Search

Teenage pregnancy and child marriage continue to rise in Malawi despite the introduction of compulsory Life Skills education in primary schools in 2002. A qualitative approach, employing focus group discussions with participants was used to explore the barriers faced by teachers in delivering sexual and reproductive health education in primary schools in southern districts of Malawi. Pupils, teachers and parents from a total of 10 primary schools, seven in Mangochi and three in Zomba, were invited to participate in focus group discussions on barriers to sexual and reproductive health education. The teaching experience of teachers ranged from one to six years. Pupils were aged between 10 to 19 years while parents had to have a child learning sexual and reproductive health at school to participate. Thematic analysis revealed several barriers to delivering sexual and reproductive health education: over-emphasis on abstinence, an unconducive learning environment, existence of sexual practices linked to becoming of age rites, peer pressure, lack of sexual and reproductive health reinforcement by parents, and inadequate training for teachers. Policymakers and curriculum developers/implementers should create an approach which is inclusive of all stakeholders and able to provide young people with comprehensive sexuality education that is rights based and effective.

In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL. Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi. More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi. There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers. Following the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL. The development of the APL should be based on research evidence. All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process. The APL should be part of the national health system or community services. The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop. [ABSTRACT FROM AUTHOR]

Policy development and implementation are key to improving access to Assistive Technology (AT). In this paper, we describe a strength-based framework for doing this at national level. We used an action research approach, with the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) as the primary frame of reference. Primary data were collected using the World Health Organisation's rapid Assistive Technology Assessment (rATA). We describe the process of applying our emergent framework and how our findings support it. We identified seven guiding principles for effective policy process: Participatory, Resource aware, Outcomes focused, Collaborative, Evidence-informed, supporting good practices, and System strengthening – which can be summarized by the acronym PROCESS. Five crucial building blocks for effective AT policy development emerged: Identification of the assistive technology ecosystem, Demography of disability and AT use, Evaluation of inclusion and participation in existing policy, Alignment with UNCRPD and Sustainable Development Goals (SDGs), and Locality of implementation – which can be summarized with the acronym IDEAL. The IDEAL PROCESS incorporates key content building blocks and core process principles, constituting a systematic framework for guiding the development of context sensitive AT policy and a strength-based pathway to improving access AT. [ABSTRACT FROM AUTHOR]

The Enabling Universal and Equitable Access to Healthcare for Vulnerable People in Resource Poor Settings in Africa (Equitable) Project was conducted in Malawi, Namibia, South Africa, and the Sudan between 2009 and 2012. It was aimed at determining the challenges which vulnerable groups, such as persons with disabilities, experience when accessing health care. It also aimed at identifying non-users of health services at the community level and reasons why they were not accessing these services. The study found that members of the Zion Church do not seek treatment from public or private health facilities, or from traditional healers. Not much has been written about how members of the Zion Church in Malawi seek health care. This paper explores how members of the Zion Church seek health care during illness episodes. The study was conducted in four districts in Malawi. A total of twenty-five members and non-members of this church were interviewed to determine how they sought health care. The study found that members of the Zion Church do not use Western medicine: the church does not allow them to seek treatment either from Western health facilities or traditional healers, otherwise they risk excommunication. Senior members of the church pray for the sick, and patients also seek treatment from the Zion Church clinic, where prayers, blessed water, and amulets are used in the treatment of diseases. Non-members who seek treatment from the Zion Church Clinic are advised to first seek treatment from traditional healers and health facilities. The Zion Church clinic should be the last resort for these non-member patients, most of whom have been sick for a long time. After being cured, some of the non-members have been converted and joined the church. Our conclusion is that while medical pluralism exists in Malawian communities, members of the Zion Church only access treatment from their church elders and church clinics. They do not use Western medicine.

Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78–80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7–61.0) and 63.5% (63.3–63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0–99.0) and 98.4% (98.3–98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally. It is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age. The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions. The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons. The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning [ABSTRACT FROM AUTHOR]