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Introduction: Programme Science (PS) and community‐led monitoring (CLM) intersect in unexpected and promising ways. This commentary examines a CLM initiative in Malawi and South Africa to highlight the crucial role of CLM in bolstering the PS framework. By leveraging data sources often overlooked by conventional research and evaluation approaches, CLM emerges as a pivotal element in enhancing programme effectiveness. This paper delineates the fundamental principles of CLM, presents programme outcomes derived from CLM methodologies and contextualizes these findings within the broader framework of PS. Discussion: The Citizen Science Project implements CLM continuously at 33 health facilities: 14 in Malawi (eight in Kasungu District and six in Dedza District), and 19 in South Africa (all in the West Rand District), representing a total catchment area of 989,848 people. Monitoring indicators are developed in an iterative process with community groups. The indicators are unique to each country, but both focus on the uptake of health services (quantitative) and barriers to access (qualitative). Monthly clinic records surveys capture 34 indicators in Malawi and 20 in South Africa and are supplemented by qualitative interviews with care recipients and healthcare workers. Qualitative interviews provide additional granularity and help confirm and explain the more macro trends in service coverage as described in quantitative data. The resulting data analysis reveals key themes that help stakeholders and decision‐makers to solve problems collaboratively. Noteworthy outcomes include a substantial increase in multi‐month dispensing of antiretroviral therapy (ART) during COVID‐19 (from 6% to 31%) with a subsequent recovery surpassing of HIV service benchmarks in Malawi post‐pandemic. Conclusions: While quantifying direct impact remains challenging due to the project's design, CLM proves to be a robust methodology that generates credible data and produces impactful outcomes. Its potential extends beyond the health sector, empowering community leadership and fostering interventions aligned with community needs. As CLM continues to evolve, its integration into PS promises to improve relevance, quality and impact across diverse disciplines. [ABSTRACT FROM AUTHOR]

Agricultural markets remain major issue downgrading root and tuber crop farmers who form the mainstream of the agricultural producers in Malawi. Recent evidence however reveals that orange‐fleshed sweet potato (OFSP) (Ipomea batatas) is currently being sold in produce markets along with the non‐orange varieties, sometimes in differentiated form in Malawi. The main objective of this study was to examine factors affecting market participation of sweet potato farmers in southern region of Malawi. Using a double‐hurdle model, this paper analyzed both the factors affecting farmer decision to participate and the extent/intensity of participation in market. The first tier of the double hurdle focused on decision to participate in the market using probit model and the second tier addressed factors affecting intensity of participation using truncated normal regression model. The paper used data collected from 360 farmers in southern districts of Malawi. Out of 360, 146 farmers had grown OFSP in the season preceding the survey. Double hurdle results indicate that farm size, output, age of a farmer (household head), and early maturing trait significantly determined decision to participate in the market. Further, results on intensity of participation indicate that access to market training, farm size, asset value, and output positively determined the intensity and negatively determined by distance to main market and gender of a farmer (household head). Based on the research findings, higher output levels and early maturing trait were found to increase smallholder farmer market participation. It is therefore recommended that strategies aimed at increasing household capacity to produce surplus produce through market tailored extension messages and productivity enhancement technologies could be highly effective in fostering smallholders' participation in commercial markets. Again, enhanced capacity building of research institutions to breed sweet potato varieties based on market demand is pivotal for increased market participation. Furthermore, research suggests that improving smallholder farmers' access to market price information, asset value, and farm size can help increase their intensity in the market. Therefore, it is critical for policymakers to holistically comprehend these socioeconomic factors in order to address the issue of smallholder farm households' decisions about market participation and the degree to which they participate. Core Ideas: Orange fleshed sweet potato is currently being sold along with non‐orange varieties, sometimes in differentiated.Decision to participate in market is significantly influenced by output, farm size, age early maturing attribute.Market intensity is determined by access to training, distance to market, farm size, gender, asset value and output.Breeding programs should integrate both sensory and agronomic traits such as early maturity and good taste. [ABSTRACT FROM AUTHOR]

This paper examines the politics and dynamics of the policy design and practical policy implementation realities of institutional transformation in a developing country context. The paper finds that there has been a mismatch between policy design templates of institutional transformation and the actual practice in terms of transformational implementation outcomes. Taking decentralisation reforms within the Ministry of Health in Malawi as a case study, the paper underscores that the contextual realities of institutional transformation in the country have been manifested by path dependence tendencies characterised by reproduction that takes shape in a contradictory fashion to the underlying institutional logics. The resultant policy of the reproduction and contradiction in terms of policy practice is institutional legitimacy crisis characterised by support from institutional entrepreneurs that are benefiting from positive feedback and increasing returns of the old institution, and challengers that regard the reproductions and contradictions as restrictive and mismatching institutional transformation design. [ABSTRACT FROM AUTHOR]

The paper presents interview data from Malawian government representatives, trade unionists, employers and people with disabilities from the country's largest cities Lilongwe and Blantyre. Findings relate to the gap between the discourse of employers and government officials and that of workers with disabilities. Firstly, we find a policy‐based assumption of a formalised workforce that is not representative of the predominantly informal disabled workforce. Secondly, the disruptive, intermittent and often reactive nature of non‐governmental organisation (NGO) interventions can limit long‐term inclusivity agendas and undermine the work of disabled activists in Malawi. Lastly, we present findings on the stigmatised nature of disability in these urban centres. We find that stigma is economic: Urban workers with disabilities are discriminated against locally by employers, landlords and banks on assumptions they will not produce or earn enough to meet productivity demands, rent or repayment costs. [ABSTRACT FROM AUTHOR]

At the beginning of 2020, the world came to a stand‐still when governments across the globe decided to enter states of 'emergency' or 'disaster' over the breakout of the COVID‐19 pandemic. The responses to the pandemic included stringent movement restrictions and hygiene advice preventing face‐to‐face interactions. As a result, many activities, including schooling, working, and shopping were moved online, drastically increasing exposure to cyber threats and risks. It is unclear if and how the rapid increase in internet use corresponded to an improvement in cybersecurity mindset development in countries of the Southern African Development Community (SADC). This paper explores the effect of the increase in digital technology usage due to the COVID‐19 pandemic restrictions on the relationship between cybersecurity awareness‐raising initiatives and the development of higher levels of cybersecurity mindset in Botswana, Lesotho, and Malawi. These three countries have a similar cybersecurity footprint and an average cybersecurity capacity level for the region. The research applies a comparative multiple case study approach relying on a thematic review of the literature and related documents, supported by in‐depth interviews with purposefully selected key informants from the three selected SADC countries. Findings suggest that since the start of the COVID‐19 pandemic, awareness‐raising programs have gained some momentum in our selected countries, but the cybersecurity mindset has not improved. That was attributed to low frequency and poor quality of campaigns added to the lack of training, education and lived experience. The paper highlights the need to increase the frequency and improve the quality of programmes, for greater impact on the development of local cybersecurity mindsets. [ABSTRACT FROM AUTHOR]

Should a typical developing country invest more in agriculture or education? At what stage of development is it optimal to invest more in each of these sectors? These are important questions that governments of developing countries grapple with when designing investment plans. In this paper, I propose a soil–human capital conceptual framework of development and use it to explain estimates of agricultural returns to schooling in Malawi. I use panel survey data for Malawi and rely on the exogenous education policy changes and spatial variation in access to schooling to identify effects of schooling on agricultural incomes. In addition, I correct for selection into income activities within a panel data and instrumental variables estimation framework. I find annual agricultural returns to schooling in Malawi of 3%–4% after correcting for selection and unobserved heterogeneity and 7% in the uncorrected specifications. I also find consistently higher returns to schooling in the nonagricultural sector for those not living in the village of birth and higher returns in the agricultural sector for those living in the village of birth. Given the size of the farm sector, wealth in Malawi is still in the soil, but that future growth in wealth depends on human capital investments. [ABSTRACT FROM AUTHOR]

The Blantyre Water Board (BWB) is a water management organization located in Malawi, south‐central Africa. The water board's backward operation mode, combined with the growth of local public utilities, has placed it in a difficult position to face difficult challenges at the country level. The main aim of this paper is to examine the organizational structure, management, and operation mode of BWB, as well as the issues that require further investigation. Additionally, options are discussed to predict the factors that will affect water services and changes in water demand over the next few years, using certain benchmarking criteria and assumptions. After taking into consideration the current situation and the newly acquired knowledge, it has become necessary to reform the BWB. It is proposed in this paper that reform initiatives should be implemented in the water services sector, within organizations, and between organizations in Blantyre, with the goal of assisting in the development of water company operations to make them more suitable and sustainable to meet the needs of modern life, particularly for residents of low‐income areas (LIAs) in the country. [ABSTRACT FROM AUTHOR]

With global estimates showing an increasing trend in flooding and its adverse effects on communities and population health, resilience is presented as a concept with potential to help integrate disaster risk management, sustainable development, and climate change adaptation concerns. Resilience research and practice have conceptual and empirical challenges of how to understand, characterize and measure resilience, particularly at community level. Using a multidimensional framework, this paper takes a systems approach to understanding, characterizing, and measuring community flood resilience. Through cluster analysis, bivariate methods and multivariable‐adjusted binary logistic regression modeling, we developed a context and hazard specific construct of community flood resilience and investigated its predictor variables. The factors defining the community flood resilience construct captured the community needs to withstand disasters through purpose‐built infrastructure, early warning systems for preparedness and utilization of local human capacity for adaptation. These results strengthen the previous arguments for utilizing a comprehensive multidimensional framework for resilience analysis. Access to services for improved health and psychosocial well‐being was significantly associated with the three‐item measure of being more flood resilient. Additionally, a strong sense of place and resistance to relocation were presented as key elements of resilience, maintaining community system function, and preserving livelihoods. The study further found that these key factors would not be adequate to guarantee community flood resilience outside the transformative capacity of a well‐resourced village civil protection committee that can prepare and mobilize stakeholders in response to flood emergencies. Our results suggest that, in the context where policymakers seek to strengthen resilience of communities without relocating them, a focus on public health and on strengthening and utilizing local capacities as adaptation, are key in disaster risk management policymaking and implementation. For the international research community, this study demonstrated the importance of utilizing context and hazard specific measures for defining, characterizing, and measuring resilience to inform policy. [ABSTRACT FROM AUTHOR]

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Telecentres provide access to Information and Communication Technonology (ICT) services to disadvantaged communities. With the coming of mobile technologies such as smartphones, some services that telecentres provide such as internet can easily be accessed through mobile technologies. This, therefore, questions the relevance of telecentres in the age of mobile technologies. Two main questions exist: are telecentres still relevant? If yes, why do people still use telecentres in the age of mobile technologies? This paper aims at answering these questions. It also discusses the challenges that users face in using telecentres. Qualitative data were collected from telecentre users and managers of two telecentres in Malawi through focus groups and interviews. Gioia methodology was used to analyze the data. The study reveals four main reasons why people still patronize telecentres: (i) to socialize with fellow users; and (ii) that it is cheaper to access services in the telecentre as compared to using smartphones for the same services; (iii) telecentres provide services compatible with users' needs such as library services and computers; (iv) and to attain ICT skills some of which are applied in using smartphones. However, users face numerous challenges such as limited space within telecentres and unreliable power. The study is valuable as it provides insights into why governments should continue investing in telecentres. It also comes at a right time when the government of Malawi plans to abandon the community telecentre model to adopt the school managed model that may limit the number of users thereby limiting the benefits of telecentres in the presence of mobile technologies. [ABSTRACT FROM AUTHOR]

One of the main barriers to adopting smallholder agricultural mechanization in developing countries is the mismatch between the economies of scale of machines and farm size. Private sector‐led mechanization services hold a promise to address this challenge, but there is a lack of evidence on demand for smallholder mechanization services. This study estimates the farmers' willingness to pay for mechanization services using the double‐bounded contingent valuation method and data from 1512 households. Results show that, on average, farmers are willing to pay 11%, 33%, and 5% more than prevailing market rates for land preparation, maize shelling, and transportation services, respectively. The amounts farmers are willing to pay for the mechanization services vary by sex, age group, size of cultivated land, the value of farmer assets, market access, and agroecology. Men are willing to pay 26%, 25%, and 11% more than women for land preparation, maize shelling, and transportation services. Moreover, 40% of female and 90% of male farmers are willing to pay more than or equal to the prevailing market rate for land preparation services. The high demand for mechanization services among smallholder farmers points to the need for making the machinery available to rural communities through mechanization service providers or machinery hiring centers run by the private sector. The paper concludes by discussing the contextual factors and policy options for promoting smallholder mechanization in Malawi. [EconLit Citations: O33, Q11, Q13, Q16]. [ABSTRACT FROM AUTHOR]

Recognizing the significance of data for policy change to improve population health, many developing countries and Health Partners have invested for decades in Health Management Information System (HMIS). Despite huge investments in technologies and capacity building to support the management of routine health data, there is still a problem in trying to make substantial improvements on gains made so far. A number of researchers have reported on lack of motivation, ownership, data use and work overload as some of the reasons explaining the persistent problem with routine health data quality. However not much has been reported on how legitimacy seekers and providers negotiate for the legitimacy of data quality management practices. We drew on this gap to explore how gaps are negotiated between the legitimacy seekers and the legitimacy providers when seeking legitimacy of data quality management practices in HMIS at micro level. Using institutional theory pillars: institutionalization and legitimation, we framed our qualitative study in soft systems methodology (SSM). We collected data using observations, semi‐structured interviews, and study of artifacts to answer our question based on the Malawi's District Health Information System (DHIS2) use case. Our findings revealed three factors shaping the gap negotiation: coercive approach, technical support and social relationship and moral judgment. The paper's contribution is two‐fold, (a) from a practical perspective we identify the pertinent context issues that come into play when negotiating a gap between the data cadres and the managers (from the Ministry of Health and partners) in the course of seeking legitimacy of data quality management practices; (b) theoretically we promote the application of SSM models with an institutional perspective in making sense of complex situations relating to legitimation. [ABSTRACT FROM AUTHOR]

This paper presents the first comprehensive analysis of the present‐day stress from boreholes near an active continental rifting zone in the Moatize Basin, Mozambique. The state of present‐day stress in this area that is located ca. 100 km away from the Eastern African Rift System (EARS) is poorly understood, and most of our knowledge is from earthquake focal mechanisms that provide stress information from the deeper part of the lithosphere, and to a lesser extent from surface geological features in the Malawi region. Considering the limited reliability of earthquake‐derived stress orientations near plate boundaries, poor coverage of low to moderate magnitude earthquakes in eastern Africa, and ambiguity about the latest activity of geological structure; other well‐established methods are required to shed light on the active tectonics of EARS. In this study, we analyse stress orientation using log data from 95 vertical boreholes in a mine site to investigate the neotectonic stress pattern of the region. Analysis of 17.9 km of televiewer logs resulted in interpretation of 1188 stress‐related borehole failures. The results indicate a mean regional trend of 045° ± 31° for the maximum horizontal stress (SHmax). Our investigation reveals that the regional state of stress in the study area is controlled by superposition of stress sources that act at very different spatial scales. The consistency between our results and predictions by plate‐scale geodynamic models of stress orientations confirm that the regional pattern of stress in this area is mainly controlled by first (>500 km) and second (distances between 500 and 100 km) order stress sources (i.e., large tectonic forces and lateral density variations). However, high‐resolution data used in this study reveal that third (between 100 and 1 km) and fourth (<1 km) order stress sources from stiffness contrasts, rock fabric and geological structures have a great impact on the stress perturbations at smaller and local scales. [ABSTRACT FROM AUTHOR]

This study investigated aspects of the ornamental fish export trade in Malawi to understand potential impacts of the trade on exploited fish populations in Lake Malawi and recommend measures for management of the ornamental fishery. Information about the ornamental fish export trade in Malawi was sourced from hardcopy file records maintained by the Department of Fisheries between 1998 and December 2019, and semistructured interviews with ornamental fish exporters in Malawi. The information reported in this paper includes ornamental fish capture process and localities of capture within Lake Malawi, the number of ornamental fish exporters, fish export volumes and values in US$ equivalent at 2020 prices, export destinations, temporally shifts in fish collection localities, and the species exported and their conservation status. These results are discussed in relation to the management of the ornamental fishery in Malawi and many recommendations have been proposed relating to the sustainability of the ornamental fishery in Malawi. Since there are many common issues that affect ornamental fisheries worldwide, the findings and recommendations of this study may be applicable for the management of many other ornamental fisheries worldwide. [ABSTRACT FROM AUTHOR]

In sub‐Saharan Africa, adolescent girls and young women (AGYW) have high levels of unmet need for contraception, particularly those who are unmarried or nulliparous. Conversations with partners, peers, and family members influence AGYW contraceptive decision‐making yet little is known about conversation content and impact or how they vary by relationship status and parity. This paper draws on qualitative data from 60 AGYW (aged 15–24) participating in a sexual and reproductive health study in Malawi to examine contraceptive conversation patterns among participants and their social ties. AGYW's relationship status and parity influenced whether they talked about contraceptives, who they talked to about contraceptives, and the type of contraceptives that were endorsed during conversations. Unmarried and nulliparous AGYW were less likely to discuss contraceptives with all social ties and when conversations occurred, norms and misinformation regarding nonbarrier methods were reinforced, and condoms were largely prescribed. Conversations with intimate partners often provided permission for contraceptive use while conversations with peers and older women in the family provided information on contraceptive methods. Our results highlight the unique roles that social ties play in AGYW contraceptive decision‐making and suggest that existing contraceptive conversation patterns might exclude unmarried, nulliparous AGYW from accurate and comprehensive contraceptive information and options. [ABSTRACT FROM AUTHOR]

We investigate the effect of import duty, import excise and import value‐added taxes (VAT) on Malawi's import prices, values and volumes in trading with Africa. We find that import taxes increase import prices, with import VAT having the largest impact. Import duties lead to higher import values, but by a much smaller extent and import duties and VAT have a positive relationship with import quantities from COMESA while a negative one with SADC countries. In relation to AfCFTA, an increase in relative market access increases the probability of a product being from an African country, while high import duties decrease the probability of Malawian importers trading with other African countries. The presence of import VAT further reduce these odds. Zero tariffs in the AfCFTA may only increase intra‐African trade marginally. Other policies on market access and other import taxes need to be assessed, while accounting for potential fiscal implications. [ABSTRACT FROM AUTHOR]

Support for the enrolment of adolescents in research has been constrained by uncertainties in parental involvement, and the lack of clarity in the ethical and legal frameworks. We conducted a scoping review to examine articles that explored the opinion of scholars on the question of adolescent consent and conditions for parental waivers in research in sub‐Saharan Africa (SSA). Guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) tool, we searched electronic databases (PubMed, EMBASSE, EBSCOHOST) and also reviewed the references of articles identified for additional relevant literature. We included full text English articles focusing on adolescent consent and parental waivers in SSA that were published between 2004 and 2020. We excluded studies focusing on healthcare, theses, and reviews. We reviewed a total of 21 publications from South Africa (n = 12), Kenya (n = 4) and Botswana, Malawi, Nigeria, Uganda and Zimbabwe (n = 1 each). We identified four broad thematic issues: the current position regarding parental waivers and self‐consent; parental involvement in the consent process; the role of community approval or consent when adolescent self‐consent approaches were used; and complexities and ambiguities in legal requirements and ethical guidelines on adolescent consent. Our findings show inconsistencies and ambiguities in the existing legal and ethical frameworks within and across different countries, and underscore the need for consistent and clearer guidance on parental waivers and adolescent self‐consent. Harmonization of the legal and ethical frameworks taking into account varying contexts is critically important to ensure research on adolescents in SSA meets adolescents' specific unmet needs. [ABSTRACT FROM AUTHOR]

A key constraint to cassava productivity in Africa is the lack of adoption of improved cassava varieties tolerant to pests and diseases. To understand the drivers of adoption behavior, we examine the simultaneous adoption of improved cassava varieties and intercropping by 1200 smallholder farmers in Malawi, Tanzania, and Uganda. Using a linear model, we find that varietal characteristics, such as yield and early maturity, are critical drivers of adoption. Access to extension and credit is associated with an increase in the attractiveness of yield‐improving characteristics. We conclude that a more targeted extension approach would increase technology adoption in these countries. [ABSTRACT FROM AUTHOR]

Leguminous‐based intercropping, combined with conservation agriculture, is a promising approach to improve soil fertility, crop yields, and sustainable land use for smallholder farmers in sub‐Saharan Africa, including Malawi. This study aimed to assess the effects of incorporating legume‐based intercropping systems involving pigeon pea (Cajanus cajan) and cowpea (Vigna unguiculata) into the deep bed farming (DBF) system promoted by Tiyeni in northern Malawi. The study used a split plot design with cropping systems (CS) as the main plots and tillage systems (TS) as the sub‐plots. All treatments were replicated three times. The study encompassed two cropping seasons, where CS included legume‐based treatments, sole cropped maize (Zea mays) without fertilizer (MZ) and sole cropped maize with 92 kg top dressing N fertilizer per hectare (MZ + 92), while TS included DBF and conventional tillage (CT). The study found that all plots with leguminous crops on both DBF and CT showed higher levels of ammonium (NH4+), nitrate (NO3−) and phosphorus (P) in the soil, but DBF had significantly higher levels over 2 years. Intercropping systems showed higher land productivity (land equivalent ratio > 1) than sole cropping in both years, indicating that legume‐based cropping can improve land use efficiency and yields. It can be noted from this study that intercropping systems based on cereals and legumes, implemented in DBF, has the potential to sustain agricultural intensification in sub‐Saharan African countries where access to chemical fertilizers is limited among smallholder farmers. Core Ideas: Tiyeni's deep bed farming (DBF) in Malawi reports significant increases in maize crop yields.Impacts of leguminous intercropping (pigeon pea and cowpea) in DBF and conventional tillage (CT) plots are compared.Intercropping increases soil fertility in DBF and CT, but levels are significantly higher in DBF after 2 years.Intercropping within DBF can enhance food security and support sustainable agriculture. [ABSTRACT FROM AUTHOR]

Background: Covid 19 has fast‐paced the use of technological innovations, mainly the internet. However, Internet use can lead to several behavioral and psychological conditions, such as cyberbullying and distorted relationships, which could lead to suicide ideation. Suicide is the second leading cause of death among young adults. Aim: To assess the association between Internet addiction and suicide ideation among university students in Malawi. Furthermore, to assess the factors associated with suicidal thoughts among Malawian college students who surf the World Wide Web. Methods: This cross‐sectional study utilized secondary research and used data available from https://data.mendeley.com/drafts/xbfbcy5bhv. Internet addiction was measured using the Internet Addiction Test. The dependent variable includes suicide ideation. Binary logistic regression was used to analyze the relationship between the dependent and independent variables. The value of p < 0.05 was considered statistically significant. Results: Out of the 620 participants, 514 (82.2%) were aged between 15 and 24. The majority were males 401 (64.7%). The mean IAT score was 46.08 (SD = 14.60). The IAT score was 44.81 (SD = 13.85) among males and 48.40 (SD = 15.65) among females (p = 0.003). About 341 (55%) of students use the internet excessively. Suicide ideation was prevalent among 101 (16.3%) of the students. Suicide ideation was significantly associated with internet addiction. (p < 0.001). The odds of developing suicidal thoughts increased about 3 times among excessive internet users compared to average users (OR = 2.91, 95% CI = 1.213–7.018). However, age, gender, discipline, and year of study were not associated with suicide ideation. Conclusion: The study suggests that internet addiction affects suicide ideation mainly through distorting social relationships. School settings should increase awareness regarding the safe use of the internet to ensure a balance between online and real‐life interactions and curb suicide. [ABSTRACT FROM AUTHOR]

Most studies that have evaluated the welfare impacts of agricultural input subsidy programmes (ISPs) in developing countries have focused on measuring their effects on various outcomes of interest such as agricultural productivity. I estimate the consumer surplus accrued by direct and indirect beneficiaries of ISPs in Malawi. Malawi's Farm Input Subsidy Programme (FISP), introduced in 2005, is the largest such scheme in sub‐Saharan Africa. I find that the programme provides low direct benefits compared to the public costs of the programme. At the national level, the benefit‐cost ratio (BCR) is up to 0.37 for FISP households with no option to resell the fertiliser accessed through the programme. When reselling of the fertiliser is allowed for, the BCR increases to 0.64 including spillover benefits to direct non‐beneficiaries of FISP. I also found 60% of all fertiliser vouchers and benefits accrued to farm households with above the median wealth level. Many farmers demand 25 kg of fertiliser or less at the subsidised price. Thus, when resource poor direct beneficiaries have the option to buy 25 kg bags of fertiliser in addition to the 50 kg bags currently being offered under FISP, their benefits increase by about 53% compared to the status quo. Overall, my results suggest that a more flexible redemption of the fertiliser vouchers as well as complementary investments such as improved access to credit could increase the programme's contribution to farmers' welfare. [ABSTRACT FROM AUTHOR]

Background: The elderly comprises the fastest‐expanding age group globally, with the greatest increase occurring in developing countries. The elderly populace is prone to develop various ocular morbidities. Purpose: To determine the distribution of ocular morbidities among the elderly population visiting a private eye care facility in Malawi. Methods: This was a retrospective cross‐sectional study conducted at St. John's Hospital in Mzuzu, Malawi. We retrieved data from the hospital's ophthalmic outpatient registry from January, 2021 to December, 2021. A nonprobability census sampling technique was used to retrieve 52 elderly patients. Data analysis were done employing SPSS (v.26). Results: This study found according to gender a larger proportion were females 27 (51.9%) compared males, who accounted for 25 (48.1%). Refractive error 21 (40.4%) was the most prevalent ocular morbidity followed by cataract 13 (25.0%), pinguecula 6 (11.5%), and glaucoma 4 (7.7%). Although clear differences exist in the distribution of ocular morbidities according to sex (p = 0.529) and age (p = 0.328), the differences are not statistically significant. Conclusion: The pattern of eye diseases is typical to the country. More resources should be targeting main causes of preventable blindness including refractive error and cataracts at the facility. [ABSTRACT FROM AUTHOR]

Climate change poses a significant threat to endemic and endangered montane bird species with limited elevation and temperature ranges. Understanding their responses to changes in climate is essential for informing conservation actions. This study focused on the montane dwelling Yellow‐throated Apalis (Apalis flavigularis) in Malawi, aiming to identify key factors affecting its distribution and predicting its potential distribution under different climate change scenarios. Using an ensemble species distribution modeling approach, we found that the mean temperature of the driest quarter (Bio9), mean temperature of the wettest quarter (Bio8), and precipitation seasonality (Bio15) were the most important variables that influenced the distribution of this species. Across future climate scenarios, the species' geographic range declined where range losses varied from 57.74% (2050 RCP 6.0) to 82.88% (2070 RCP 6.0). We estimate its current range size to be 549 km2 which is lower than some previous estimates of its spatial distribution. Moreover, our projections indicate that under future climate scenarios, the species will shift to higher elevations with a large proportion of suitable areas located outside forests, posing challenges for adaptation. Our results suggest that the species may be under greater threat than previously thought; hence, urgent conservation actions are required. We recommend reinforcing the protection of areas predicted to remain suitable under future climate scenarios and the development of a species conservation action plan. [ABSTRACT FROM AUTHOR]

Animal flesh foods are rich in bioavailable iron but infrequently consumed by young children. We aimed to determine whether flesh food intake was associated with iron and anaemia status among 585 Malawian infants enroled in a 6‐month egg‐feeding trial. The percentage of days of small fish, large fish and meat consumption were assessed through weekly 7‐day animal‐source food screeners. Grams of intake were assessed through 24‐h recalls conducted at 6–9, 9–12 and 12–15 months of age. Plasma ferritin, soluble transferrin receptor (sTfR) and haemoglobin concentrations were measured at 6–9 and 12–15 months of age. Iron biomarkers were adjusted for inflammation during analysis. At enrolment, each flesh food category was consumed by <5% of children in the past 24 h. Over the next 6 months, small fish, large fish and meat were consumed on 25%, 8% and 6% of days, respectively, with mean usual intakes of <5 g/day. More frequent small fish consumption was associated with lower sTfR (geometric mean ratio [95% CI]: 0.98 mg/L [0.96, 1.00] per 10 percentage point difference) but not ferritin (1.03 µg/L [0.98, 1.07]) or haemoglobin (1.01 g/dL [1.00, 1.01]). Large fish consumption was associated with higher anaemia (prevalence ratio [95% CI]: 1.09 [1.01, 1.19]) and lower iron deficiency (0.96 [0.93, 1.00]) prevalence. Gram intakes of flesh food categories were not associated with any iron or anaemia indicators. Small fish were a primary contributor to flesh food intake in this cohort of Malawian children, although usual portions were small. Fish was associated with modest improvements to iron status, but meat was too infrequent to be associated with anaemia and iron deficiency. Key messages: Small fish was the most frequently consumed flesh food among young children: 4% at enrolment and 40% at the 6‐month follow‐up. On average, children consumed small fish once every 4 days.Despite small usual portions of about 5 g/day, frequent consumption of small fish was associated with moderate improvements in iron status.Large fish consumption was associated with lower iron deficiency but not with mean plasma ferritin or sTfR. Meat was infrequently consumed and not associated with any iron or anaemia measures.Reducing the burden of iron deficiency among young Malawian children may require provision of supplemental dietary iron, improved complementary feeding practices, addressing underlying barriers to flesh food consumption and controlling inflammation and infectious diseases. [ABSTRACT FROM AUTHOR]

The Malawi Rift is localized within Precambrian amphibolite‐granulite facies metamorphic belts, bounded by up to 150 km long border faults, and generates earthquakes throughout ∼40 km thick crust. Rift‐related faults are inferred to exploit pre‐existing weaknesses that allow rifting of otherwise dry and strong crust. It is unclear what these weaknesses are, and how localization into weak zones can be reconciled with strength required for lower crustal seismicity. We present results of mineral equilibria modeling, which indicate that Proterozoic metamorphism generated dry crust dominated by a quartz‐feldspar assemblage that is metastable at current conditions. For rift propagation to be possible at current cool thermal gradients and in mechanically strong, dry quartzofeldspathic rocks, mid‐ to lower‐crustal strain must be localized into relatively weak, inherited shear zones that deform primarily by aseismic, viscous creep. These shear zones are embedded within high‐strength crust, and interaction between creeping shear zones and enveloped or surrounding rocks may locally increase stress and trigger frictional, seismic slip at mid‐ to lower‐crustal depths. Over time, this interaction may produce a fracture network that allows infiltration of fluids. We therefore suggest that during rifting of previously deformed and metamorphosed crust, major faults are most likely to grow from below, with their location and orientation prescribed by underlying inherited viscous shear zones. In this case, fluids may infiltrate and locally weaken metastable lower crust, including allowing time‐dependent fluid‐driven seismicity and local partial melting, but length‐scales of this weakening is limited by the scale of the permeability network. Plain Language Summary: In Malawi, East Africa, the Earth's crust is slowly splitting apart. This "rifting" has two unusual characteristics: (a) the crust is thick and strong and therefore difficult to split apart, and (b) there are earthquakes at greater depth and temperature than typical for the continents. We propose that the reason rifting occurs with these two characteristics, in this location, is that the crust is inherited from past periods of mountain building. Based on thermodynamic principles, specifically what minerals are stable under what conditions, we model the composition of Malawi crust in the geological past. We then compare those results to current conditions. We find that the likely inherited composition of Malawi crust is unstable under current conditions, but needs an addition of water to undergo reactions to new, stable minerals. We also note that deformation is only possible in weak zones inherited from past deformation, and these zones will deform by high‐temperature flow of rock, not generating earthquakes. However, flow of local weak zones may induce fracturing in surrounding harder rocks, generating local earthquakes and a fracture system that water can flow along. Over time, this water infiltration can weaken the crust and ultimately allow continental rifting as seen further north in Africa. Key Points: The Malawi crust is mostly dry, metastable and frictionally strong, and rifting requires viscous flow in inherited lower crustal shear zonesMajor faults are likely to grow from below, with their location and orientation prescribed by underlying inherited viscous shear zonesViscous flow in heterogeneous crust may trigger lower crustal seismicity generating permeability that allows infiltration of external fluids [ABSTRACT FROM AUTHOR]

Introduction: Birth asphyxia is a leading cause of neonatal mortality in sub‐Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. Material and methods: This was a prospective cross‐sectional study. Data were collected using a perinatal e‐Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5‐minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Clinical Trial: Pan African Clinical Trial Registry 202006793783148. Results: Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17–1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34–16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13–1.68) and Uganda (OR 1.29, 95% CI 1.02–1.64), but was non‐significant in Tanzania (OR 1.44, 95% CI 0.81–2.56) and Malawi (OR 0.98, 95% CI 0.67–1.44). Conclusions: There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration. [ABSTRACT FROM AUTHOR]

Objective: Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding. Design: A formative, multi‐site, observational cohort study using convergent parallel, mixed‐methods design. Setting: Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania. Population or Sample: Moderately low birthweight infants (MLBW; 1.50–2.49 kg). Methods: We assessed infant feeding and care practices through: (1) assessment of in‐facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1‐year follow‐up of 1114 MLBW infants. Focus group discussions and in‐depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders. Main Outcome Measures: The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system‐level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants. Results: Hospital‐level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in‐facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age. Conclusions: Enrolment and follow‐up of this vulnerable population required additional effort from researchers and the community. Using a mixed‐methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence‐based planning of targeted large‐scale interventions. Multi‐site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base. [ABSTRACT FROM AUTHOR]

What explains variation in African states' commitment to pensions? This article argues that differences in the structure of contestation and legacies of state‐labour relations matter. When competition is confined to fewer and more stable parties, social welfare appeals gain currency to mobilise swing voters and makes it more likely that pensions will become a subject of political competition. However, legacies of labour accommodation can strengthen certain elements of pension reform, but also reinforce certain policy mindsets such as contributory insurance. These ideas are developed with case studies of Ghana and Malawi. The cases utilise process‐tracing evidence to demonstrate how specific structures of contestation and labour legacies led to divergent pathways of pension reform. The article highlights the significant challenges involved in strengthening pensions in Africa, and therefore the limited potential for a reconstitution of state‐citizen relations based on pension access. [ABSTRACT FROM AUTHOR]

Social and humanitarian cash transfers in sub‐Saharan Africa are increasingly used to support a wide range of vulnerable populations with long‐term support or immediate relief. Designing and implementing cash transfers typically involves a range of transnational actors and government stakeholders who continuously exert power which in turn affects state–citizen relations. The data informing this article come from 109 key informant interviews with (inter)national‐level stakeholders involved in three social cash transfers and two humanitarian cash transfers in Lesotho and Malawi. This article argues that donor‐designed targeting approaches in Lesotho and Malawi create space for new state–citizen relations, but that these are relatively shallow and reconfigured once technical capacity allows for targeting approaches that rely less on communities. It contributes to the literature on the role of transnational actors in social protection by showing that their role is significant when it comes to creating new redistributive relations, even if transnational actors are unable to convince host governments to take full fiscal responsibility for their initiatives due to differing views on who deserves what kind of support. [ABSTRACT FROM AUTHOR]

The decision of the United Kingdom government to reduce its Official Development Assistance by £ 4.6 billion in 2020 was framed by its proponents as a nationalist response to a domestic financial crisis. This Conservative‐led austerity measure triggered the early closure of hundreds of aid projects globally. Concerned British politicians equated the cuts to moral failures as humanitarian and civil society actors claimed the lost funding would devastate the world's most vulnerable populations. In the vast space between British funders and the so‐called 'beneficiaries' of aid is a diverse cadre of mid‐level actors 'doing' and, in this case, 'un‐doing' development programming. This article examines their experiences in prematurely closing British‐funded projects in one postcolonial context, Malawi. Drawing upon semi‐structured interviews, the article explores the emotional, material and relational consequences of austerity. It builds on Didier Fassin's theorization of moral economies to argue that the timing and approach of this funding withdrawal violated the accepted moral economies of aid, breaching obligations between Malawian mid‐level aid workers and community members (including family) as well as among institutions. It concludes by considering how this particular rupture to the relational infrastructure of aid has prompted demands for recalibrated resourcing futures in Malawi. [ABSTRACT FROM AUTHOR]

There are sizeable energy access deficits in the developing world. Leveraging panel data from the experimental impact evaluations of three unconditional cash transfer programs in Malawi and Zambia, we investigate how ultra‐poor households in rural areas adapt their energy portfolios when experiencing exogenous increases in income. Households make several changes to the primary fuel sources that they use on a regular basis after receiving 3 to 4 years of transfers—moving from fires to torches for lighting purposes and reducing collected firewood use for cooking purposes. In general, households are more likely to make income‐induced adjustments to lighting fuels than to cooking fuels. While facilitating some movement away from firewood (arguably the most inferior energy source), the unconditional cash transfers rarely enable households to completely abandon this fuel. This is understandable given the range of pressing needs facing the beneficiary households—such as food security, the enhancement of which is the primary purpose of the transfer programs. Although recipient households are able to meet a greater share of their energy needs with relatively improved fuels (such as charcoal/coal in Zambia) and obtain assets for generating solar power, the observed impacts are unlikely to be large enough to lead to meaningful health impacts (such as lower respiratory disease via reductions in indoor air pollution). However, the cash transfers appear to enhance well‐being in other ways through the energy use channel—for example, by reducing the time households spend foraging for fuel resources. [ABSTRACT FROM AUTHOR]

Droughts are a key feature of weather systems over Malawi and southern Africa. Their societal relevance in Malawi underscores the need for improved understanding of drought characteristics and atmospheric processes that drive them. We use the Standardized Precipitation and Evapotranspiration Index with the run theory to identify and characterize droughts in observations (1961–2017) and CMIP5 models across Malawi. We find no major differences in drought duration, severity, and intensity between the northern and southern parts of Malawi. However, circulation patterns associated with droughts in the two regions are different, and typically organized in such a way that droughts in one region coincide with wetter conditions in the other. Anomalous circulation patterns diminishing moisture convergence and convection over the affected region are a typical feature of summer droughts. We show that precipitation variability is principally governed by advected moisture, transported via three main tracks of northwesterly, northeasterly, and southeasterly moisture fluxes. The three tracks interact to form a convergence zone with a peak situated over Malawi. Variability in the respective moisture flux tracks influences the variability in the location and intensity of the convergence zone, and thus the location of the ensuing drought. We note links between variability in the moisture advection tracks and El Nino Southern Oscillations and other modes of variability including the Indian Ocean Dipole and Subtropical Indian Ocean Dipole. Both negative and positive biases in drought frequency are apparent in CMIP5 models but the majority overestimate drought duration and severity. The relationship between precipitation and net total moisture flux is consistently simulated. However, we note significant model inconsistencies in the relationship between precipitation and moisture flux from the southeasterly track, which potentially undermines the confidence in model simulation of drought processes over Malawi. [ABSTRACT FROM AUTHOR]

Aim: To evaluate hand hygiene knowledge and demonstrated technique before and after implementation of the hand hygiene programme and its sustainability among Malawian kindergarten students. Design: Quasi‐experimental design, utilizing a repeated measure at three points, namely, before intervention (T0), soon after intervention (T1) and follow‐up (T2). Methods: The hand hygiene programme consisted of integrating hand hygiene protocol into the school health curriculum, setting up proper handwashing facilities, training school teachers, health talks and developing reminders on hand hygiene. Fifty‐three kindergarten children aged 3–6 years were enrolled in the programme. Data were collected at 3 months' intervals (T0, T1, and T2). Parents, teachers, school authorities and children were involved in the implementation and evaluation of the intervention, utilizing a multilevel approach. Results: There was a significant difference in knowledge scores across three time points (T0, T1 and T2), Chi‐Square (2, n = 53) = 79.02, p < 0.005 and handwashing technique across the three time points, Chi‐Square (2, n = 53) = 88.04, p < 0.005. There was a large effect size of 0.62 on the effect of handwashing technique scores from T0 to T1. [ABSTRACT FROM AUTHOR]

Malawi's food and nutrition security heavily relies on rainfed agricultural production, which is prone to the effects of climate change, such as floods and dry spells. To improve the situation, policies have been established as a guide to assist in the implementation of agricultural technologies in the country. This study aims to evaluate the effect of two national policies on addressing nutrition, economics, and food security by introducing modern/existing technologies in the Phalombe district in Malawi. To gain insight into the representative farm operations, financial, demographic, and consumption behaviors of smallholder farmers, the data were obtained through a combination of focus group discussions, expert opinions, and various published reports, including both government and nongovernment sources. The farm simulation model (FARMSIM) was utilized to analyze district‐level crop and livestock farm operations. In this study, four irrigation technologies (treadle pump system, motorized pump system, solar‐powered system, and river diversion irrigation system) were assessed among the agricultural interventions implemented in Malawi. Also, seven land uses (i.e., corn, onion, bean, rice, tomato, leafy vegetable, and cabbage) were developed and simulated under irrigation scenarios. The irrigation systems and land use scenarios were evaluated based on economics, productivity, nutrition, and risk. The treadle pump and leafy vegetable scenario were generally identified as the most preferred combination. In addition, the productivity and riskiness of the other scenarios can be improved by selecting the best combination of crop and irrigation systems. The study concludes that government and private investment in subsidies for large‐scale irrigation systems, as well as improvements to market prices and infrastructure, are necessary to boost food security and enhance the livelihood of smallholder farmers in rural Malawi. [ABSTRACT FROM AUTHOR]

Tobacco use is a well‐established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital‐based ESCC case‐control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy‐nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever‐tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83‐5.23), and in Malawi (OR 2.45, 95%CI 1.80‐3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94‐2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26‐2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk. [ABSTRACT FROM AUTHOR]

This study reports onthe effect of various production steps on levels of aflatoxins during preparation of thobwa, a traditional maize‐based fermented non‐alcoholic beverage, brewed across Malawi. The effect of boiling, fermentation and their interaction on the level of aflatoxins, the trends of aflatoxin reduction during brewing, and the distribution of aflatoxins between the solid and liquid phases of the beverage were studied using VICAM AflaTest immunoaffinity fluorometric assay. Fermenting and boiling thobwa pre‐mix‐, with initial aflatoxin content of 45–183 μg/kg, resulted in aflatoxin reduction of 47% (13–61 μg/kg) on average. Fermentation and boiling contributed about 20 and 33% aflatoxin reduction, respectively, but without interactive effect between the two factors. Fermenting the thobwa for 24 h led to further reduction of aflatoxins to about 37% of the initial content, and remainedconstant for up to 8 days. Thobwa is a popular beverage in Malawi which is consumed in large quantities by all gender categories including infants, therefore the presence of aflatoxins may constitute a significant health risk factor. This study highlights the need to use raw materials with low levels of aflatoxins for production of maize‐based non‐alcoholic beverages to ensure consumer safety. [ABSTRACT FROM AUTHOR]

Understanding ecological‐ and management‐related predictors of mammal space use within protected areas is critical for management planning. This is particularly true in small, fenced and isolated reserves where we hypothesised that management‐related activities will influence large herbivore space use more than ecological characteristics. We used camera trap data to assess the space use patterns for 18 ungulate species in the small and isolated Majete Wildlife Reserve (Majete) in the understudied Miombo woodland ecoregion of southern Malawi. In the 2018 dry season, the 691 km2 reserve was systematically surveyed for ungulate presence at 140 camera trap locations. Over a period of 5456 camera days, the survey yielded 11 078 independent detections of 18 ungulate species and three predators. Using a single‐species occupancy modelling framework, the probability of space use of ungulates was assessed in relation to five management (fire exposure, fire frequency, water availability, distance from fence and road) and five ecological (visibility, grass biomass, vegetation type, terrain ruggedness and predator abundance) space use covariates, while accounting for imperfect detection. Top‐ranked models contained multiple covariates for 15 of the 16 species modelled, with only nyala's (Tragelaphus angasii) space use best predicted by vegetation type only. Distance to water, vegetation type, visibility and fire frequency were predictors having strong influences on six or more species each. More management‐related covariates reflected in top models, but ecological covariates had more meaningful effect sizes making us reject the hypothesis. Importantly though, distance from the roads and fence were also identified as prominent predictors. Notably, black rhinoceros' (Diceros bicornis) probability of space use increased with distance from the reserve boundary. Beyond informing habitat management for ungulates in Majete, these results can form the basis for understanding species‐specific space use patterns in other small reserves with similar characteristics and threats. [ABSTRACT FROM AUTHOR]

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The cost and affordability of least‐cost healthy diets by time and place are increasingly used as a proxy for access to nutrient‐adequate diets. Recent work has focused on the nutrient requirements of individuals, although most food and antipoverty programs target whole households. This raises the question of how the cost of a nutrient‐adequate diet can be measured for an entire household. This study identifies upper and lower bounds on the feasibility, cost, and affordability of meeting all household members' nutrient requirements using 2013–2017 survey data from Malawi. Findings show only a minority of households can afford the nutrient‐adequate diet at either bound, with 20% of households able to afford the (upper bound) shared diets and 38% the individualized (lower bound) diets. Individualized diets are more frequently feasible with locally available foods (90% vs. 60% of the time) and exhibit more moderate seasonal fluctuation. To meet all members' needs, a shared diet requires a more nutrient‐dense combination of foods that is more costly and exhibits more seasonality in diet cost than any one food group or the individualized diets. The findings further help adjudicate the extent to which nutritional behavioral change programs versus broader agricultural and food policies can be relied upon to improve individual access to healthy diets. [ABSTRACT FROM AUTHOR]

Summary: Motivation: Sub‐Saharan African governments have subsidized farm inputs—fertilizer and seed especially—to increase food production by small‐scale farmers to improve food security. A potential drawback of such schemes is that they may encourage farmers to put their children to work in the fields, harming their education. Purpose: Did the Malawi Farm Input Subsidy Programme that began in 2005/2006 increase child labour on the holdings of beneficiary smallholders? Methods and approach: The article analyses data from the Malawi Integrated Household Panel Survey to examine the effect of seed and fertilizer subsidies on child labour. The study employs a correlated‐random‐effects‐control function regression, using district coupon allocation as an instrumental variable for coupons received by households. Findings There was statistically significant evidence that the Farm Input Subsidy Programme (FISP) increased child labour. The effect, however, was relatively small. At the sample mean, it was estimated that the programme led to a 12 percentage point increase in the likelihood that children would work on the farm and that the children would work an additional 72 minutes a week on the fields. The FISP, however, did not affect the enrolment of children in school. Effects varied socially: children in male‐headed, uneducated, and smallholder households were the most affected. Policy implications: Although the observed effects are not large, they are unwelcome. Two policy corrections could eliminate them. One, the award of subsidy coupons could be made conditional on children's school performance. Two, given that the effects barely applied in households where parents had been to school, agricultural training should stress the importance of children attending school and not working in the fields. [ABSTRACT FROM AUTHOR]

In farm households, we argue that access to farmland, HT ht , differs and farmland allocation is overseen by a principal. We note that in accepting this price, her stock of human recognition decreases, that is, HT ht . At this level, the value of her overall well-being due to increased intra-household farmland access will be, at the minimum, equal to her threshold well-being, that is HT ht . [Extracted from the article]

Objective: To describe the use of point‐of‐care ultrasound (POCUS) in an acute‐care paediatric setting in Malawi, including clinical indications, types of examinations and frequency of positive findings. Methods: Retrospective, cross‐sectional study of a convenience sample of POCUS examinations performed in one tertiary referral hospital in Lilongwe, Malawi over 1 year. POCUS examinations were performed by Paediatric Emergency Medicine physician consultants as part of routine clinical practice and at the request of local clinicians. Images were saved along with the clinical indication and physician interpretation for quality review. Ultrasounds performed by the radiology department and those examinations that were technically faulty, missing clinical application or interpretation were excluded. Results: In total, 225 ultrasounds of 142 patients were analysed. The most common clinical indications for which examinations were completed were respiratory distress (23%), oedema (11.7%) and shock/arrest (6.2%). The most common examinations performed were cardiac (41.8%) and lung (15.1%), focused assessment with sonography in trauma (FAST; 12.9%) and ultrasound‐guided procedural examinations (9.8%). Pathology was identified in 68% of non‐procedural examinations. Cardiac examinations demonstrated significant pathology, including reduced cardiac function (12.8%), gross cardiac structural abnormality (11.8%) and pericardial effusion (10.3%). Conclusions: POCUS was used for both clinical decision‐making and procedural guidance, and a significant number of POCUS examinations yielded positive findings. Thus, we propose that cardiopulmonary, FAST and procedural examinations should be considered in future for the POCUS curriculum in this setting. [ABSTRACT FROM AUTHOR]

Introduction: Improving peri‐ and postnatal facility‐based care in low‐resource settings (LRS) could save over 6000 babies' lives per day. Most of the annual 2.4 million neonatal deaths and 2 million stillbirths occur in healthcare facilities in LRS and are preventable through the implementation of cost‐effective, simple, evidence‐based interventions. However, their implementation is challenging in healthcare systems where one in four babies admitted to neonatal units die. In high‐resource settings healthcare systems strengthening is increasingly delivered via learning healthcare systems to optimise care quality, but this approach is rare in LRS. Methods: Since 2014 we have worked in Bangladesh, Malawi, Zimbabwe, and the UK to co‐develop and pilot the Neotree system: an android application with accompanying data visualisation, linkage, and export. Its low‐cost hardware and state‐of‐the‐art software are used to support healthcare professionals to improve postnatal care at the bedside and to provide insights into population health trends. Here we summarise the formative conceptualisation, development, and preliminary implementation experience of the Neotree. Results: Data thus far from ~18 000 babies, 400 healthcare professionals in four hospitals (two in Zimbabwe, two in Malawi) show high acceptability, feasibility, usability, and improvements in healthcare professionals' ability to deliver newborn care. The data also highlight gaps in knowledge in newborn care and quality improvement. Implementation has been resilient and informative during external crises, for example, coronavirus disease 2019 (COVID‐19) pandemic. We have demonstrated evidence of improvements in clinical care and use of data for Quality Improvement (QI) projects. Conclusion: Human‐centred digital development of a QI system for newborn care has demonstrated the potential of a sustainable learning healthcare system to improve newborn care and outcomes in LRS. Pilot implementation evaluation is ongoing in three of the four aforementioned hospitals (two in Zimbabwe and one in Malawi) and a larger scale clinical cost effectiveness trial is planned. [ABSTRACT FROM AUTHOR]

Summary: Motivation: International donors piloted social cash transfers in Africa in the 2000s. Successful pilots need to be expanded, to be nationally owned, and to be funded by regular budgets. How this may be done depends on domestic politics, which vary by country. Donors need to engage with local politics if they wish their pilots to be institutionalized. Malawi is one such case, where a change of president opened a window for policy reforms. Purpose: Why were donors, over six years, unable to persuade Bingu wa Mutharika's government of Malawi to adopt social cash transfers; but succeeded with Joyce Banda's administration within two months of her being in office? Methods and approach: I adopt John Kingdon's multiple streams framework, originally developed in 1984 to explain how agenda are set in the USA. He observed separate streams of problems, potential policy responses, and politics which may converge at critical junctures—policy windows—when new policies may be adopted. I interviewed 25 policy‐makers in Malawi, including political leaders, donor staff, government civil servants, and civil society officers to trace policy‐making for social cash transfers. Findings Malawi can be seen to have a super‐presidential system, in which presidents and their closest allies overwhelmingly set the agenda, aligned to their ideological views and political interests. When presidents change, a policy window opens. Mutharika prioritized increasing the maize harvest and stabilizing the economy. The input subsidies used to achieve the former, he saw as "home‐grown" solutions, were preferred to donor orthodoxies. Social protection was for him another donor orthodoxy. It did not align with his beliefs and conflicted with his interests in food security. When Mutharika died suddenly in 2012, Vice‐President Banda took over. Her experience was different to that of her predecessor: she had worked with civil society, was acutely aware of poverty, and had good relations with external non‐governmental organizations and donors. She saw priorities in rising vulnerability and exclusion, she favoured safety nets, and was anxious to gain support for her administration. Social protection came rapidly into favour, pilots were expanded into a national programme. Policy implications: Political leaders support programmes that benefit both development and political survival. Understanding how a brief policy window opened in 2006 (for a draft social support policy) before a larger window opened in 2012, shows both inflection points happened when donor framing on social protection aligned with the ideas and interests of ruling elites. Three useful lessons emerge for donors promoting social protection. First, alignment of ideas and interests matter more than persuasion. Second, framing of social protection should consider domestic politics—in this case the political utility of cash transfers compared to farm subsidies. Third, the interplay of ideas and interests matters—in this case an incoming president faced by an economic crisis while trying to consolidate power saw social protection as a way to alleviate the crisis and build support. Kingdon's framework serves well to analyse this case, but not entirely. It focuses on the ideas and interests of the elites, and may ignore changing ideas among citizens in which Malawi's elites maintained the farm subsidies while citizens grew increasingly sceptical of their value. [ABSTRACT FROM AUTHOR]

The 2018 implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty‐eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance‐based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty‐seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI. Key messages: 1.National policies and national and subnational plans need to be effectively communicated throughout the health system and systematic coordination are important to institutionalising Baby‐Friendly Hospital Initiative (BFHI).2.Technical assistance, commonly provided for professional competency building, could support hospital practices, procedures and management.3.Understanding the motivations of providers and health systems and monitoring key indicators are important for incentives and sanctions to be effective.4.Documenting and sharing programmatic experiences are critical as countries adopt the new BFHI guidance.5.Multisectoral advocacy for the ten Steps is needed to secure national and local commitment and funding across and beyond the health system. [ABSTRACT FROM AUTHOR]

Previously, we developed and applied a glasshouse screen for potato tuber yield under heat stress and identified a candidate gene (HSc70) for heat tolerance by genetic analysis of a diploid potato population. Specific allelic variants were expressed at high levels on exposure to moderately elevated temperature due to variations in gene promoter sequence. In this study, we aimed to confirm the results from the glasshouse screen in field trials conducted over several seasons and locations including those in Kenya, Malawi and the UK. We extend our understanding of the HSc70 gene and demonstrate that expression level of HSc70 correlates with tolerance to heat stress in a wide range of wild potato relatives. The physiological basis of the protective effect of HSc70 was explored and we show that genotypes carrying the highly expressed HSc70 A2 allele are protected against photooxidative damage to PSII induced by abiotic stresses. Overall, we show the potential of HSc70 alleles for breeding resilient potato genotypes for multiple environments. [ABSTRACT FROM AUTHOR]

Challenges to the changing spaces of geography fieldwork have been pronounced during the COVID‐19 pandemic, through one of the most significant shifts since Bracken and Mawdsley wrote 'Muddy glee' in 2004, from 'doing' to 'imagining' fieldwork. Drawing on personal involvement in conducting virtual qualitative fieldwork during the pandemic on the experiences of older people with incontinence and their caregivers in Ethiopia and Malawi as a researcher with cerebral palsy, this commentary assesses new forms of 'muddiness' and the possibilities of inclusive data collection to evoke a sense of glee in the virtual field. The commentary reflects on how, away from challenging environments and in the virtual field, researchers with disabilities can discover a less physically 'muddy' glee by being included in fieldwork conducted online. The commentary draws on the new, tacit sense of muddiness experienced due to the physical separation between researcher and participant during the virtual era. The author provides reflections on routes to a new glee using technology and redressing the imbalances of power between researchers from the global North and partners in the global South, to further round out the picture of fieldwork to include women with disabilities going beyond the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Capture‐recapture, a method devised for estimating wildlife population sizes using technologies like bird banding, has been repurposed for use with "rare and elusive" human populations. Capture‐recapture is implemented to count "key populations," groups that constitute a small portion of the general population but are at high risk of HIV infection, including men who have sex with men. Drawing on ethnographic work in Malawi, I excavate mundane and oblique forms of capture (of labor, value, and viral material) and recapture (producing captive experimental populations) through which key populations come into being. Moving beyond the critical register of dehumanization (counting men as if they were animals) illuminates how efforts to count, care for, and keep track of key populations are mediated by relations of capture and elusion that are simultaneously predatory and capacitating, and entanglements that exceed the confines of a peculiar population‐size estimate method. [quantification, population, capture, global health, biopolitics, data, Malawi, Africa] [ABSTRACT FROM AUTHOR]

Zinc (Zn) deficiency remains a public health problem in Malawi, especially among poor and marginalized rural populations, linked with low dietary intake of Zn due to consumption of staple foods that are low in Zn content. The concentration of Zn in staple cereal grain can be increased through application of Zn‐enriched fertilizers, a process called agronomic biofortification or agro‐fortification. Field experiments were conducted at three Agricultural Research Station sites to assess the potential of agronomic biofortification to improve Zn concentration in maize grain in Malawi as described in registered report published previously. The hypotheses of the study were (i) that application of Zn‐enriched fertilizers would increase in the concentration of Zn in maize grain to benefit dietary requirements of Zn and (ii) that Zn concentration in maize grain and the effectiveness of agronomic biofortification would be different between soil types. At each site two different subsites were used, each corresponding to one of two agriculturally important soil types of Malawi, Lixisols and Vertisols. Within each subsite, three Zn fertilizer rates (1, 30, and 90 kg ha−1) were applied to experimental plots, using standard soil application methods, in a randomized complete block design. The experiment had 10 replicates at each of the three sites as informed by a power analysis from a pilot study, published in the registered report for this experiment, designed to detect a 10% increase in grain Zn concentration at 90 kg ha−1, relative to the concentration at 1 kg ha−1. At harvest, maize grain yield and Zn concentration in grain were measured, and Zn uptake by maize grain and Zn harvest index were calculated. At 30 kg ha−1, Zn fertilizer increased maize grain yields by 11% compared with nationally recommended application rate of 1 kg ha−1. Grain Zn concentration increased by 15% and uptake by 23% at the application rate of 30 kg ha−1 relative to the national recommendation rate. The effects of Zn fertilizer application rate on the response variables were not dependent on soil type. The current study demonstrates the importance of increasing the national recommendation rate of Zn fertilizer to improve maize yield and increase the Zn nutritional value of the staple crop. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused unprecedented disruptions to surgical care worldwide, particularly in low-resource countries. We sought to characterize the association between pre-and intra-pandemic trauma clinical outcomes at a busy tertiary hospital in Malawi. Methods: We analyzed trauma patients that presented to Kamuzu Central Hospital in Lilongwe, Malawi, from 2011 through July 2021. Burn patients were excluded. We compared patients based on whether they presented before or during the pandemic (defined as starting March 11, 2020, the date of the official WHO designation). We used logistic regression modeling to estimate the adjusted odds ratio of death based on presentation. Results: A total of 137,867 patients presented during the study period, with 13,526 patients during the pandemic. During the pandemic, patients were more likely to be older (mean 28 vs. 25 years, p < 0.001), male (79 vs. 74%, p < 0.001), and suffer a traumatic brain injury (TBI) as their primary injury (9.7 vs. 4.9%, p < 0.001). Crude trauma-associated mortality was higher during the pandemic at 3.7% vs. 2.1% (p < 0.001). The odds ratio of mortality during the pandemic compared to pre-pandemic presentation was 1.28 (95% CI 1.06, 1.53) adjusted for age, sex, initial AVPU score, transfer status, injury type, and mechanism. Conclusions: During the pandemic, adjusted trauma-associated mortality significantly increased at a tertiary trauma center in a low-resource setting despite decreasing patient volume. Further research is urgently needed to prepare for future pandemics. Potential targets for improvement include improving pre-hospital care and transportation, planning for intensive care utilization, and addressing nursing shortages. [ABSTRACT FROM AUTHOR]