9 research outputs found
The public image of Zambia Railways
No full textThis report, based on a practical attachment with Zambia Railways, the author discusses the company's poor image within the historical and current context. Beginning with a background of the company, the author gives the terms of reference, methodology and literature review on railways in general, in the context image-building. The author then discusses the conceptual framework highlighting various relevant communication theories within the context of communication for development. The report is concerned with definitions of the basic concepts which the author has used throughout the report. A section follows this on the author's personal experience during the attachment. This is done with a view of putting the reader of the report into context. The main the problems and constraints of ZR, and what management perceives as possible solutions are also discussed. The author's personal input during the attachment included the focus group discussions, interviews, and the meetings which are discussed in a separate chapter. Before the concluding chapter, the author discusses the findings of the attachment in the light of communication theories as presented in the conceptual framework. The last chapter gives a generic conclusion on how Zambia Railways requires knowledge of the market, industry and available technology to survive and make profit. She has recommended good communication with their major customers. This can easily change the perceived bad image of Zambia Railways. Recommendations were also made following the various discussions and views presented in the report. The public Image of Zambia Railways was worth looking at because the corporate image of any progressive company is inevitable for its growth
Assessing antimicrobial use patterns in Christian Health Association of Malawi (CHAM) health facilities: A cross-sectional study protocol.
No full textThe threat of antimicrobial resistance (AMR) in Malawi is high with reported mortality of 19,300 annually, the 23rd highest age-standardised mortality. One of the drivers of AMR is misuse of antibiotics, a phenomenon that has not been adequately researched in Malawi. This study aims to investigate antimicrobial use using health facility, prescribing and patient indicators in Christian Health Association of Malawi (CHAM) health facilities. This will be a multiple cross-sectional study, which will collect data from facilities (22), prescriptions (660), and patients (303). Data will be collected using KoboToolbox v2021, and exported into Microsoft Excel version 2016 for cleaning and coding. Variables will be categorised according to the antimicrobial use indicators. The study will use STATA Version 14 statistical software for data analysis. Subsequently, facilities will be entered into ArcGIS Version 10.7.1 to map hotspots of irrational antimicrobial use. The study will run from October 2024 to June 2025. This study will provide detailed information on frequently used antimicrobials, the cost of antimicrobials relative to medicine budget, the intensity of exposure to antimicrobials, the availability of antimicrobials, patients' understanding of antimicrobials use, and availability of important documents for antimicrobial use. Secondarily, the study will unravel the prevalence of irrational antimicrobial use, the main factors contributing to it, and location where irrational use is most prevalent. These findings will inform the national antimicrobial stewardship action plan, aiming to safeguard the available antimicrobials
Distribution of Rotavirus alphagastroenteritidis Strains in Blantyre, Malawi, During and After the COVID-19 Pandemic
Get PDFRotavirus alphagastroenteritidis remains the leading cause of severe gastroenteritis in children under five years, despite widespread vaccine use. The COVID-19 pandemic disrupted healthcare and vaccination delivery, while non-pharmacological interventions may have influenced R. alphagastroenteritidis transmission. We conducted hospital-based surveillance of R. alphagastroenteritidis gastroenteritis at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, from October 2019 to October 2024. Children under five presenting with acute gastroenteritis were enrolled; 99.1% of vaccine-eligible participants had received at least one R. alphagastroenteritidis vaccine dose. Stool samples were tested for R. alphagastroenteritidis by enzyme immunoassay (EIA) and genotyped using RT-PCR. Among 1135 enrolled children, 29.1% (330/1135) were R. alphagastroenteritidis-positive. Cases occurred year-round except for December 2020–January 2021, when no R. alphagastroenteritidis infections were detected, and February–March 2023, when no samples were collected. The prevalence varied significantly by age group between children greater than 23 months of age to the rest of the age groups (<6 months, 6–11 months, and 12–22 months) (p = 0.0046). The most common R. alphagastroenteritidis G-genotypes were G3 (38.7%), G2 (25.4%), and G12 (17.2%), with G2 emerging as the predominant strain from June 2023. G3P[8] was the most frequent G–P combination (25%). Its overall prevalence did not change during the pandemic; however, genotype distribution shifted compared to pre-COVID-19 patterns. Sustained surveillance and genomic analyses are essential to monitor evolving strain dynamics and inform vaccine policy.</p
from patients with cholera-like illness during the 2022–2023 cholera outbreak in Malawi
No full textAeromonas caviae is an increasingly recognized etiological agent of acute gastroenteritis. Here, we report five draft genomes of A. caviae isolated from suspected cholera cases during the 2022-2023 cholera outbreak in Malawi
A baseline assessment of antimicrobial stewardship core element implementation in selected public hospitals in Malawi: findings from the 2023 National Program Audit
Get PDFAntimicrobial resistance (AMR) is a significant global health challenge, particularly in low- and middle-income countries (LMICs). In Malawi, frequent stockouts of essential medicines and the widespread dispensing of antibiotics without prescriptions have exacerbated the AMR burden, highlighting the urgent need for robust antimicrobial stewardship (AMS) interventions. This study presents the first documented baseline assessment of AMS core elements across six public healthcare facilities within Malawi’s AMR sentinel surveillance network. Understanding the baseline status of AMS implementation provides a critical reference point to guide future interventions, inform policy, and prioritize resources in the national response to AMR. This descriptive analysis used data from a national AMS program audit conducted from July 10–14, 2023, in six public hospitals: Malamulo Adventist Hospital, Mzimba South District Hospital, Kamuzu Central Hospital, Queen Elizabeth Central Hospital, Zomba Central Hospital, and Mzuzu Central Hospital. The World Health Organization (WHO) Healthcare Facility AMS Assessment Tool was used to evaluate implementation across key AMS domains, including leadership, accountability, stewardship actions, education, monitoring, surveillance, and reporting. A total of 30 AMS committee members participated using a consensus-based approach. Of the six hospitals assessed, only one (Kamuzu Central Hospital) demonstrated strong implementation of AMS core elements, achieving a score of 79%. The remaining facilities reported moderate to low performance, with Mzimba District Hospital scoring the lowest (24%). Leadership commitment was inconsistent; only one (16.7%) hospital had fully integrated AMS into its annual plans, and resource allocation was limited. AMS ward rounds and antibiotic prescription audits were either absent or only partially implemented across most facilities. Education and training initiatives were fragmented, with only one (16.7%) hospital partially integrating AMS into staff induction. This situational analysis reveals critical gaps in AMS implementation across Malawi’s national AMR surveillance hospitals. Limited leadership commitment, infrequent AMS ward rounds, and inconsistent education for healthcare workers were major barriers. Targeted interventions are needed to strengthen leadership, establish feasible facility-level AMS actions, and build sustainable capacity among healthcare workers
A baseline assessment of antimicrobial stewardship core element implementation in selected public hospitals in Malawi: findings from the 2023 National Program Audit
Get PDFBackgroundAntimicrobial resistance (AMR) is a significant global health challenge, particularly in low- and middle-income countries (LMICs). In Malawi, frequent stockouts of essential medicines and the widespread dispensing of antibiotics without prescriptions have exacerbated the AMR burden, highlighting the urgent need for robust antimicrobial stewardship (AMS) interventions. This study presents the first documented baseline assessment of AMS core elements across six public healthcare facilities within Malawi’s AMR sentinel surveillance network. Understanding the baseline status of AMS implementation provides a critical reference point to guide future interventions, inform policy, and prioritize resources in the national response to AMR.Materials and methodsThis descriptive analysis used data from a national AMS program audit conducted from July 10–14, 2023, in six public hospitals: Malamulo Adventist Hospital, Mzimba South District Hospital, Kamuzu Central Hospital, Queen Elizabeth Central Hospital, Zomba Central Hospital, and Mzuzu Central Hospital. The World Health Organization (WHO) Healthcare Facility AMS Assessment Tool was used to evaluate implementation across key AMS domains, including leadership, accountability, stewardship actions, education, monitoring, surveillance, and reporting. A total of 30 AMS committee members participated using a consensus-based approach.ResultsOf the six hospitals assessed, only one (Kamuzu Central Hospital) demonstrated strong implementation of AMS core elements, achieving a score of 79%. The remaining facilities reported moderate to low performance, with Mzimba District Hospital scoring the lowest (24%). Leadership commitment was inconsistent; only one (16.7%) hospital had fully integrated AMS into its annual plans, and resource allocation was limited. AMS ward rounds and antibiotic prescription audits were either absent or only partially implemented across most facilities. Education and training initiatives were fragmented, with only one (16.7%) hospital partially integrating AMS into staff induction.ConclusionThis situational analysis reveals critical gaps in AMS implementation across Malawi’s national AMR surveillance hospitals. Limited leadership commitment, infrequent AMS ward rounds, and inconsistent education for healthcare workers were major barriers. Targeted interventions are needed to strengthen leadership, establish feasible facility-level AMS actions, and build sustainable capacity among healthcare workers
Omicron B.1.1.529 variant infections associated with severe disease are uncommon in a COVID-19 under-vaccinated, high SARS-CoV-2 seroprevalence population in Malawi
Get PDFBackground:
The B.1.1.529 (Omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the fourth COVID-19 pandemic wave across the southern African region, including Malawi. The seroprevalence of SARS-CoV-2 antibodies and their association with epidemiological trends of hospitalisations and deaths are needed to aid locally relevant public health policy decisions.
Methods:
We conducted a population-based serosurvey from December 27, 2021 to January 17, 2022, in 7 districts across Malawi to determine the seroprevalence of SARS-CoV-2 antibodies. Serum samples were tested for antibodies against SARS-CoV-2 receptor binding domain using WANTAI SARS-CoV-2 Receptor Binding Domain total antibody commercial enzyme-linked immunosorbent assay (ELISA). We also evaluated COVID-19 epidemiologic trends in Malawi, including cases, hospitalisations and deaths from April 1, 2021 through April 30, 2022, collected using the routine national COVID-19 reporting system. A multivariable logistic regression model was developed to investigate the factors associated with SARS-CoV-2 seropositivity.
Findings:
Serum samples were analysed from 4619 participants (57% female; 60% aged 18–50 years), of whom 878/3794 (23%) of vaccine eligible adults had received a single dose of any COVID-19 vaccine. The overall assay-adjusted seroprevalence was 83.7% (95% confidence interval (CI), 79.3%–93.4%). Seroprevalence was lowest among children <13 years of age (66%) and highest among adults 18–50 years of age (82%). Seroprevalence was higher among vaccinated compared to unvaccinated participants (1 dose, 94% vs. 77%, adjusted odds ratio 4.89 [95% CI, 3.43–7.22]; 2 doses, 97% vs. 77%, aOR 6.62 [95% CI, 4.14–11.3]). Urban residents were more likely to be seropositive than those from rural settings (91% vs. 78%, aOR 2.76 [95% CI, 2.16–3.55]). There was at least a two-fold reduction in the proportion of hospitalisations and deaths among the reported cases in the fourth wave compared to the third wave (hospitalisations, 10.7% (95% CI, 10.2–11.3) vs. 4.86% (95% CI, 4.52–5.23), p < 0.0001; deaths, 3.48% (95% CI, 3.18–3.81) vs. 1.15% (95% CI, 1.00–1.34), p < 0.0001).
Interpretation:
We report reduction in proportion of hospitalisations and deaths from SARS-CoV-2 infections during the Omicron variant dominated wave in Malawi, in the context of high SARS-CoV-2 seroprevalence and low COVID-19 vaccination coverage. These findings suggest that COVID-19 vaccination policy in high seroprevalence settings may need to be amended from mass campaigns to targeted vaccination of reported at-risk populations.
Funding:
Supported by the Bill and Melinda Gates Foundation (INV-039481)
Genomic insights into the 2022–2023Vibrio cholerae outbreak in Malawi
Get PDFMalawi experienced its deadliest Vibrio cholerae (Vc) outbreak following devastating cyclones, with >58,000 cases and >1700 deaths reported between March 2022 and May 2023. Here, we use population genomics to investigate the attributes and origin of the Malawi 2022–2023 Vc outbreak isolates. Our results demonstrate the predominance of ST69 clone, also known as the seventh cholera pandemic El Tor (7PET) lineage, expressing O1 Ogawa (~ 80%) serotype followed by Inaba (~ 16%) and sporadic non-O1/non-7PET serogroups (~ 4%). Phylogenetic reconstruction revealed that the Malawi outbreak strains correspond to a recent importation from Asia into Africa (sublineage AFR15). These isolates harboured known antimicrobial resistance and virulence elements, notably the ICEGEN/ICEVchHai1/ICEVchind5 SXT/R391-like integrative conjugative elements and a CTXφ prophage with the ctxB7 genotype compared to historical Malawian Vc isolates. These data suggest that the devastating cyclones coupled with the recent importation of 7PET serogroup O1 strains, may explain the magnitude of the 2022–2023 cholera outbreak in Malawi
Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries
No full textIntroduction The Package of Essential Noncommunicable Disease Interventions—Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up.Methods and analysis Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews.Ethics and dissemination This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project’s course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals
