Ascertainment of childhood vaccination histories in northern Malawi

OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies

A resilience lens to explore seaweed farmers’ responses to the impacts of climate change in Tanzania

Seaweed-based mariculture is an important source of livelihoods for impoverished coastal communities in Tanzania. However, the impacts of climate change across East Africa are putting a strain on the growth of the seaweed industry. Smallholder farmers are already mobilizing strategies to cope with challenges such as disease outbreaks, but they are struggling to maintain seaweed production and derive sufficient income. A better understanding of the challenges they face and the factors inhibiting their ability to build resilience is needed to inform policies and development programmes to achieve the Sustainable Development Goals, particularly Goal 13 on Climate action and Goal 14 on Life Below Water. The global demand for seaweed is expanding rapidly. Strengthening the adaptability of seaweed production to climate change is important for farmers to rely on it as a source of livelihoods on which they can build their own resilience to climate change. Drawing on qualitative data from key informant interviews in four Tanzanian seaweed-producing areas, this paper assesses the long-term resilience capacities of seaweed farmers to respond to one of the main hazards: diseases affecting seaweed crops. While several strategies help farmers maintain their income, most of them only support resilience in the short term. The increasing pressure on marine resources and the lack of regulations for supporting an equitable and sustainable seaweed-based mariculture sector do not bode well for farmers’ long-term adaptation to climate change and environmental degradation. Seaweed farming remains a crucial source of livelihoods for poor coastal communities in Tanzania, but it does not currently lead to positive transformative changes in their socio-economic conditions. Policies aiming to support sustainable aquaculture, particularly in tropical ecosystems that are highly vulnerable to climate change, must address the existing social, economic and knowledge inequities that prevent poor communities from building their resilience

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

AbstractBackgroundTo explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve.Methods and findingsWe used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength.ConclusionMetrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.</jats:sec

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.</jats:p

Autonomous Innovations in the Rural Communities of Developing Countries I—A Narrative Analysis of Innovations and Synergies for Integrated Natural Resource Management

Vulnerable sectors of the population living in poverty in developing countries are highly dependent on renewable natural resources for their livelihoods and daily lives. Sustainable resource management, improving the well-being of vulnerable people, and building resilience to shocks are global challenges. This study analyzed the outcomes of various autonomous innovations by the people themselves and the enablers of these innovations in the communities of developing countries. This analysis of 20 autonomous innovations from six countries revealed that these innovations produced outcomes that simultaneously improved multiple indicators of human well-being, including “basic materials for a good life”, “safety”, “health”, and “good social relations”. The process of promoting public values, such as education, health improvement, and landscape conservation as a by-product of collective actions was an important enabler of these innovations, as well as the innovator’s proactive attitude toward continuous improvement. Public values and supporting ecosystem services were emphasized from the early stages of collective actions, to realize synergies toward integrated natural resource management. It is also important to achieve conditions in which collective actions could be practiced autonomously and adaptively. These results revealed the great potential of autonomous innovations emerging among socially vulnerable groups and the important mechanisms for promoting autonomous innovations for the transformation of social-ecological systems toward sustainable futures

Indicators per implementation strength domain and health worker type.

Indicators per implementation strength domain and health worker type.</p