The findings do not support a hypothesis that provision of SQ-LNSs to women in pregnancy and postpartum and to children from 6 to 18 mo of age would promote child growth in this Malawian study area. This trial was registered at clinicaltrials.gov as NCT01239693.

BackgroundWhereas poor maternal nutritional status before and during pregnancy is widely associated with adverse birth outcomes, studies quantifying this association in low income countries are scarce. We examined whether maternal pre-pregnancy body mass index (BMI) and weight gain during pregnancy are associated with birth outcomes in rural Malawi.MethodsWe analyzed the associations between pre-pregnancy BMI and average weekly gestational weight gain (WWG) and birth outcomes [duration of gestation, birth weight, length-for-age z-score (LAZ), and head circumference-for-age z-score (HCZ)]. We also determined whether women with low or high pre-pregnancy BMI or women with inadequate or excessive WWG were at increased risk of adverse birth outcomes.ResultsThe analyses included 1287 women with a mean BMI of 21.8 kg/m2, of whom 5.9% were underweight (< 18.5 kg/m2), 10.9% were overweight (≥ 25 kg/m2), 71.8% had low WWG [below the lower limit of the Institute of Medicine (IOM) recommendation], and 5.2% had high WWG (above IOM recommendation). In adjusted models, pre-pregnancy BMI was not associated with duration of pregnancy (p = 0.926), but was positively associated with birth weight and HCZ (<0.001 and p = 0.003, respectively). WWG was positively associated with duration of gestation (p = 0.031), birth weight (p<0.001), LAZ (p<0.001), and HCZ (p<0.001). Compared to normal weight women, underweight women were at increased risk of having stunted infants (p = 0.029). Women with low WWG were at increased risk of having infants with low birth weight (p = 0.006) and small head circumference (p = 0.024) compared to those with normal weight gain. Those with high BMI or high WWG were not at increased risk of adverse birth outcomes.ConclusionsWWG is an important predictor of birth outcomes in rural Malawi. The high prevalence of inadequate WWG compared to low pre-pregnancy BMI highlights the need to investigate causes of inadequate weight gain in this region.

BackgroundThe number of preterm birth is increasing worldwide, especially in low income countries. Malawi has the highest incidence of preterm birth in the world, currently estimated at 18.1 percent. The aim of this study was to explore the perceived causes of preterm birth, care practices for preterm newborn babies and challenges associated with preterm birth among community members in Mangochi District, southern Malawi.MethodsWe conducted 14 focus group discussions with the following groups of participants: mothers (n = 4), fathers (n = 6) and grandmothers (n = 4) for 110 participants. We conducted 20 IDIs with mothers to preterm newborns (n = 10), TBAs (n = 6) and traditional healers (n = 4). A discussion guide was used to facilitate the focus group and in-depth interview sessions. Data collection took place between October 2012 and January 2013. We used content analysis to analyze data.ResultsParticipants mentioned a number of perceptions of preterm birth and these included young and old maternal age, heredity, sexual impurity and maternal illness during pregnancy. Provision of warmth was the most commonly reported component of care for preterm newborns. Participants reported several challenges to caring for preterm newborns such as lack of knowledge on how to provide care, poverty, and the high time burden of care leading to neglect of household, farming and business duties. Women had the main responsibility for caring for preterm newborns.ConclusionIn this community, the reported poor care practices for preterm newborns were associated with poverty and lack of knowledge of how to properly care for these babies at home. Action is needed to address the current care practices for preterm babies among the community members.

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The MoH requires that ART sites that have adopted the EMR system also continue to run paper-based systems to serve as backup in the eventuality of EMR system failures. EMR data are fi rst backed up on the server at the health facility where the system is running and at an off-site central server on a daily basis. Case registration and information on ART outcomes generated through printouts of master card data in the form of adhesive labels from the EMR are manually transcribed by clinic staff into the paper-based register. The ART supervision team observed that there were differences in the data that were transferred and reported using the paper-based system as compared to the EMR. As national reporting and drug forecasting depends on the EMR, inaccuracies in the paper-based system in case of EMR failure could have important programmatic implications, such as incorrect drug forecasting.Our objective was to assess the extent of inaccuracies in the transcription of case registration and recorded deaths between the EMR and the paper-based data system. METHODS Design, study setting and populationWe conducted a retrospective audit of routine programme data at fi ve ART sites in the central and southern regions of Malawi. These ART sites included three district hospitals (Dedza, Ntcheu and Salima), one mission hospital (St Gabriel's Mission Hospital) and one central hospital (Queen Elizabeth Central Hospital [QECH]). The district hospitals each have two nurses, a clinician and two clerks. They typically attend to more than 200 patients on a clinic day, and their ART registers currently have more than 3000 patients each. QECH has four nurses, three clinical offi cers and two clerks, who attend to more than 400 patients per day; their ART register has more than 10 000 patients. St Gabriel's Mission Hospital has three nurses, two clinicians and one clerk, who see more than 100 patients a day; their ART register includes more than 200 patients. These sites were chosen as they were among the fi rst sites to start ART in Malawi, had high case loads and were among the fi rst to implement the EMR. All these fi ve sites also run paper-based register systems.All patients enrolled in the ART programme up to 31 December 2010 at these fi ve ART sites were included in the study. A review of the paper registers was conducted at all fi ve health facilities between January and February 2011. Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor Setting: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi. Objective: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure. Design: Retrospective analysis of routine programme data.Results: A total of 31 763 registrations and 2...