Person:

Kalanga, Noel

The aim of our study was to explore and understand the factors that affect growth of low birth weight (LBW) infants in a rural district of Neno in Malawi in order to optimize their care. We surveyed 64 households of LBW infants born between April and June 2014. We collected quantitative data on socio-demographics and food security, and performed nutrition and development assessments of the LBW infants at six months of age. We also conducted qualitative in-depth interviews with a subset of 10 mothers of the LBW infants and with 3 nurses at postnatal clinics. We then merged the quantitative and qualitative datasets for a final interpretation. At six months of age, LBW infants were more likely to be underweight (mean weight-for-age Z-score -3.01±0.97) or stunted (mean height-for-age Z-score -2.45 ±1.34) than the WHO reference group. The majority (93.8%) of the households had moderate to severe food insecurity. Contributing factors to these poor outcomes included recurrent illness, resource scarcity and lack of social support. Most mothers opted for mixed feeding as a coping mechanism for the LBW infant’s slow growth; this mixed feeding without clean water and proper hygiene, could even worsen the health outcomes of these infants. Structural violence in poor households causes poor health outcomes of LBW infants. The responsibility of caring for LBW infants is so challenging because these children have so many unmet needs. Optimum care can be achieved with a variety of biosocial interventions.

HIV/AIDS remains the 2nd most common cause of death in low and middle-income countries (LMICs), and only 34% of eligible patients in LMICs received antiretroviral therapy (ART) in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program from August 1, 2006, when ART first became available, through December 31, 2013. We used GPS data to calculate patient-level distance to care, and examined number of annual ART visits and one-year lost to follow-up (LTFU) in HIV care. The number of ART patients in Neno increased from 48 to 4,194 over the decentralization period. Mean travel distance decreased from 7.3 km when ART was only available at the district hospital to 4.7 km when ART was decentralized to 12 primary health facilities. For patients who transferred from centralized care to nearer health facilities, mean travel distance decreased from 9.5 km to 4.7 km. Following a transfer, the proportion of patients achieving the clinic’s recommended ≥4 annual visits increased from 89% to 99%. In Cox proportional hazards regression, patients living ≥8 km from a health facility had a greater hazard of being LTFU compared to patients <8 km from a facility (adjusted HR: 2.0; 95% CI: 1.8—2.3). ART decentralization in Neno District was associated with increased ART enrollment, decreased travel distance, and increased retention in care. Increasing access to ART by reducing travel distance is one strategy to achieve the ART coverage and viral suppression objectives of the 90-90-90 UNAIDS targets in rural impoverished areas.