Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial.

We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public and private healthcare facilities. The treatment arm used Vitalk; the control arm received links to Internet resources. The research team was blinded to the assignment. Of 1,584 participants randomly assigned to the treatment and control arms, 215 participants in the treatment and 296 in the control group completed baseline and endline anxiety assessments. Six assessments provided outcome measures for: anxiety (GAD-7); depression (PHQ-9); burnout (OLBI); loneliness (ULCA); resilience (RS-14); and resilience-building activities. We analyzed effectiveness using mixed-effects linear models, effect size estimates, and reliable change in risk levels. Results support our hypothesis. Difference-in-differences estimators showed that Vitalk reduced: depression (-0.68 [95% CI -1.15 to -0.21]); anxiety (-0.44 [95% CI -0.88 to 0.01]); and burnout (-0.58 [95% CI -1.32 to 0.15]). Changes in resilience (1.47 [95% CI 0.05 to 2.88]) and resilience-building activities (1.22 [95% CI 0.56 to 1.87]) were significantly greater in the treatment group. Our RCT produced a medium effect size for the treatment and a small effect size for the control group. This is the first RCT of a mental health app for healthcare workers during the COVID-19 pandemic in Southern Africa combining multiple mental wellbeing outcomes and measuring resilience and resilience-building activities. A substantial number of participants could have benefited from mental health support (1 in 8 reported anxiety and depression; 3 in 4 suffered burnout; and 1 in 4 had low resilience). Such help is not readily available in Malawi. Vitalk has the potential to fill this gap.

Socio-economic Inequality in Comprehensive Knowledge about HIV in Malawi.

Background: Having comprehensive knowledge about HIV is crucial in the fight against HIV and AIDS, and in achieving the global aspiration of ending AIDS as a public health threat by 2030. Low comprehensive knowledge about HIV can undercut efforts to halt the spread of the epidemic. It is important, however, to also determine if socioeconomic inequality is a factor in having a comprehensive knowledge about HIV in order to ensure that socioeconomic considerations are embedded in interventions. In this paper, the objective is to assess trends, as well as socioeconomic related inequality in comprehensive knowledge about HIV in Malawi. Methods: The current study uses a non-parametric approach and the concentration index. It draws upon secondary data from three rounds of the Malawi Demographic and Health Survey (MDHS) of 2004, 2010 and 2016. Results: Our results point to an increase in comprehensive knowledge about HIV over the 12-year period, from 28% in 2004 to around 44% in 2016. However, upon using the Erreygers concentration index, a wealth related inequality in comprehensive knowledge about HIV is uncovered. The poorer are less informed and the richer are better informed: comprehensive knowledge about HIV is concentrated among the rich. Furthermore, inequality in comprehensive knowledge about HIV has worsened over this period. Across gender, there is greater inequality among men than women. However, the rural-urban difference in wealth-related inequality in comprehensive knowledge about HIV dropped in 2016. Conclusion: The results show that comprehensive knowledge about HIV has increased. Furthermore, it is established that comprehensive knowledge about HIV is concentrated among the wealthier in the 2004 -2016 period. Our results suggest that there should be a targeted approach in messaging and disseminating information regarding HIV and AIDS, using methods that are pro-poor.