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Masangwi S.,University of Malawi | Ferguson N.,University of Strathclyde | Grimason A.,Scotland Chikhwawa Health Initiative SCHI | Grimason A.,Africa Academy for Environmental Health | And 4 more authors.
International Journal of Environmental Research and Public Health | Year: 2015

Developing countries face a huge burden of infectious diseases, a number of which co-exist. This paper estimates the pattern and variation of malaria and diarrhea coexistence in Chikhwawa, a district in Southern Malawi using bivariate multilevel modelling with Bayesian estimation. A probit link was employed to examine hierarchically built data from a survey of individuals (n = 6,727) nested within households (n = 1,380) nested within communities (n = 33). Results show significant malaria [ σ2u1 =0.901 (95% : 0.746,1.056)] and diarrhea [σ2u2 =1.009 (95% CI : 0.860,1.158) ] variations with a strong correlation between them [ ru(1,2) 0.565 = ] at household level. There are significant malaria [ σ2v1 =0.053 (95% : 0.018,0.088) ] and diarrhea [ σ2v2 =0.099 (95% CI : 0.030,0.168) ] variations at community level but with a small correlation [ σ(1,2)v = 0.124 ] between them. There is also significant correlation between malaria and diarrhea at individual level [ r(1,2)e = 0.241]. These results suggest a close association between reported malaria-like illness and diarrheal illness especially at household and individual levels in Southern Malawi. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Grimason A.M.,University of Malawi | Grimason A.M.,Africa Academy for Environmental Health | Beattie T.K.,University of Strathclyde | Morse T.D.,University of Malawi | And 6 more authors.
Water SA | Year: 2013

This paper compares data gathered from a study of the chemical and bacteriological quality of drinking-water from 28 rural borehole supplies in Chikhwawa, Malawi, with a tiered classification scheme (Class 0 being ideal through to Class III being unsuitable for drinking without prior treatment) developed by investigators from the Institute for Water Quality Studies, Department of Water Affairs and Forestry, South Africa. In general, the majority of borehole water supplies were classified as Class 0 or Class I supplies based upon the chemical analysis and bacteriological examination. However the classification of a borehole water supply was variable and depended upon the parameter, date of sampling and whether or not it was based on the mean or individual concentration. A number of boreholes were classified as II or III as they contained elevated levels of fluoride and nitrate suggesting that consumption over short or prolonged periods of time may lead to adverse or serious health effects, such as skeletal fluorosis in adults and methaemoglobinaemia in infants. Research is required to develop practicable, affordable and sustainable methods to enable villagers to treat Class II/III water supplies and improve the quality of their drinking-water to a class suitable for human consumption.

Grimason A.M.,University of Malawi | Grimason A.M.,Africa Academy for Environmental Health | Morse T.D.,University of Malawi | Morse T.D.,University of Strathclyde | And 7 more authors.
Water SA | Year: 2013

This paper presents data on the physico-chemical quality of groundwater supplies in Chikhwawa, Malawi. Eighty-four water samples were collected and analysed for a range of chemical constituents (Al, As, Ca, Cd, Co, Cr, Cu, Fe, Hg, Mg, Mn, Ni, Pb, Se, V, Zn, K, Na,Cl-, F-, NO3 -, SO4 2-), pH, temperature, electrical conductivity and turbidity, from 28 boreholes located in 25 remote, rural villages (n=3 per village) distributed along the east (n=15) and west (n=10) banks of the Shire River. Samples were collected every 2 months during the wet season, over a period of 5 months (December to April). Results were compared with national (Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL)) and international (World Health Organization Guideline Values (WHO GV)) drinking-water standards. In general, most parameters complied with the Malawi Bureau of Standards Maximum Permissible Levels (MBS MPL) for borehole water supplies. The MBS MPL standards for iron, sodium and nitrate were slightly exceed at a few boreholes, technically rendering the water supply unwholesome but not necessarily unfit for human consumption. In contrast, significantly high nitrate (< 200 mg/ℓ) and fluoride (< 5 mg/ℓ) concentrations at levels which constitute a significant risk to the health of the consumer were detected in borehole samples in a number of villages and warrant further investigation. Water committee members complained of problems associated with taste (saltiness or bitterness) and appearance (discoloured water) primarily on the west bank, presumably as a result of the high sodium and chloride levels, and precipitation of soluble iron and manganese, respectively. This resulted in some water collectors reverting to the use of surface water sources to obtain drinking-water, a practice which should be dissuaded through the education of water and village health committees.

Masangwi S.J.,University of Strathclyde | Masangwi S.J.,University of Malawi | Ferguson N.S.,University of Strathclyde | Grimason A.M.,University of Strathclyde | And 7 more authors.
International Journal of Environmental Health Research | Year: 2010

This paper examines household and community-level influences on diarrhoeal prevalence in southern Malawi. A Bayesian multi-level modelling technique is used in the estimation of hierarchically built data from a survey of individuals nested within households nested within communities. Households have strong unobserved influence on diarrhoeal illness ([image omitted] =4.476; 95% CI: 2.081, 6.871). A joint Wald test of significance shows that an individual's age [[image omitted] ] and school [[image omitted] ] have strong influence on an individual's diarrhoeal prevalence. An individual's history of malarial-like illness also has a strong positive relationship with diarrhoeal prevalence [=0.606, p=0.000]. Household factors that influence diarrhoea include employment status of head of household [= -0.619, p0.021], maternal age [=-0.013, p0.003], and size of household [=-0.669, p=0.000]. The positive relationship between diarrhoea and malaria-like episodes highlights common risk factors hence the need for common approaches to combat the diseases. Significant household effects underline the importance of household considerations in policy issues.

Masangwi S.J.,University of Malawi | Masangwi S.J.,University of Strathclyde | Grimason A.M.,University of Malawi | Grimason A.M.,University of Strathclyde | And 7 more authors.
International Journal of Environmental Research and Public Health | Year: 2012

A survey was conducted in Southern Malawi to examine the pattern of mothers' knowledge on diarrhoea. Diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average at 17%. Using hierarchically built data from a survey, a multilevel threshold of change analysis was used to determine predictors of knowledge about diarrhoeal aetiology, clinical features, and prevention. The results show a strong hierarchical structured pattern in overall maternal knowledge revealing differences between communities. Responsible mothers with primary or secondary school education were more likely to give more correct answers on diarrhoea knowledge than those without any formal education. Responsible mothers from communities without a health surveillance assistant were less likely to give more correct answers. The results show that differences in diarrhoeal knowledge do exist between communities and demonstrate that basic formal education is important in responsible mother's understanding of diseases. The results also reveal the positive impact health surveillance assistants have in rural communities. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

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