Knowledge, Attitudes, and Practices on COVID-19 Vaccination among General Adult Population in Malawi: A Countrywide Cross-Sectional Survey.

Vaccination is one of the essential measures in reducing transmission, morbidity, and mortality rates of a disease. However, the COVID-19 vaccination is facing hesitancy across the globe, Malawi included. A population-based cross-sectional study was conducted in Malawi to document knowledge, attitudes, and practices on COVID-19 vaccination. The study targeted the general adult population and employed a multi-stage sampling technique. The Census Enumeration Areas within the 16 selected districts served as a primary sampling unit. Among the total 3068 participants, 1947 (63.6%) were female. About 1039 (34.1%) participants had primary education, while only 169 (5.5%) had college education. A total of 2936 (95.7%) participants knew about the COVID-19 vaccine, and 2063 (68.4%) felt that the COVID-19 vaccine was effective. A total of 1180 (38.7%) got vaccinated. Knowledge of the COVID-19 vaccination was significantly associated with participants' education levels, location, occupation, marital status, household family income, and whether they were suffering from chronic illness or not. Overall, the level of knowledge and attitudes about the COVID-19 vaccination was good. This study has also established that different population groups have statistically different levels of knowledge and attitudes regarding COVID-19 vaccination. This study has also indicated a significant relationship between the rate of vaccination and several factors. Therefore, this calls for stakeholders to continue awareness and group-targeted tailored campaigns so as to increase COVID-19 vaccination.

COVID-19 vaccine express strategy in Malawi: An effort to reach the un-reach.

OBJECTIVES: To establish the impact of "Covid-19 Vaccination express" (CVE) on vaccine uptake in Malawi. DESIGN: Retrospective cross-sectional study to compare the daily vaccine administration rate in CVE and routine covid vaccination (RCV). RCV data was collected from March 2021 to October 2021. The data regarding CVE was collected from 5 November 2021 to 31 December 2021. Data was collected regarding (1) the total number and type of vaccine doses administered and (2) Demographic details like age, gender, occupation, presence of comorbidities, the first dose, or the second dose of the people who received a vaccine. RESULTS: From March-December 2021, a total of 1,866,623 COVID-19 vaccine doses were administered, out of which 1,290,145 doses were administered at a mean daily vaccination rate of 1854 (95 % CI: 1292-2415) doses as a part of RCV, and 576,478 doses were administered at a mean daily vaccination rate of 3312 (95 % CI: 2377-4248) doses as a part of CVE. Comparing the mean daily doses (Astra Zeneca, AZ doses 1 & 2) administered in the CVE and RCV showed that the mean daily doses of AZ vaccine administered were significantly higher in the CVE (p < 0.05). CONCLUSION: CVE successfully increased the uptake of the Covid-19 vaccine.

Responding to salinity in a rural African alluvial valley aquifer system: To boldly go beyond the world of hand-pumped groundwater supply?

Effective response to groundwater salinity in the developing world may critically safeguard drinking-water supplies. Groundwater resources throughout rural Africa are exploited by a vast and increasing number of hand-pumped boreholes for community supply. Our research in TA Ngabu (Shire Valley), Southern Malawi aims to: define groundwater-salinity problem occurrence within the semi-arid alluvial-valley aquifer, rural developing-world setting; critique current capacity to respond; and, to discuss future response options - in particular considering the need to explore alternative options that boldly go beyond the world of hand-pumped groundwater supply. Salinity problem definition was achieved through survey of 419 hand-pumped boreholes that revealed widespread brackish groundwater leading to non-potable (unpalatable) drinking-water supplies. Persistent non-functionality or abandonment of boreholes was typically ascribed to salinity. Whilst salinity is conceptualised to arise from shallow-groundwater evaporation, formation-evaporite dissolution and faulted-area upwelling, sparse data locally renders attribution of salinity sources to individual boreholes difficult. There is a significant need to better resolve the vertical distribution of salinity and local controlling processes. Problem response capacity was hampered by multiple factors, including, sector inertia, low drilling costs compromising water-point integrity, and lack of technical vision for alternatives. Various recommendations are made to improve response capacity continuing to work at the hand-pump supply scale. However, in areas where salinity is significant, exploring the feasibility of other options is advocated in conjunction with technical capacity development. Groundwater options may utilise high borehole yields possible from alluvial aquifers, grossly under-exploited by hand pumps. Groundwater at depth, albeit of unknown quality typically, or pipeline transfers of probable good-quality groundwater from valley-margin units, should be considered. Surface-water pipeline supplies may be viable for (growing) population centres. Canal-fed irrigation schemes (pending for the area), should be multiple-use, protective of groundwater and embrace pipeline drinking-water supply and managed-aquifer-recharge opportunities. Advancing desalination technologies, although presently unaffordable, should be kept under review.

Risk assessment to groundwater of pit latrine rural sanitation policy in developing country settings.

Parallel global rise in pit-latrine sanitation and groundwater-supply provision is of concern due to the frequent spatial proximity of these activities. Study of such an area in Malawi has allowed understanding of risks posed to groundwater from the recent implementation of a typical developing-country pit-latrine sanitation policy to be gained. This has assisted the development of a risk-assessment framework approach pragmatic to regulatory-practitioner management of this issue. The framework involves water-supply and pit-latrine mapping, monitoring of key groundwater contamination indicators and surveys of possible environmental site-condition factors and culminates in an integrated statistical evaluation of these datasets to identify the significant factors controlling risks posed. Our approach usefully establishes groundwater-quality baseline conditions of a potentially emergent issue for the study area. Such baselines are foundational to future trend discernment and contaminant natural attenuation verification critical to policies globally. Attribution of borehole contamination to pit-latrine loading should involve, as illustrated, the use of the range of contamination (chemical, microbiological) tracers available recognising none are ideal and several radial and capture-zone metrics that together may provide a weight of evidence. Elevated, albeit low-concentration, nitrate correlated with some radial metrics and was tentatively suggestive of emerging latrine influences. Longer term monitoring is, however, necessary to verify that the commonly observed latrine-borehole separation distances (29-58m), alongside statutory guidelines, do not constitute significant risk. Borehole contamination was limited and correlation with various environmental-site condition factors also limited. This was potentially ascribed to effectiveness of attenuation to date, monitoring of an emergent problem yet to manifest, or else contamination from other sources. High borehole usage and protective wall absence correlated with observed microbiological contamination incidence, but could relate to increased human/animal activity close to these poorly protected boreholes. Additional to factors assessed, a groundwater-vulnerability factor is recommended that critically relies upon improved proactive securing of underpinning data during borehole/latrine installations. On-going concerns are wide ranging, including poorly constrained pit-latrine input, difficulties in assessing in-situ plume natural attenuation and possible disposal of used motor oils to latrines.

A job analysis of community health workers in the context of integrated nutrition and early child development.

Stunting and poor child development are major public health concerns in Malawi. Integrated nutrition and early child development (ECD) interventions have shown potential to reduce stunting, but it is not known how these integrated approaches can be implemented in Malawi. In this paper, we aimed to evaluate the current jobs status of community health workers and their potential to implement integrated approaches. This was accomplished by a desk review of nutrition and ECD policy documents, as well as interviews with key informants, community health workers, and community members. We found that Malawi has comprehensive policies and well-outlined coordination structures for nutrition and ECD that advocate for integrated approaches. Strong multidisciplinary interaction exists at central levels but not at the community level. Integration of community health workers from different sectors is limited by workload, logistics, and a lack of synchronized work schedules. Favorable, sound policies and well-outlined coordination structures alone are not enough for the establishment of integrated nutrition and ECD activities. Balanced bureaucratic structures, improved task allocation, and synchronization of work schedules across all relevant sectors are needed for integrated intervention in Malawi.