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BackgroundEach year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC).MethodsHealth systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.ResultsEight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.ConclusionThis HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

Abstract Background Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC). Methods Health systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. Results Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2–34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. Conclusion This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

Providing emergency care in low resource settings relies on delivery by lower cadres of health workers (LCHW). We describe the development, implementation and mixed methods evaluation of a mobile health (mHealth) triage algorithm based on the WHO Emergency, Triage, Assessment, and Treatment (ETAT) for primary-level care. We conducted an observational study design of implementation research. Key stakeholders were engaged throughout implementation. Clinicians and LCHW at eight primary health centres in Blantyre district were trained to use an mHealth algorithm for triage. An mHealth patient surveillance system monitored patients from presentation through referral to tertiary and final outcome. A total of 209,174 children were recorded by ETAT between April 2017 and September 2018, and 155,931 had both recorded mHealth and clinician triage outcome data. Concordance between mHealth triage by lower cadres of HCW and clinician assessment was 81·6% (95% CI [81·4, 81·8]) over all outcomes (kappa: 0·535 (95% CI [0·530, 0·539]). Concordance for mHealth emergency triage was 0.31 with kappa 0.42. The most common mHealth recorded emergency sign was breathing difficulty (74·1% 95% CI [70·1, 77·9]) and priority sign was raised temperature (76·2% (95% CI [75·9, 76·6]). A total of 1,644 referrals out of 3,004 (54·7%) successfully reached the tertiary site. Both providers and carers expressed high levels of satisfaction with the mHealth ETAT pathway. An mHealth triage algorithm can be used by LCHWs with moderate concordance with clinician triage. Implementation of ETAT through an mHealth algorithm documented successful referrals from primary to tertiary, but half of referred patients did not reach the tertiary site. Potential harms of such systems, such as cases requiring referral being missed during triage, require further evaluation. The ASPIRE mHealth primary ETAT approach can be used to prioritise acute illness and support future resource planning within both district and national health system.

BackgroundMother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission.MethodsWe collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas.ResultsOverall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27–0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89–1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12–1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10–1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80–1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15–49 years) in 2022.ConclusionMaternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.

Introduction The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment.Methods The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary.Ethics and dissemination This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences.Trial registration number https://doi.org/10.17605/OSF.IO/X3Q4H

Malawi, as a developing country, faces serious environmental and health challenges associated with waste generation, transportation and disposal. Currently, available waste services rendered to the public are not sufficient to accommodate all residents in all cities due to rapid urban population growth. This paper highlights challenges that hinder effective municipal solid waste handling in Malawi. The literature survey has shown that existing dumping sites are in a bad state and do not meet the required standards, thereby posing danger to the diversity, ecological systems, environment and public health. Waste reduction through recycling of organic wastes into farmyard manure, plastic and metals exist on a small scale among some households and they are getting income. The challenges associated with municipal waste management are inadequate funding, lack of disposal infrastructure, weak enforcement of rules and regulations and the use of inappropriate vehicles for waste transportation. The activities such as the conversion of waste to energy, civic educating of residents, promoting recycling activities, expanding waste collection services to all residents and opening new engineered landfills and sufficient funding of municipalities would upscale waste management process.

Abstract Background Significant improvements in under-five mortality in Malawi have been demonstrated over the past thirty years; however, Malawian healthcare remains with gaps in availability and access to quality pediatric critical care nursing training and education. To improve expertise of pediatric critical care nurses in Malawi, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital (QECH), and Mercy James Center (MJC) entered a partnership with Seed Global Health, a US non-governmental organization. A needs assessment was conducted to understand the training needs of nurses currently working in pediatric critical care and in preparation for the development of a specialized Master’s in Child Health pathway in Pediatric Critical Care (PCC) Nursing at KUHeS. Methods The needs assessment was completed using a survey questionnaire formatted using an ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) framework. The questionnaire had Likert scale and yes/no questions. Data was manually entered into excel and was analyzed using descriptive statistics. Results One hundred and fifty-three nurses at QECH and MJC responded to the survey. Most nurses were between the ages of 25 and 35 years (N = 98, 64%), female (N = 105, 69%), and held either a Bachelors (N = 72, 47%) or diploma (N = 70, 46%) in nursing. Nurses had high rates of confidence in certain skills: airway management (N = 120, 99%), breathing assessment & management (N = 153, 100%). However, nurses demonstrated little to no confidence in areas such as: mechanical ventilation (N = 68, 44%), ECG evaluation (N = 74, 48%), and arterial blood gas collection & interpretation (N = 49, 32%). Conclusion It is important to identify priority areas for training and skills development to address in the PCC master’s within the child health pathway at KUHeS. Ideally this partnership will produce practice-ready PCC nurses and will establish a recognized PCC nursing workforce in Malawi.

Abstract Background Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses. Methods We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions. Results Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility. Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

Maize has been cultivated and continues to be cultivated for its usability in calorie supply to humans and livestock. There has been great interest in pigmented landrace maize varieties (PLMVs) due to their importance in the pharmaceutical industry. Landraces are to a large extent a repository of the gene pool that enriches biodiversity and maintains but also stabilizes the ecosystem in a sustainable way. PLMVs are still being cultivated by smallholder farmers in smaller portions of their fields and home surroundings despite the high adoption of white hybrid maize. This study examined the ash, moisture, mineral, crude protein, fat, and carbohydrate content of three different PLMVs from central (Ntcheu and Dedza districts) and northern (Mzimba district) Malawi. The mineral content of soils from fields where PLMVs were grown was also analyzed. The study areas experience a warm temperate climate and higher rainfall in summer than in winter but they differ in that Ntcheu has the highest average annual temperature of 20.3°C while Dedza receives the highest annual precipitation of about 1010 mm. Mzimba’s average annual temperature and precipitation are 20.1°C and 915 mm, respectively. The study showed that orange maize from Dedza had a significantly higher content of calcium (71.00 ± 0.58 mg·kg−1), magnesium (819.00 ± 0.58 mg·kg−1), and phosphorus (2720.35 ± 0.03 mg·kg−1). Significantly higher contents of zinc (54.61 ± 0.43 mg·kg−1) and potassium (808.58 ± 0.27 mg·kg−1) were observed in purple maize from Dedza and Ntcheu, respectively. Red maize from Dedza had a significantly higher content of iron (59.80 ± 0.26 mg·kg−1). Purple maize from Dedza has significantly higher carbohydrate content (65.52 ± 0.07%). The findings also revealed that red maize from Dedza provenance had a high content of crude protein (12.57 ± 0.07%) and fat (10.73 ± 0.14%). Moisture (17.30 ± 0.21%) and ash (2.28 ± 0.02%) were significantly higher in orange maize from Dedza. Dedza’s provenance revealed a high content of the analyzed attributes in PLMVs. Mineral analysis showed different levels of mineral bioavailability in different PLMVs and in the soils where maize was grown. It can, therefore, be concluded that production location and maize variety have an influence on the attributes of PLMVs. Understanding the physicochemical attributes of PLMVs and its maximum utilization have the potential of improving food and nutrition security in Sub-Saharan African countries and globally.

Different tree species can directly or indirectly affect soil conditions. They influence soil microbial diversity and abundance and hence soil respiration. Trees and soil respiration have a complex relationship that is poorly understood, as does the seasonal and spatial variation that naturally occurs in them. This study was therefore conducted to evaluate soil respiration processes under two native tree species, Msuku (Uapaca kirkiana) and Mtondo (Julbernardia paniculata), and one introduced tree species, Malaina (Gmelina arborea). In 2019 (March and October), soil samples were taken at 0.5m, 1.5m, 2.5 m, and 3.5m intervals from the trunks of the chosen tree species at depths of 0-10 cm and 10-20 cm. Using the alkali absorption method, soil respiration was assessed. The findings demonstrated that respiration decreased with the increase in horizontal distance from the trunk of both indigenous species. On the contrary, soil respiration increased with the increase in horizontal distances from the trunks of introduced tree species. The findings also demonstrated that respiration was higher at 0-10 cm than at 10-20 cm soil depths in both March and October under all three tree species. The higher microbial soil respiration in the surface layer could be attributed to better soil aeration, as opposed to the sub-surface soil. Furthermore, soil respiration was higher for soils collected in March than soils collected in October, probably because March is associated with the rainy season in which soil moisture content is higher than October. It can be concluded that different tree species strongly influence spatial and vertical soil respiration differently. This calls for proper selection of tree species to be utilised in agroforestry. Therefore, knowledge of nutrient uptake of various tree species and the influence of tree species on soil processes, but also microbial population effects on nutrient cycling linked to various tree species is essential. [ABSTRACT FROM AUTHOR]

Amaç: Tüberküloz (TB) mycobacterium tuberculosis tarafından oluşmakta ve öksürme, hapşırma, gülme ve şarkı söyleme yoluyla yayılmaktadır. Laboratuvar çalışanları normal populasyona göre 3-9 kat daha fazla enfeksiyon riski altındadırlar. Laboratuvar çalışanları için gerekli güvenliği sağlamak için laboratuvar güvenliği öncelikli hedefler arasına alınmalı ve laboratuar koşulları optimize edilmelidir. Blantyre şehri TB primer mikroskobi merkezi laboratuvar çalışanlarında işçi güvenliğini değerlendirmek. Materyal ve Metod: Blantyre şehri TB primer mikroskobi merkezi ekipman uygunluğu, tesisin yerleşimi ve iş pratiği açısından değerlendirildi. WHO/AFRO ISO 15189 un standardize edilmiş kontrol listesi kullanıldı ve gelişmekte olan ülkeler için minimum güvenlik skoru >80 dir. Her merkez bu skor kullanılarak aldığı puanlara göre derecelendirildi. Bulgular: Ndirande, Lirangve ve Chileka mikroskobi merkezlerindeki güvenlik kabinleri fonksiyonel değildi. South Lunzuda güvenlik kabini bulunamadı. Ndirande ve Limbe de hastaların bekleme odası ve laboratuvar kapılarında bulunan havalandırma kanalları özellikle yayma hazırlama sırasında enfeksiyonun bulaş riskinin artmasına neden olmaktadırlar. Bangwe, Chilomoni, Ndirande, Chileka, Güney Lundzu ve Limbe mikroskobi merkezleri balgam taşıma kutularına sahip değillerdi. Sonuç: Blantyre kenti TB mikroskobi merkezlerinde büyük bir güvenlik tehlikesi vardı. Dokuz merkezeden sadece bir tanesi minumum güvenlik şartlarını karşılamıştır ki bu incelenen merkezlerde toplam %89"luk bir başarısızlığı işaret etmektedir. Sonuç olarak Blantyre şehir merkezindeki TB yayma mikroskopi merkezleri laboratuvar koşulları ve güvenlik prosedürleri oldukça zayıftır. Hükümet ve diğer ilgili makamlar bir araya gelerek ülkedeki TB laboratuvarlarının ve benzer sorunlar yaşayan diğer merkezlerin güvenlik sorunlarını ele alarak laboratuvar çalışanlarının güvenliğini sağlamalıdırlar.

Purpose: Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is transmitted through coughing, sneezing, laughing and singing. Laboratory workers’ risk of infection is 3 to 9 times higher than the general public as they handle potentially infectious samples. Laboratory safety should therefore be prioritized and optimized to provide sufficient safety to laboratory workers. The aim of this study was to assess the safety of the laboratory workers in TB primary microscopy centres in Blantyre urban. Material and Methods: TB primary microscopy centers in Blantyre urban were assessed in aspects of equipment availability, facility layout, and work practice, using a standardized WHO/AFRO ISO 15189 checklist for the developing countries which sets the minimum safety score at ≥80%. Each center was graded according to the score it earned upon assessment. Results: The safety hoods were not functional in Ndirande, Lirangwe and Chileka microscopy centres. No safety hood was found in South Lunzu. In Ndirande and Limbe the exhaust ducts face the patients’ waiting area and door to the laboratory, putting them (patients and laboratory technicians) to a greater risk of infection when smear preparation begins. Bangwe, Chilomoni, Ndirande, Chileka, South Lunzu and Limbe microscopy centres had no sputum transportation boxes. Conclusion: There is a great compromised safety in the TB microscopy centers in Blantyre urban. Only one (1) microscopy center out of nine (9) reached the minimum safety requirement representing an 89 percent (%) failure of TB primary microscopy centers to provide safety to laboratory workers. Laboratory conditions and safety procedures in TB primary smear microscopy centres in Blantyre urban are poor. Government and other stake holders should therefore be committed in addressing the safety challenges of TB laboratories in the country (in primary Tb microscopy centres and other referral centres which face the same challenges) to ensure safety to the laboratory workers. [Cukurova Med J 2014; 39(2.000): 262-270]

A child's illness and admission in a hospital are stressful and can negatively affect the child and his/her caregivers. The stress is further exacerbated when a child is critically ill and has been admitted to an intensive care unit (ICU). The effects can be reduced when caregivers of the sick children are present and involved in decision making and actual care of their hospitalized children, a care model called family-centered care. Malawi has adopted family-centered care model in the newly instituted Mercy James Pediatric ICU. Little is known about experiences of caregivers with FCC in Malawi. This qualitative study was therefore conducted to explore experiences of caregivers on their involvement in decision making and care at Mercy James Pediatric ICU in Blantyre, Malawi. This was a descriptive qualitative study with a sample size of fifteen participants, however, data saturation was reached with ten participants. One on one in-depth interviews were conducted among a purposively selected sample of ten caregivers whose children had been discharged from the PICU. Content analysis was deductively and manually undertaken to analyze data with the aid of delve software to organize the data. Findings show that not every caregiver was involved in the decision making of their children's care, and if they did, it was not adequate. Barriers to effective involvement such as using a foreign language had a negative impact on comprehensive involvement of caregivers in decision making for their children's care. All participants were, however, involved in the physical care of their children. It is important that health care workers should continuously encourage caregivers to get involved in the decision making and care of their children. [ABSTRACT FROM AUTHOR]