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Against the background of low women's participation in farm decision making processes, Malawi's agriculture sector adapted and up- scaled Household Approach, a gender transformative tool known for its impact in enhancing participation of women in farm decision making processes. In this study, participation in farm decision making is defined as the involvement of women, men and youth in decision making process in relation to visioning, planning, implementation, monitoring and evaluation. The objective of this study was to determine level of participation of women under Household Approach in farm decision making processes. This was a cross- sectional study. Using a semi-structured interview, a quantification of the extent of participation of various gender categories in decision making in various areas was determined. Thirty- three households were purposively selected due to their participation in Household Approach. Analysis of women participation in decision making, was done by computing women's decision score. Decision score for men and youth was also computed so that a comparison is made to women's level of participation. Women took joint decisions in all farm decision making processes with a higher participation score in household visioning (0.91) compared to men (0.83) and youth (0.44). When it came to implementing production activities of an enterprise (maize) which is a major source of their livelihood determining fulfilment of their visions, there were significant variations among their participation score in decision making in relation to maize enterprise production ([chi]2 (2) = 40.282, p = 0.000) with a mean rank participation score of 25.00, 39.94 and 8.56 in men, women and youth, respectively. This implies that much as implementation of maize production activities are jointly done with men, women still do a greater part of maize production work. When it came to monitoring, women had a lower participation score (0.68) compared to men (0.81), but higher than the youth (0.33). The lower participation score in monitoring among women was due to multiple roles the women have. This study recommends that sharing of roles be encouraged among peer households. Key words: Level, Women, participation, Household Approach, Farm, Decision making, Pragmatic, Cross- sectional, INTRODUCTION Agriculture accounts for 30% of Gross Domestic Product (GDP), generates over 80% of national export earnings in Malawi [1] and employs 76% of the country's workforce [2]. In Malawi, [...]

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6-2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2-3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7-24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4-17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients. [ABSTRACT FROM AUTHOR]

Objective: To identify the prevalence of respiratory syncytial virus (RSV) in a cohort of children under 5 years of age with World Health Organization (WHO)-defined pneumonia and the factors associated with developing severe RSV-associated community-acquired pneumonia (CAP) in primary care in a single centre in Northern Malawi., Methods: The BIOmarkers TO diagnose PnEumonia (BIOTOPE) study was a prospective cohort study conducted from March to June 2016 that took place in a primary care centre in Northern Malawi. Data from this study was used to identify the characteristics of children under 5 years of age who presented with RSV and WHO-defined CAP. Means, standard deviations, medians and ranges were calculated for continuous variables. A univariate logistic regression was performed to examine the potential predictor variables., Results: Four hundred and ninety-four infants presented with CAP and were eligible for inclusion in the study; RSV infection was detected in 205 (41.6%) of the infants. Eight factors were associated with increased risk for RSV CAP in the univariate model: age, born at term, presenting for care in June, crowded living environment, not being exclusively breastfed, not having received zinc or vitamin A supplementation in the last six months. Infants with RSV were more likely to have an oxygen saturation ≤92% compared to infants with other causes of pneumonia and more likely to have severe pneumonia as defined by the WHO., Conclusion: This study supports that RSV-associated CAP is linked to modifiable and non-modifiable risk factors; further research is indicated to determine which interventions would be most impactful. Developing and implementing an infant or maternal vaccine could be a cost-effective way to prevent RSV-associated CAP and mortality in developing nations. More research is needed to understand seasonal patterns of CAP and research over extended periods can offer valuable insights on host, environmental and pathogen-specific factors that contribute to RSV-associated CAP., (© The Author(s) [2024]. Published by Oxford University Press.)

Competing Interests: Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests is here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf

Objectives: A cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among healthcare workers (HCWs) and health managers, and to describe policy influence through a policy documents review in Malawi., Setting: The survey was performed at eight hospitals, ministry of health offices and 10 non-governmental organisations. We collected data in March and April 2021., Participants: Of 95 HCWs and health managers invited; 92 participated. 21/92 (23%) were female, and 17/92 (18%) participants were from clinics that piloted the integrated care for TB and DM., Outcome Measures: We described awareness levels on TB/DM comorbidity, perceptions and experiences in TB/DM care. Furthermore, development processes and contents of included documents were analysed., Results: 16/17 (94%) of HCWs from clinics piloting integrated care and 65/75 (86%) HCWs from hospitals that do not use integrated care for TB and DM responded that integrated care was acceptable and feasible. In qualitative data, shortage of resources, inadequate information sharing were common themes. We included seven relevant documents for the analysis. On development process and content, six of seven documents were scored ≥70%. In these documents, DM is a recognised risk factor for TB, and integration of healthcare services for infectious diseases and non-communicable diseases is recommended, however, these documents lacked information specifically on integrated care for TB and DM., Conclusion: In this study, we identified inadequate information sharing, and lack of resources as major factors impeding implementation of integration of services, however, awareness on TB/DM comorbidity was high., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To explore the experiences of schoolchildren, school personnel and parents who participated in a school-based hand hygiene programme implemented by nurses in Malawi., Background: There is low uptake of hand hygiene practice in developing countries due to limited resources available and no standardized hand hygiene policy., Introduction: Current health policies acknowledge the advantage of investing in disease prevention and health promotion among young children in Malawi. School nurses should adopt good evidence-based practice in promoting school-based hand hygiene programmes which remain a challenge in Malawi., Methods: In this descriptive qualitative study, 10 focus group discussions were conducted with 23 females and 14 males including schoolchildren, school personnel and parents participating in a school-based hand hygiene programme. The programme was implemented by nurses in three primary schools between May and July 2017 in Malawi. Data from these discussions were coded and analysed using thematic analysis., Findings: The school-based hand hygiene programme was well received by participants. Four themes illustrated effective strategies in implementing the hand hygiene programme from the participants' view, including 'Being committed', 'Sharing responsibilities', 'Disseminating good practice' and 'Appreciating assets'. These are essential resources and strategies that school nurses need to mobilize and integrate when they advocate handwashing policy by delivering hygiene promotion activities., Discussion: School nurses play a significant role in helping to achieve United Nation's Sustainable Development Goal 3 through promoting hand hygiene to minimize transmission of diseases and reduce mortality rate., Conclusion and Implications for Nursing and Health Policy: An evidence-based protocol based on study findings is beneficial for school nurses in formulating handwashing policies. It is important for developing countries to formulate the much-need policies for primary care practices., (© 2019 International Council of Nurses.)