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Objective: to evaluate the effectiveness of continuing training for traditional birth attendants (TBAs) on their reproductive knowledge and performance., Setting: Mzuzu Central Hospital in the northern region of Malawi. PARTICIPANTS AND ANALYSIS: a total of 81 TBAs trained during 2004 and 2006 in Mzuzu, Malawi received continuing training courses. Their reproductive knowledge was assessed by a structured questionnaire during 2004 and 2007. A multivariate generalised estimating equation (GEE) model was constructed to determine the associations between their reproductive knowledge scores and age, years of education, time since the last training course, test frequency and number of babies delivered., Findings: from July 2004 to June 2007, a total of 1984 pregnant women visited these trained TBAs. A total of 79 (4.0%) mothers were referred to health facilities before the birth due to first-born or difficult pregnancies. No maternal deaths occurred among the remaining mothers. There were 26 deaths among 1905 newborn babies, giving a perinatal mortality rate of 13.6 per 1000 live births. The GEE model demonstrated that knowledge scores of TBAs were significantly higher for TBAs under the age of 45 years, TBAs with more than five years of education, TBAs who had taken a training course within one year, and TBAs with a higher test frequency., Conclusion and Implications for Practice: continuing training courses are effective to maintain the reproductive knowledge and performance of trained TBAs. It is recommended that continuing training should be offered regularly, at least annually., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

To evaluate the awareness of HIV/AIDS prevention education, and the acceptance of HIV testing among residents on Likoma Island, Malawi, a cross-sectional, population-based study of 579 residents aged > or =15 years from seven villages on Likoma Island was conducted during July and August 2007. Most of the subjects studied could correctly answer questions about their awareness of AIDS and knowledge of the ways to reduce HIV transmission. Moreover, the proportion of respondents (65.8%) who possessed complete knowledge of HIV/AIDS prevention was greater than the national average. By contrast, condom utilization was slightly lower. Our results also showed that a high proportion of respondents (70.3%) had been HIV tested at any time, 93.5% of them voluntarily. Among correlated factors, females [adjusted odds ratio (AOR)=1.7, 95% CI 1.1-1.6] and polygamous individuals (AOR=3.3, 95% CI 1.5-7.0) were more likely to receive an HIV test. Past experience of being HIV tested was a strong predictor of possessing good knowledge and attitudes towards HIV/AIDS prevention. We conclude that antiretroviral treatment provided by Likoma District Hospital has led to the successful scale-up of HIV testing in Likoma Island and consequently improved the awareness of HIV/AIDS. However, the use of condoms remains largely unsupported, and there is therefore still a need to intensify general HIV/AIDS education on the island.

Our study evaluates the usefulness and the limitations of using the medical records of a central referral hospital to develop a child injury surveillance system in northern Malawi. The most prevalent types of injury were falls (29.6%), road traffic injuries (22.0%), burns (21.4%) and poisoning (15.1%). Older children (aged 5-14 years), in the cool-dry season (May to August) and the hot-dry season (September to October), were significant predictors for total injury admissions. Our study indicated that hospital medical records are a valuable component of a child injury surveillance system and can illustrate the trends and patterns of moderate to severe injuries as well as suggest potential prevention strategies for local settings. Combined with a specially designed trauma registry form, it is possible for developing countries at local level to combat the emerging public health issues.