This paper has two purposes: first of all, we examine grandmothers' role and views of child feeding practices in northern Malawi, and their influence on younger women's practices. Secondly, we consider the implications of these findings for health promotion activities and models of health education. Data were collected from semi-structured interviews, focus groups and a participatory workshop. Findings demonstrate that, to address child feeding practices which have an effect on nutrition, attention must be paid to the broader context that influences child nutrition, including extended family relations. Paternal grandmothers have a powerful and multifaceted role within the extended family in northern Malawi, both in terms of childcare and in other arenas such as agricultural practices and marital relations. Grandmothers often differ in their ideas about early child feeding from conventional Western medicine. Some practices have existed in the area at least since colonial times, and have strong cultural significance. Despite the important integrated role, older women have within households and communities in this part of Malawi, hospital personnel often have disparaging and paternalistic attitudes towards 'grannies' and their knowledge. Health education rarely involves grandmothers, and even if they are involved, their perspectives are not taken into consideration. Hospital staff often reject grandmother knowledge as part of a broader modernization paradigm which views 'traditional knowledge' as backward. Grandmothers view current child health conditions within a broader context of changing livelihood conditions and a high prevalence of HIV/ AIDS. The paper concludes by discussing the challenges of involving grandmothers in health education, and the difficulties of incorporating local knowledge into a medical system that largely rejects it.

Objective-To assess the continuity of care and outcome of pediatric HIV prevention, testing, and treatment services, focusing on early infant diagnosis with DNA PCR. Design-A retrospective observational cohort.Methods-Maternal HIV antibody, infant HIV DNA PCR test results, and outcome data from HIV-infected infants from the prevention of mother-to-child transmission, early infant diagnosis, and pediatric HIV treatment programs operating in Lilongwe, Malawi between 2004 and 2008 were collected, merged and analyzed.Results-Of the 14,669 pregnant women who tested HIV antibody positive, 7,875 infants (53.7%) received HIV DNA PCR testing. One thousand eighty-four infants (13.8%) were HIVinfected. 320 (29.5%) children enrolled into pediatric HIV care, with 202 (63.1%) at the Baylor Center of Excellence. Among these, antiretroviral therapy was initiated on 110 infants (54.5%) whose median age was 9.1 months (interquartile range, 5.4 to 13.8) and a median of 2.5 months (interquartile range, 1.4 to 9.2) after HIV clinic registration. Sixty-nine HIV-infected infants (34.2%) died or were lost by December 2008. Initiation of antiretroviral therapy increased the likelihood of survival seven-fold (odds ratio, 7.1; 95% confidence interval, 3.68 -13.70).

Legume species are uniquely suited to enhance soil productivity and provide nutrient-enriched grains and vegetables for limited-resource farmers. Yet substantial barriers to diversification with legumes exist, such as moderate yield potential and establishment costs, indicating the need for long-term engagement and farmer-centered research and extension. This review and in-depth analysis of a Malawian case study illustrates that farmer experimentation and adoption of legumes can be fostered among even the most resource-poor smallholders. Multi-educational activities and participatory research involving farmer research teams was carried out with 80 communities. Over five years more than 3000 farmers tested legumes and gained knowledge of legume contributions to child nutrition and soil productivity. The average area of expansion of legume systems was 862 m 2 in 2005; 772 m 2 for women and 956 m 2 for men indicating a gender dimension to legume adoption. Farmers chose edible legume intercrops such as pigeonpea and groundnut over the mucuna green manure system, particularly women farmers. Interestingly, expansion in area of doubled-up edible legumes (854 m 2 in 2005) was practiced by more farmers, but was a smaller area than that of mucuna green manure system (1429 m 2 ). An information gap was discovered around the biological consequences of legume residue management. Education on the soil benefits of improved residue management and participatory methods of knowledge sharing were associated with enhanced labour investment; 72 % of farmers reported burying legume residues in 2005 compared to 15 % in 2000. Households reported feeding significantly more edible legumes to their children compared with control households. Participatory research that incorporated nutritional education fostered discussions within households and communities, the foundation for sustained adoption of legume-diversified systems.

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The Soils, Food and Healthy Communities project in Malawi uses an interdisciplinary participatory approach to improving child nutrition with resource-poor farmers. The overall research question is: Can legume systems improve soil fertility, food security, and child nutrition? Over 2000 farmers are now experimenting with legume systems in the region. While this article examines the social issues that mitigate the potential success of legume options tested by the farmers, it does not aim at discussing extensively the complex web of interactions between soil fertility, food security, and nutritional status of children. Instead, its focus is on the research process, and more specifically on the social dimensions and participatory approaches, which influenced farmers' adoption of organic matter technologies and legume options. The Farmer Research Team was critical in mobilizing community interest in changing agricultural practices to improve child health, but faced challenges in village politics and workload. The linkage with child nutrition was a major reason for increased adoption of legumes, and gender relations played a key role in the adoption. A deeper understanding of the limits of participatory approaches helped to develop innovations that may be replicated elsewhere, such as inclusion of grandmothers and a farmer apprenticeship program.

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