farmers were selected through a census sampling method to participate in qualitative and quantitative data collection using a semi-structured interview guide and a questionnaire. Qualitative data were analysed using Atlas.ti, Version 8.0 software to perform thematic content analysis. Quantitative data were analysed using SPSS version 28 for descriptive statistics. The study revealed that there are various water governance institutions within the schemes, namely, the scheme committee, the Water Users Association, and the Informal water institutions. These water governance institutions have varied roles regarding irrigation water governance within the schemes. Based on the findings, this study recommends that water governance institutions should be active in performing their roles and responsibilities in irrigation schemes to foster improvement in adherence to the water rules and regulations in place

Public understanding and awareness of and response to monkeypox virus outbreak: A cross-sectional survey of the most affected communities in the United Kingdom during the 2022 public health emergency.

OBJECTIVES: Our objective was to examine the public response to public health and media messaging during the human monkeypox virus (MPXV) outbreak in the UK, focusing on at-risk communities. METHODS: A co-produced, cross-sectional survey was administered in June and July 2022 using community social media channels and the Grindr dating app. Basic descriptive statistics, logistic regression, and odds ratio p values are presented. RESULTS: Of 1932 survey respondents, 1750 identified as men, 88 as women, and 64 as gender non-conforming. Sexual identity was described as gay/lesbian/queer (80%), bisexual (12%), heterosexual (4%), and pansexual (2%); 39% were aged <40 years; 71% self-identified as White, 3% as Black, 8% as Asian, 2%as LatinX, and 11% as 'Mixed or Other' heritage groups. In total, 85% were employed and 79% had completed higher education. A total of 7% of respondents identified themselves as living with HIV. Overall, 34% reported limited understanding of public health information, 52% considered themselves at risk, 61% agreed that people with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, 86% reported they would accept a vaccine, and 59% believed that MPXV originated from animals. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%). CONCLUSIONS: Vaccine acceptability was very high, yet the understanding and acceptance of public health information varied. Social determinants of health inequalities already shaping the UK landscape risk were compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities and better dissemination of public health messaging by trusted healthcare professionals are essential for the public health response

Prevention of sexual transmission of mpox: a systematic review and qualitative evidence synthesis of approaches.

BACKGROUND: The ongoing multi-country mpox outbreak in previously unaffected countries is primarily affecting sexual networks of men who have sex with men. Evidence is needed on the effectiveness of recommended preventive interventions. To inform WHO guidelines, a systematic review and qualitative evidence synthesis were conducted on mpox preventive behavioural interventions to reduce: (i) sexual acquisition; (ii) onward sexual transmission from confirmed/probable cases; and (iii) utility of asymptomatic testing. METHODS: Medline, EMBASE, PubMed, Cochrane and WHO trial databases, grey literature and conferences were searched for English-language primary research published since 1 January 2022. A reviewer team performed screening, data extraction and bias assessment. A qualitative thematic synthesis explored views and experiences of engagement in prevention in individuals at increased risk. RESULTS: There were 16 studies: 1 on contact-tracing, 2 on sexual behaviour, and 13 on asymptomatic testing. Although MPXV was detected in varying proportions of samples (0.17%-6.5%), the testing studies provide insufficient evidence to fully evaluate this strategy. For the qualitative evidence synthesis, four studies evaluated the experiences of most affected communities. Preferences about preventive interventions were shaped by: mpox information; the diversity of sexual practices; accessibility and quality of mpox testing and care; and perceived cost to wellbeing. CONCLUSIONS: Evidence on the effectiveness of interventions to prevent the sexual transmission of mpox remains scarce. Limited qualitative evidence on values and preferences provides insight into factors influencing intervention acceptability. Given global and local inequities in access to vaccines and treatment, further research is needed to establish the effectiveness of additional interventions

Virtual care pathways for people living with HIV:A mixed‐methods systematic review

Background: The COVID-19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored-approaches, especially for marginalized populations.Methods: A mixed-methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two-way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle–Ottawa score and Stenfors' framework.Results: Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID-19 while others were as part of trials.Conclusions: VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a ‘gold standard’ for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings.</div