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Irrigation farming has raised concerns about the steady transmission and introduction of new vector-borne infectious diseases (VBD) in the areas involved. This systematic review aimed to determine interventions that are effective for the management and control of VBDs in irrigation areas in sub-Saharan Africa (SSA). We searched the literature on VBD interventions in SSA from published and grey literature without specifying the publication year. A search strategy identified 7768 records from various databases, and after screening, 16 were included in the final analysis. Results showed various VBD control interventions were effective, including indoor residue spray (IRS), insect-treated nets (ITN), larva source management (LSM), mass drug administration (MDA), integrated vector management (IVM), and mollusciciding. IVM was commonly practiced, and its success was because of the complementarity of the various interventions involved. Successful VBD control interventions led to improved health amongst irrigation communities and consequently improved agricultural productivity. However, some challenges to these interventions were identified, which include seasonal changes and climate variability, insecticide and drug resistance, and farmers’ attitudes toward accepting the interventions. Regardless, results showed that VBD control and management can be integrated into irrigation farming before or after the establishment of the irrigation scheme.

The 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.

To establish the impact of “Covid-19 Vaccination express” (CVE) on vaccine uptake in Malawi. 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. 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). CVE successfully increased the uptake of the Covid-19 vaccine.

Background and aims Hepatitis B (HBV) poses a significant public health challenge in Malawi with a pooled prevalence of 8% in the general population. This study aimed to determine the prevalence of HBV infection among healthcare workers in Salima District, Malawi, and assess the severity of positive cases. Methods In September 2020, a cross-sectional study was conducted in all public health facilities across Salima District and screened 854 healthcare workers for hepatitis B virus (HBV) using antigen point-of-care tests. Data on demographics and risk history were collected. Those who tested positive were linked to care, and further assessments were carried out by medical officers. Family members of positive cases were also screened for HBV. Descriptive statistics were used to summarize the data, with categorical variables presented as frequencies and percentages, and quantitative variables as means with standard deviations. The relationship between demographic factors and HBV prevalence was analyzed using unadjusted prevalence ratios (PR). Results The prevalence of HBV infection among healthcare workers was 2.93% (25 infections, 95% CI: 1.90–4.29%). Infections were more common among males (95% CI: 0.81–5.98%), married participants (95% CI: 0.13–1.07%), and those unvaccinated against HBV. Environmental health personnel (95% CI: 0.78–69.46%) exhibited the highest chronic HBV prevalence. All positive cases were enrolled in the HBV clinic within two weeks of diagnosis, and none had signs of severe liver disease. Discussion Despite lower prevalence than the general population, HBV infection rates remain concerning among healthcare workers, particularly those in non-clinical roles. The lack of vaccination history is a notable risk factor for infection. Conclusion The study underscores the elevated prevalence of HBV infection among healthcare workers in the Salima District, emphasizing the importance of vaccination and prompt linkage to care.

Introduction Bacterial bloodstream and urinary tract infections present a huge health burden especially in low-resource settings, which is worsened by the escalating burden of antimicrobial resistance (AMR). However, surveillance data on antimicrobial susceptibility profiles of pathogens remains scarce in Malawi. Therefore, this study aimed at establishing trends and patterns of AMR among common pathogens causing adult bloodstream and urinary tract infections in Malawi. Methods This was a secondary analysis of records from bacterial culture and susceptibility testing results of routinely collected adult blood and urinary tract samples from seven facilities in Malawi between January 2020 and August 2024. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method and interpreted according to EUCAST guidelines. The outcome of interest was the AST results of the bacterial isolates. Data were analyzed using SPSS version 28. Results Out of the 2787 isolates collected, 80.6% ( n  = 2246) were from urine samples and 19.4% ( n  = 541) were from blood samples. 74.1% ( n  = 2066) of the isolates were Gram-negative organisms. Escherichia coli (37.6%, n  = 1048) and Klebsiella pneumoniae (8.3%, n  = 232) were the most frequent isolates. A total of 16,696 ASTs were performed on the isolates, with 54.3% ( n  = 9,068) showing resistance to the antibiotics tested. Among Gram-positive organisms, there was increasing resistance to co-trimoxazole (71.4-83.3%), vancomycin (20.0-31.0%), with consistently high resistance rates to ciprofloxacin, erythromycin and gentamicin. Gram-negative organisms showed trends of increasing resistance to ceftriaxone (63.0-72.4%), co-trimoxazole (72.7-89.7%), and piperacillin and tazobactam (0.0-35.8%), with a notable significant increase in resistance to ciprofloxacin (66.7-81.0%, p  = 0.001). There was an increasing trend of Enterobacteriaceae resistance to third-generation cephalosporins (58.9-71.5%). Overall, pathogens with the highest resistance include Citrobacter freundii (62.1%, n  = 755/1216), Staphylococcus sp. (62.0%, n  = 163/263) and K. pneumoniae (57.1%, n  = 941/1648). Among the commonly isolated pathogens, E. coli , K. pneumoniae and Enterobacter spp. showed highest resistance to multiple antibiotics. Conclusion The study revealed high resistance levels among pathogens that cause BSIs and UTIs in public hospitals in Malawi. Most pathogens demonstrated high resistance against multiple antibiotic classes. The high AMR trends and patterns pose a significant risk to healthcare provision, calling for enhancing surveillance and upscaling efforts to address the challenge.

Background/Objectives: Strengthening antimicrobial stewardship (AMS) programs is an invaluable intervention in the ongoing efforts to contain the threat of antimicrobial resistance (AMR), particularly in low-resource settings. This study evaluates the impact of the Telementoring, Education, and Advocacy Collaboration initiative for Health through Antimicrobial Stewardship (TEACH AMS), which uses the virtual Extension for Community Healthcare Outcomes (ECHO) learning model to enhance AMS capacity in Kenya, Ghana, and Malawi. Methods: A mixed-methods approach was used, which included attendance data collection, facility-level assessments, post-session and follow-up surveys, as well as focus group discussions. Results: Between September 2023 and February 2025, 77 virtual learning sessions were conducted, engaging 2445 unique participants from hospital-based AMS committees and health professionals across the three countries. Participants reported significant knowledge gain, and data showed facility improvements in two core AMS areas, including the implementation of multidisciplinary ward-based interventions/communications and enhanced monitoring of antibiotic resistance patterns. Along those lines, participants reported that the program assisted them in improving prescribing and culture-based treatments, and also evidence-informed antibiotic selection. The evidence of implementing ward-based interventions was further stressed in focus group discussions, as well as other strengthened practices like point-prevalence surveys, and development or revision of stewardship policies. Substantial improvements in microbiology services were also shared by participants, particularly in Malawi. Other practices mentioned were strengthened multidisciplinary communication, infection prevention efforts, and education of patients and the community. Conclusions: Our findings suggest that a virtual case-based learning educational intervention, providing structured and tailored AMS capacity building, can drive behavior change and strengthen healthcare systems in low resource settings. Future efforts should aim to scale up the engagements and sustain improvements to further strengthen AMS capacity.

Background Viral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps. Methods We searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model. Results Searches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p  = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3). Conclusions Hepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi.

Malawi declared a state of national disaster due to the COVID-19 pandemic on 20th March 2020 and registered its first confirmed coronavirus case on the 2 April 2020. The aim of this paper was to document policy decisions made in response to the COVID-19 pandemic from January to August 2020. We reviewed policy documents from the Public Health Institute of Malawi, the Malawi Gazette, the Malawi Ministry of Health and Population and the University of Oxford Coronavirus Government Response Tracker. We found that the Malawi response to the COVID-19 pandemic was multisectoral and implemented through 15 focused working groups termed clusters. Each cluster was charged with providing policy direction in their own area of focus. All clusters then fed into one central committee for major decisions and reporting to head of state. Key policies identified during the review include international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, and mandatory face coverings and a testing policy covering symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over a variety of mediums, efforts to improve access to water, sanitation, nutrition and unconditional social-cash transfers for poor urban and rural households.

BackgroundOwing to their detachment from urban areas, people living in rural areas of Malawi are on the receiving end of health services and socio-economic benefits. The study therefore explored how Malawians living in these areas are adhering to coronavirus disease 2019 (COVID-19) containment measures and the factors that affect the COVID-19 fight amongst this population.AimThe study investigated how the rural population in Malawi adheres to COVID-19 containment measures.SettingThe study was conducted in two districts in Northern Malawi.MethodsData were collected from 263 participants. The chi-square (χ2) test was performed to determine the association between demographic variables and COVID-19 prevention practices and factors affecting the COVID-19 fight.ResultsEducation was significantly associated with wearing of masks (p = 0.01), use of sanitisers (p < 0.01) and practising social distancing (p = 0.07). Monthly income was associated with the use of sanitisers (p < 0.01). Women were more exposed to fake news about COVID-19 (p = 0.09); older people were more likely to disregard COVID-19 containment measures for cultural reasons (p = 0.07); and monthly income was associated with a lack of resources for following COVID-19 containment measures (p < 0.01).ConclusionFindings show that factors affecting the COVID-19 fight are influenced by various socio-economic factors which should therefore be taken into account in policy planning aiming at controlling the pandemic.ContributionThe study provides health stakeholders with a policy direction that enhances better coordination, implementation and monitoring of COVID-19 response and recovery activities in rural areas in Malawi. The findings have implications on controlling current and future communicable diseases; the proposed strategies might be employed in fighting similar current and future pandemics.

Background The roles and functionality of technical working groups (TWGs) in the health sectors vary across countries, still they aim to support government and ministries in formulating evidence-informed recommendations for policies and facilitate dialogue and alignment of activities among stakeholders within the health sector. Thus, TWGs have a role in enhancing the functionality and effectiveness of the health system structure. However, in Malawi, the functionality of TWGs and how they utilize research evidence to contribute to decision-making is not monitored. This study sought to understand the TWGs' performance and functionality in enabling evidence-informed decision-making (EIDM) in Malawi's health sector. Methods A cross-sectional descriptive qualitative study. Data were collected through interviews, documents review and observation of three TWG meetings. Qualitative data were analysed using a thematic approach. The WHO-UNICEF Joint Reporting Form (JRF) was used to guide the assessment of TWG functionality. Results TWG functionality varied in the Ministry of Health (MoH) in Malawi. The reasons for those perceived to be functioning well included meeting frequently, diverse representation of members, and that their recommendations to MoH were usually considered when decisions were made. For the TWGs that were perceived as not functioning well, the main reasons included lack of funding, periodic meetings and discussions that needed to provide clear decisions on the actions to be taken. In addition, evidence was recognized as important in decision-making, and research was valued by decision-makers within the MoH. However, some of the TWGs lacked reliable mechanisms for generating, accessing and synthesizing research. They also needed more capacity to review and use the research to inform their decisions. Conclusions TWGs are highly valued and play a critical role in strengthening EIDM within the MoH. Our paper highlights the complexity and barriers of TWG functionality in supporting pathways for health policy-making in Malawi. These results have implications for EIDM in the health sector. This suggests that the MoH should actively develop reliable interventions and evidence tools, strengthen capacity-building and increase funding for EIDM.