How to engage farmers that have limited formal education is at the foundation of environmentally-sound and equitable agricultural development. Yet there are few examples of curricula that support the co-development of knowledge with farmers. While transdisciplinary and participatory techniques are considered key components of agroecology, how to do so is rarely specified and few materials are available, especially those relevant to smallholder farmers with limited formal education in Sub-Saharan Africa. The few training materials that exist provide appropriate methods, such as (...) compost making, but do not explain relationships and synergies between nutrition, social inequalities, climate change and agroecology. Some food sovereignty and agroecology courses aim at popular political education for those with more formal education. Here we describe the process of development of an innovative curriculum, which integrates agroecology, nutrition, climate change, gender and other dimensions of social equity across 2 weeks of training explicitly for smallholders in southern Africa with limited formal education. The curriculum is highly participatory; we use concepts in popular education, transformative and experiential-based learning, and theatre. It is also integrative; we link agroecology with climate change, human and soil nutrition, gender, and related components of social equity. Developed in partnership with Malawian farmers, community development experts and academics from five countries, the curriculum was piloted with 520 smallholder farming households in Malawi and Tanzania, and evaluated using qualitative techniques. Clashes of language, cultural norms, and terminology were as great of a challenge as agreeing on and conveying technical information, to weave into a coherent whole. However, farmers who participated in the curriculum training demonstrated high interest, comprehension of material and interest in immediate application to their lives. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative (...) data was used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

This research empirically investigated the CSR practices of 84 Botswana and Malawi organizations. The findings revealed that the extent and type of CSR practices in these countries did not significantly differ from that proposed by a U. S. model of CSR, nor did they significantly differ between Botswana and Malawi. There were, however, differences between the sampled organizations that clustered into a stakeholder perspective and traditional capitalist model groups. In the latter group, the board of directors, owners, and (...) shareholders were important stakeholders that appeared to be restricting extended stakeholder CSR activities in the Malawi and Botswana organizations. The sampled managers recognized the economic benefits of CSR practices and were not at odds with social objectives. (shrink)

This is a philosophical study by a group of scholars from Malawi on issues related to ethics. The author deals such issues as corruption/anti-corruption; political leadership and ethical transformation; economic ethics and free market; law and ethics; African traditional ethics--ubuntu; African work ethics, education and ethics; popular music and ethics; journalism ethics; technology and ethical implication; etc.

This paper investigates the impact of kin on child survival in a matrilineal society in Malawi. Women usually live in close proximity to their matrilineal kin in this agricultural community, allowing opportunities for helping behavior between matrilineal relatives. However, there is little evidence that matrilineal kin are beneficial to children. On the contrary, child mortality rates appear to be higher in the presence of maternal grandmothers and maternal aunts. These effects are modified by the sex of child and resource (...) ownership: female children and children in households where women, rather than men, own land suffer higher mortality rates in the presence of maternal kin. These modifiers suggest the detrimental effects of matrilineal kin may result from competition between such kin for resources. There are some positive effects of kin on child survival: the presence of elder siblings of both sexes is correlated with higher survival rates, and there is some weak evidence that paternal grandmothers may be beneficial to a child’s survival chances. There is little evidence that any male kin, whether matrilineal or patrilineal, and including fathers, affect child mortality rates. This study highlights the importance of taking social and ecological context into account when investigating relationships between kin. (shrink)

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy (...) will assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

BackgroundHuman infection studies (HIS) are valuable in vaccine development. Deliberate infection, however, creates challenging questions, particularly in low and middle-income countries (LMICs) where HIS are new and ethical challenges may be heightened. Consultation with stakeholders is needed to support contextually appropriate and acceptable study design. We examined stakeholder perceptions about the acceptability and ethics of HIS in Malawi, to inform decisions about planned pneumococcal challenge research and wider understanding of HIS ethics in LMICs.MethodsWe conducted 6 deliberative focus groups and (...) 15 follow-up interviews with research staff, medical students, and community representatives from rural and urban Blantyre. We also conducted 5 key informant interviews with clinicians, ethics committee members, and district health government officials.ResultsStakeholders perceived HIS research to have potential population health benefits, but they also had concerns, particularly related to the safety of volunteers and negative community reactions. Acceptability depended on a range of conditions related to procedures for voluntary and informed consent, inclusion criteria, medical care or support, compensation, regulation, and robust community engagement. These conditions largely mirror those in existing guidelines for HIS and biomedical research in LMICs. Stakeholder perceptions pointed to potential tensions, for example, balancing equity, safety, and relevance in inclusion criteria.ConclusionsOur findings suggest HIS research could be acceptable in Malawi, provided certain conditions are in place. Ongoing assessment of participant experiences and stakeholder perceptions will be required to strengthen HIS research during development and roll-out. (shrink)

Since 2016, drones have been deployed in various development projects in sub-Saharan Africa, where trials, tests, and studies have been rolled out in countries, including Tanzania, Uganda, Rwanda, Malawi, Ghana, and the Democratic Republic of the Congo. The use cases of drones vary, ranging from imagery collection to transportation of vaccines, lab samples, blood products, and other medical supplies. A wide range of stakeholders is involved, including governments, international organizations, educational institutions, as well as industry. Based on a field (...) study conducted in 2019, this article investigates how drones are used for medical supply delivery in Malawi-a country where the community is underserved for healthcare and related infrastructure underdeveloped, while airspace is largely open and regulations generally relaxed. The objective of presenting this case study is to contribute to the evidence regarding the rapid deployment of medical cargo drones across the African continent, and to spark critical reflections over the utility, suitability, and impacts of incorporating drones in the existing health supply chain systems in resource-poor settings. The discussion revolves around two aspects: 1) the emergent “African Drone Rise”-is it ok “as it is Africa”? and 2) the normative role of technology in the aid sector-is it “a solution looking for a problem”? In conclusion, a call for more structured guidance for the systematic examination and evaluation of the medical cargo drone case is raised. (shrink)

ObjectiveInformed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent.MethodsQualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus (...) group discussion were used to collect data. Participants were 22 clinical officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework.ResultsDefinition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions.ConclusionsHealth workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process. (shrink)

This study was aimed at examining the impacts of the Sharing economy on the individual and community Quality of Life and wellbeing by looking at their associated influencing factors using Village Savings and Loans Associations as a model of sharing economy in Malawi. An online community-based cross-sectional study design was conducted from November 2020 through January 2021. In the survey, 402 Village Savings and Loans Associations members from the Mzuzu City area participated, recruited using snowball and respondent-driven sampling techniques. (...) The sample size was computed using a single population proportion using the Yamane formula. Descriptive statistics and ordinal logistic regression model techniques were also employed. Additionally, we used the Chi-Square test, two-way ANOVA, and Ordinal regression model to determine statistical associations between socioeconomic data and QOL and wellbeing variables with a 5% level of significance. On the aspect of community wellbeing, the findings of our study indicated that income provided members with options to live a better QOL and wellbeing within the community by either facilitating payment for better education, eating healthier foods, acquiring assets, etc. Further, the absence of discrimination provided a platform for voice, inclusion, and social trust, enhancing freedom of expression. We also found that education facilitated better earnings and knowledge of public health-related issues. As for the contribution to the sharing economy, our study has emphasized the role played by trust in enhancing sharing economy. We recommend and encourage people to join these VSLAs so as to improve their QOL and wellbeing. However, there is a need to replicate the study on a larger scale to validate our study findings for effective policy formulation and implementation geared to improving the overall quality of people’s lives. Based on these findings, we further recommend that authorities reinstate programs like National Strategy for Financial Inclusion 2016–2020 and Savings and Loan Groups Best Practice Guidelines 2016–2017 that could further enhance the future of VSLAs, which are vital for QOL and community wellbeing of the people in developing countries like Malawi. (shrink)

Based on interviews with climate-change activists and NGO workers in Finland and Malawi, this article reconsiders the ways in which the coordination of identity projects and action is approached in social movement scholarship. Rather than beginning with personal and collective identities, we take our cue from recent work by Laurent Thévenot and trace actors’ forms of engagement—the various ways actors produce commonality. As we show, doing so in vastly different social contexts allows us to see permutations in such forms (...) afforded by participation in a transnational social movement and to identify patterns of collective action that we would otherwise be apt to miss. Finnish activists narrated their activities by way of engaging in the forms of the common good driving the climate movement, but coordinated various situations also through engagement in familiarity, comfort, and ease. Malawian activists and NGO employees also spoke of the common good the movements worked to achieve, but principally created common ground by engaging in shared individual choices and projects, which were jointly consecrated by fellow NGO participants. Ultimately, we argue that tracing forms of engagement enables more in-depth understanding of what is at stake when people act together in social movement organizations: moving away from collective and personal identity to patterns of engagement allows a vantage point into the processes through which commonality is created and generates new hypotheses regarding the coordination of action in social movement organizations. (shrink)

This study focuses on the relationship between politics and hunger and the national political discourse on food security in Malawi. Our aim is to better understand the role of local and national actors in pursuing policies that aim to achieve the 2030 Agenda and the Sustainable Development Goals (SDGs). The empirical focus is on the Farm Input Subsidy Program (FISP), introduced by the Malawian government in 2005–2006, which supports smallholder farmers to better access to agricultural inputs. We provide an (...) overview of the food security discourse and highlight the importance of political commitment for policy coherence that is required for achieving the SDGs. Thereafter, we introduce the policymaking scene in Malawi and FISP before critically examining the policy narratives on food security in the country. Our goal is to examine why some issues are effectively dealt with and not others. We argue that food security policies in Malawi are influenced by the political incentives they provide for electoral campaigns and for securing a regular flow of financial resources in agriculture projects that are highly dependent on foreign aid. (shrink)

The central argument of this article is that kufa kwa jongololo nkhusiya mphete, a concept that is used to encourage procreation amongst the Sena people of Nsanje District in Malawi, is a dehumanising concept for the barren men and women, in the context of HIV and AIDS and gender justice, where men and women need concepts that affirm life in all its fullness. The study uses feminist cultural hermeneutics as a tool to analyse dehumanising cultural practices, through the examination (...) of three Sena cultural practices.Contribution: The study also questions the methodology used to engage indigenous knowledge, a methodology that denies traditional communities the right to maintain secrecy on some treasured indigenous practices. At the same time, the article argues that no protection should be afforded to indigenous practices that dehumanise the lives of people on the margins of power. (shrink)

The fall of the Berlin Wall in October 1989 bears a striking resonance with the biblical fracturing of the curtain in the Jerusalem temple. It presaged the death of the post-war dispensation of Church-state relations characterised by a Church that was, in the main, subservient, acquiescent and complicit to the apartheid regime in South Africa, as well as the oppressive one-party state regimes north of the Limpopo. As the Berlin Wall collapsed, the dispensation characterised by either neutrality or docility and (...) co-option of the Church to the Apartheid and Independent states gave way to the birth of a 'prophetic' Church, which would not only gain a new lease on life, but would become a robust interlocutor of the post-Cold War state. The latter is exemplified by historical signposts such as the Rustenburg Declaration, the Pastoral letter of the Zambia Catholic Bishops Conference and the Pastoral letter by the Catholic Bishops of Malawi, among others. This paper is an analytical desktop study, which will be based on the published literature. (shrink)

BackgroundCurrent advances in biomedical research have introduced new ethical challenges in obtaining informed consent in low and middle-income settings. For example, there are controversies about the use of broad consent in the collection of biological samples for use in future biomedical research. However, few studies have explored preferred informed consent models for future use of biological samples in Malawi and South Africa. Therefore, we conducted an empirical study to understand preferred consent models among key stakeholders in biomedical studies that (...) involve collection of biological samples in Malawi and South Africa. The main objective of the study was to explore views of key stakeholders on current policies on informed consent in Malawi and South Africa. MethodsThis was a qualitative study involving in-depth interviews and focus group discussions. Thirty-four in-depth interviews and 6 focus group discussions were conducted with REC members, Funders, Policymakers, CAB members and Research Participants in Malawi and South Africa to gather their views on models of informed consent. The study was conducted in Cape Town, South Africa, and Blantyre and Lilongwe in Malawi.ResultsMost key stakeholders preferred broad consent and tiered consent to specific consent. Some participants expressed a strong preference for specific consent to other models of informed consent in biomedical research. Few participants did not have any preference for a consent model, opting for any consent model which provides adequate information about the proposed research and what their national consent regulations require. Finally, very few participants preferred blanket consent to other informed consent models.ConclusionsThis study aimed to help fill the gap in the scientific literature on key stakeholder views on consent models for future use of biological samples in Malawi and South Africa. The findings of the study have provided some evidence that may support policies on permissible consent models for future use of biological samples in sub-Saharan Africa considering the differences in informed consent regulations and guidelines. Finally, the findings can inform ongoing discussions on permissible consent models to be used for future use of biological samples. (shrink)

Background Caring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them. Research design and methods An exploratory-descriptive qualitative design was used within a larger Action Research Study. (...) Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis. Participants and research context The study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled. Ethical considerations Ethical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study. Findings The findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication. Conclusion The findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns. (shrink)

BackgroundThis paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi.DiscussionThe current research ethics regulations and guidelines in Malawi (...) do not allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes.SummaryIn conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi. (shrink)

Narratives of discrimination due to gender differentiations, educational background, cultural systems and/or political alignments are not new phenomena in human history. The concepts themselves are as old as the applications within the systems. In order to grasp the cruciality of the tendency, this article discusses the realities of discrimination among the people of northern Malawi using the Dalit experiences in India. Its emphasis is on how the Northerners of Malawi are politically and socio-economically sidelined in the entire system (...) of governance. The article draws the conclusion that theology can in some ways help to minimize the situation when tolerance and accommodation in God’s design can be put into practice in order to promote harmony and togetherness. If this can be enhanced, the ignored North can feel part of Malawi and by doing so, they can reconstruct their lost humanity and dignity. (shrink)

How to engage farmers that have limited formal education is at the foundation of environmentally-sound and equitable agricultural development. Yet there are few examples of curricula that support the co-development of knowledge with farmers. While transdisciplinary and participatory techniques are considered key components of agroecology, how to do so is rarely specified and few materials are available, especially those relevant to smallholder farmers with limited formal education in Sub-Saharan Africa. The few training materials that exist provide appropriate methods, such as (...) compost making, but do not explain relationships and synergies between nutrition, social inequalities, climate change and agroecology. Some food sovereignty and agroecology courses aim at popular political education for those with more formal education. Here we describe the process of development of an innovative curriculum, which integrates agroecology, nutrition, climate change, gender and other dimensions of social equity across 2 weeks of training explicitly for smallholders in southern Africa with limited formal education. The curriculum is highly participatory; we use concepts in popular education, transformative and experiential-based learning, and theatre. It is also integrative; we link agroecology with climate change, human and soil nutrition, gender, and related components of social equity. Developed in partnership with Malawian farmers, community development experts and academics from five countries, the curriculum was piloted with 520 smallholder farming households in Malawi and Tanzania, and evaluated using qualitative techniques. Clashes of language, cultural norms, and terminology were as great of a challenge as agreeing on and conveying technical information, to weave into a coherent whole. However, farmers who participated in the curriculum training demonstrated high interest, comprehension of material and interest in immediate application to their lives. (shrink)

Ethical problems are addressed in various ways within countries in planning for and response to pandemic influenza. Here we report on a qualitative study, in which 46 policymakers in Malawi and Ghana were interviewed on how they identified and resolved ethical problems. The study results revealed that ethical problems involving conflicts of values and choices were raised in reference to the extent and role of resources and nature of public health interventions, including the extent and processes of decision making, (...) reasoning, and justification. There is a need for an ethical framework within pandemic preparedness plans to resolve and avert these problems. (shrink)

BackgroundThere have been notable investments in large multi-partner research programmes across the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and commonly require research ethics review. These ANH studies are complex and can raise ethical issues that need pre-field work, ethical oversight and also need an embedded process that can identify, characterise and manage ethical issues as the research work develops, as such more embedded and dynamic ethics processes are needed. This work builds on notions of ‘ethics in practice’ (...) by developing an approach to facilitate ethical reflection within large research programmes. This study explores the application of a novel ‘real-time research ethics approach’ (RTREA) and how this can support ethical mindfulness. This involves embedding ethical analysis and decision-making within research implementation, with a continuous dialogue between participants and researchers. The aim is to improve ethical responsiveness and participant experience, which in turn may ethically support adherence and retention. In this case study, a bioethics team (BT) was embedded in a community-based randomised, controlled trial conducted in rural Malawi, titled the ‘Addressing Hidden Hunger with Agronomy’. To identify ethical issues, the researchers conducted ten focus group discussions, fourteen in-depth interviews with key informants, two workshops, observed two sensitisation and three activity meetings conducted by the trial team, and analysed fifteen reports from pre-trial to trial implementation.ResultsThe RTREA facilitated the identification of social and ethical concerns and made researchers aware of participants’ ‘lived research experience’. To address concerns and experiences, the BT worked with researchers to facilitate conversation spaces where social and ethical issues were discussed. Conversation spaces were designed to create partnerships and promote participatory methods to capture trial participants’ (TPs) perspectives and experiences.ConclusionsThe use of RTREA showed the value of real-time and continuous engagement between TPs and researchers. These real-time processes could be embedded to complement traditional ethical guidance and expert opinions. A deeper engagement appeared to support greater operationalising of principles of inclusion, empowerment, and participant autonomy and supported researchers ‘ethical mindfulness’ which in turn may support instrumental outcomes of high recruitment, retention, and adherence levels. (shrink)

This article is autoethnographic, based upon the authors’ experiences and reflections upon encountered moments of ethical tension whilst conducting research in rural Malawi. Given that knowledge production, as a process, has been marred by colonial forms of power, the project was underpinned by efforts to achieve a decolonial approach to the research, including the research ethics. The authors share of their endeavours to counterbalance the challenges of power asymmetries whilst researching and working with an Indigenous community whose reality can (...) be marginalised by the Western canon. The authors attempted to ensure that the values and customs of the researched community were respected and central to the research approach. When researchers are guided by local culture and customs, the participants are able to drive the research approach, incorporate their voice and share knowledge that is true to their context and reality. In this way, the research study is illustrative of how an ethics of care can help to facilitate decolonial research practice. (shrink)

ABSTRACTBuilding trust between researchers and communities involved in research is one goal of community engagement. This paper examines the implications of community engagement for trust within communities, including trust among community volunteers who assist with research and between these volunteers and other community members. We describe the experiences of two groups of community volunteers recruited as part of an HIV and TB intervention trial in Malawi: cluster representatives, recruited both to act as key informants for TB suspects and mortality (...) reporting and to identify and report community concerns, and community counsellors, recruited to provide semi-supervised HIV self-testing. We examine tensions experienced due to playing multiple roles, and the implications of volunteer responsibilities for short- and long-term community relationships. Data was collected through a workshop, in-depth interviews and focus group discussions with volunteers and community members. While the volunteer system init... (shrink)

Though a recent phenomenon, land grabs have generated considerable debate that remains highly polarized. In this debate, one view presents land deals as a path to sustainable and transformative rural development through capital accumulation, infrastructural development, technology transfer, and job creation while the alternative view sees land grabs as a new wave of neo-colonization, exploitation, and domination. The underlying argument, at least theoretically, is that international land deals unlock the much needed capital to accelerate the achievement of sustainable and transformative (...) rural development in developing countries. It is against this backdrop that this paper examines the contribution of large scale land deals in Malawi to rural development by employing the political economy perspective using the Limphasa Sugar Corporation as a case study with particular focus on the nature and interest of the actors involved; the legal framework supporting large scale land deals; major individual and community benefits; and the extent to which these large land deals can indeed bring about sustainable and transformative rural development. The findings of this article demonstrate that large scale land deals present short term benefits to local communities such as capital for rural development; technology transfer and job creation in exchange for the priceless economic and social capital that local people depend upon; destruction of local social systems; deepening of local communities’ vulnerability to economic shocks; and the entrenchment of community dependence that may in the long run result in social and political unrest. (shrink)

Southern African countries have the highest HIV infection rates in the world. In most of the countries in the region, the rate among adults is at least 10%. The fight against HIV/AIDS has mostly been inadequate owing to the lack of proper consideration of ethical and cultural issues. In this article, the authors discuss the ethical and cultural dilemmas concerning HIV/AIDS, with Malawi as a case in point. It is argued that increasing financial resources alone, as exemplified by the (...) Global Fund to Fight AIDS, Tuberculosis and Malaria initiative, without proper attention to ethical issues, morals and appropriate legal obligations, are unlikely to reduce the spread of HIV in southern Africa. (shrink)

Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent processes. Malawi does not yet have detailed (...) guidelines on assent. Understanding perspectives among children and their parents can assist in developing contextually-appropriate assent guidance. Qualitative research was conducted with children and parents in three settings in Southern Malawi, to take account of any variations between socioeconomic and cultural contexts. In each setting, interviews were conducted with parents and their children who had participated in paediatric research to understand their experiences of assent and views on appropriate assent practice. Focus groups were also conducted with children and parents, to understand broader social perspectives. We found widespread support for involving children in decisions on research participation. Participants identified a range of factors that affect children’s capacity to give assent, including intellectual capacity, emotional development, life experience and cultural norms. Age was often mentioned as a consideration, but deemed an unreliable sole indicator of capacity to assent. In relation to appropriate assent processes, participants emphasised considerations such as supporting effective understanding and minimizing harms. Views on how to achieve these aims varied; for example, there were different ideas about the appropriate order in which to approach children and parents, and about whose decision to respect in the event of disagreement. Parents and children agreed about the value of involving children in decisions on research, and about the need to promote children’s decision-making capacity while respecting parents’ interests in children’s welfare. Developing practical guidance that meets these principles is challenging, particularly given the need for flexible approaches that suit different study types, children’s capacities and family environments. Further discussion within the Malawi research and ethics community will help develop contextually-appropriate guidelines. (shrink)

Legal professionals in Malawi rely on a limited number of textbooks, outdated law reports and inadequate library services. Most documents available are in image form, are un-structured, i.e. contain no useful legal meta-data, summaries, keynotes, and do not support a system of citation that is essential to legal research. While advances in document processing and machine learning have benefited many fields, legal research is still only marginally affected. In this interdisciplinary research, the authors build semi-automatic tools for creating a (...) corpus of Malawi criminal law decisions annotated with legal meta-data, case and law citations. We used this corpus to extract legal meta-data, including law and case citations as used in Malawi by employing machine learning tools, spaCy and Gensim LDA. We set the foundation for a new methodology for classifying Malawi criminal case law according to the recently introduced International Classification of Crime for Statistical Purposes (ICCS). (shrink)

Community engagement to protect and empower participating individuals and communities is an ethical requirement in research. There is however limited evidence on effectiveness or relevance of some of the approaches used to improve ethical practice. We conducted a study to understand the rationale, relevance and benefits of community engagement in health research. This paper draws from this wider study and focuses on factors that shaped Community Advisory Group members’ selection processes and functions in Malawi. A qualitative research design was (...) used; two participatory workshops were conducted with CAG members to understand their roles in research. Workshop findings were triangulated with insights from ethnographic field notes, key informant interviews with stakeholders, focus group discussions with community members and document reviews. Data were coded manually and thematic content analysis was used to identify main issues. Results have shown that democratic selection of CAG members presented challenges in both urban and rural settings. We also noted that CAG members perceived their role as a form of employment which potentially led to ineffective representation of community interests. We conclude that democratic voting is not enough to ensure effective representation of community's interests of ethical relevance. CAG members’ abilities to understand research ethics, identify potential harms to community and communicate feedback to researchers is critical to optimise engagement of lay community and avoid tokenistic engagement. (shrink)

This paper advances critical Fair Trade literature by exploring reasons for and lessons from uneven and unequal lived experiences of Fairtrade certification. Fieldwork was conducted in 2007 and 2008 to explore views and develop interpretations from various actors directly and indirectly participating in a Fairtrade certified sugar organization in Malawi. By exploring an embedded social and political context in a production place, and challenging assumptions and expectations of a Fair Trade community empowerment approach, research reveals intended and unintended consequences (...) since certification. Findings propose lessons to adopt more nuanced understandings of place and context in Fair Trade approaches to facilitate more balanced community empowerment outcomes. (shrink)

This article identifies the dominant public narrative of AIDS in Malawi through an analysis of qualitative interview data and policy and intervention materials. The public narrative creates distinctions between “risky” and “healthy” sex that organize HIV prevention efforts around moral categories, rather than relative risk. These distinctions oppose images of backward, ignorant villagers to the protective power of “love matches”. The analysis demonstrates that the public narrative and corresponding prevention efforts only make sense in connection with the patently false (...) assumption that love, heterosexuality, and modernity effectively protect individuals from HIV. This research brings to light the unspoken assumptions of modernity in the “charmed circle” of heteronormativity, as well as the need to consider the workings of heteronormativity in studies of modernization and globalization. Furthermore, it highlights individualistic and oversimplified analytic models currently directing HIV prevention efforts and points to potentially more effective strategies. (shrink)

BackgroundMedical researchers in resource-constrained settings must make difficult moral decisions about the provision of ancillary care to participants where additional healthcare needs fall outside the scope of the research and are not provided for by the local healthcare system. We examined research stakeholder perceptions and experiences of ancillary care in biomedical research projects in Malawi. MethodsWe conducted 45 qualitative in-depth interviews with key research stakeholders: researchers, health officials, research ethics committee members, research participants and grants officers from international research (...) funding organisations. Thematic analysis was used to analyse and interpret the findings. FindingsAll stakeholders perceived the provision of ancillary care to have potential health benefits to study participants in biomedical research. However, they also had concerns, particularly related to the absence of guidance to support it. Some suggested that consideration for ancillary care provision could be possible on a case-by-case basis but that most of the support from research projects should be directed towards strengthening the public health system, emphasising public good above individual or personal benefits. Some researchers and ethics committee members raised concerns about potential tensions in terms of funding, for example balancing study demands with addressing participants’ additional health needs.ConclusionOur findings highlight the complexities and gaps in the guidance around the provision of ancillary care in Malawi and other resource-constrained settings more generally. To promote the provision of ancillary care, we recommend that national and international guidelines for research ethics include specific recommendations for resource-constrained settings and specific types of research. (shrink)

The Malabo Declaration places the transformation of agriculture and food systems at the centre of regional and national policy priorities across Africa. Transformative change in the way that food is produced, processed and consumed is seen as not only necessary for addressing the complex challenges of food security and poverty alleviation, but also as a driver of new employment opportunities and economic development. As pointed out within the recent UN Food Systems Summit, essential elements of food system transformations include digital (...) transitions and the empowerment of women and youth. However, there are few empirical examples demonstrating how these agendas come together to affect food system change. Here we focus on an enterprising group of young farmers referred to as Malawi’s new achikumbe elite, who are urban based, educated and engaging in agriculture on a commercial basis. The aim is to characterise this emergent group of agriculturalists and to understand the role that they have within the transformation of Malawi-s agricultural sector. We explore how digital platforms are supporting the emergence of this new category of farmer and positioning young people as agents of change in food systems transformation. Based on interviews and ethnographic research with 32 young farmers between 2018 and 2022 combined with interviews with representatives of service providers and agricultural organisations, we argue that this group is characterised by a higher level of education, self-dependency and use of digital platforms, enabling them to adapt their context to sourcing production resources and engaging in commercial agriculture. We present evidence that digital platforms are supporting the new achikumbe elite (NAE) to engage flexibly with new commercial markets, contracts and access a wider range of training and advice. However, while digital platforms can offer more equitable access to information and market opportunities, they also represent potential avenues for food system transformations that are inequitable. As such, we argue that there is need for digital technologies to mitigate against potential inequalities. (shrink)

Background Research ethics is intertwined with and depends on building robust and responsive research governance systems alongside researchers. Globally there has been substantial investment in agriculture, nutrition, and health (ANH) research motivated by the need to improve health outcomes, such as micronutrient deficiencies in Sub-Saharan Africa. Although there has been a notable focus on ethical issues inherent in ANH studies, there has been scanty research examining researchers’ attitudes related to ANH research. This study was conducted to explore the perspectives of (...) researchers who conducted an agronomic biofortification study in Malawi. Methodology In-depth interviews were conducted with a purposive sample of ten ANH researchers. Interviews were conducted online via Zoom, audio-recorded, transcribed verbatim, and thematically analysed using the Leadership, Ethics, Governance and Systems Framework. Results Four core aspects emerged: Leadership: The relevance of building ethics leadership and ethical competence among researchers. Ethics: There is a need to develop a framework that operationalises core ethical values that can guide the implementation of ANH research. Governance: Research guidelines were perceived to be too generic to guide ANH research. Systems: Researchers’ recommended the establishment of a specialised ANH research ethics committee. Conclusions The findings highlight the significance of building ethics leadership and supporting ethical competency amongst researchers. Researchers recommended the development of tailored approaches rather than utilising generic governance systems and frameworks that are drawn from medical research and thus not fit for purpose in this field. In Malawi, specialised ethics review committees are needed to guide ANH research. (shrink)

African women farmers have an urgent need for adequate agricultural extension information. Training extension agents in gender related issues should have high priority, considering that the majority of farmers are women and have different roles, resources, constraints, and responsibilities from men. This paper examines the extent to which these issues are incorporated into the curriculum of the two Malawian institutions of agricultural education that train extensionists. It also considers the degree to which they are recruiting women officers into fields other (...) than home economics. Administrators and lecturers at both institutions express a desire to integrate gender matters into the curriculum and to recruit more females into agricultural extension; yet both fall far short in meeting these goals. The conclusion provides recommendations on how African institutions of higher learning that train extension personnel might better accomplish these goals and suggests that African MOAs need to employ more women in agricultural research, extension, training, and policy-making positions. (shrink)

I investigate the African philosophical foundations of a pneumatological controversy inside the Church of Central African Presbyterian in Malawi. While apparently the conflict consists in difficulties in embracing both the New Pentecostal Theology and the Reformed Calvinist Theology within CCAP, it is rooted in the philosophical conflict between communitarianism and individualism. CCAP fully embraced the African communitarian philosophy mixed with Christian communism as its essence, while adherents of NPT followed individualism. Consequently, this affected the interpretation of the fundamental doctrines (...) such as sola scriptura, sola grazia, and other practices. I suggest a philosophical solution constituting in rebuilding African identity and a theological solution in promoting a new pneumatology based on the concept of enculturation. Keywords: Pneumatology, Communitarianism, Individualism, African philosophy, inculturation. (shrink)

BackgroundThe participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of high-quality research. When participants make a fair, informed, and voluntary decision to enroll in a study, they agree to fulfill their roles. However, supporting study participants to fulfill study requirements is (...) an important ethical obligation for researchers, yet evidenced as challenging to achieve. This paper reports on participants’ motivations to volunteer and remain part of a dietary study conducted in Kasungu District, Malawi.MethodsWe conducted twenty in-depth interviews (with chiefs, religious leaders, trial participants, and health surveillance assistants), five systematic ethnographic observations, and fourteen focus group discussions with trial participants and their partners. Interviews were audio-recorded and transcribed verbatim. We used a grounded theory methodology to analyse data that included coding, detailed memo writing, and data interpretation.FindingsThe findings reveal that many participants had concerns during the trial. Thematically, experiences included anxieties, mistrust of researchers, rumours, fears of exploitation, and misconceptions. Anonymous concerns collected from the participants were reported to the trial team which enabled the researchers to appropriately support participants. Despite initial concerns, participants described being supported and expressed motivation to take up their role.ConclusionThese findings highlight a diverse map of multiple notions of what is ethically relevant and what can impact participation and retention within a study. The study has revealed how embedding a responsive approach to address participants’ concerns and ethical issues can support trust relationships. We argue for the need to employ embedded ethics strategies that enhance informed consent, focus on participants’ needs and positive experiences, and support researchers to fulfill their roles. This work highlights the need for research ethics committees to focus on the risks of undue influence and prevent exploitation especially in settings with a high asymmetry in resources and power between researcher and participant groups.Trial Registration: The Addressing Hidden Hunger with Agronomy (Malawi) trial was registered on 5th March 2019 (ISCRTN85899451). (shrink)

The recent surge in land-based investments in the global South has been seen as both an opportunity for rural economic development and as a trend that poses significant social and environmental risks. This study sheds light on this debate through a look at the tobacco industry in Malawi. We employ a case study approach to investigate how rights, property, and authority associated with land and forest resources have shifted in the context of expanded investments in tobacco, and the stakes (...) for both local land users and citizens. Findings point to the need to broaden the metric of risks and trade-offs associated with large-scale land acquisitions, and to engage in a deeper reading of how these are borne out throughout history. (shrink)

BackgroundThere is growing interest in the collection, storage and reuse of biological samples for future research. Storage and future use of biological samples raise ethical concerns and questions about approaches that safeguard the interests of participants. The situation is further complicated in Africa where there is a general lack of governing ethical frameworks that could guide the research community on appropriate approaches for sample storage and use. Furthermore, there is limited empirical data to guide development of such frameworks. A qualitative (...) study to address this gap was conducted with key stakeholders in Malawi to understand their experiences and perspectives regarding storage and usage of samples for future research.MethodsThis study conducted 13 in-depth interviews with ethics committee members, regulators and researchers, and five focus group discussions with community representatives and clinical trial participants in Malawi. Interviews and focus group discussions were audio-recorded, transcribed verbatim, and thematically analysed.ResultsOn the current regulatory guidelines that governs the collection, storage and reuse of samples in Malawi, participants highlighted their different understanding of it, with some indicating that it prohibited the reuse and sharing of samples, while others believed it permitted.Views on the informed consent model used in Malawi, some stakeholders expressed that the current model limited options for sample contributors regarding future use. Researchers supported storing samples for future use in order to maximize their value and reduce research costs. However, they expressed concern over the exportation of samples highlighting that it could lead to misuse and would not support the development of research capacity within Malawi. They recommended use of broad consent or tiered consent and establishment of biobanks to address these concerns.ConclusionsStudy findings highlighted the need for a review of the current regulatory guideline and the development of infrastructure to support the use of stored biological samples for future use among the research community in Malawi. At the moment, there are ethical and practical concerns arising from the collection, storage and secondary use of biological samples make it hard to reconcile scientific progress and the protection of participants. (shrink)

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is to analyse a prototypical cluster trial conducted (...) in a low-resource setting with the Ottawa Statement; to identify ethical issues in the design or conduct of the trial not captured adequately and to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; the classification of lay health workers who deliver study interventions as health providers or research participants; the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; the timing of gatekeeper engagement, particularly when researchers face funding constraints; providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and defining vulnerable participants needing protection in low-resource settings. (shrink)

Background The intervention reported in this paper was a follow up to an empirical study conducted in Malawi with the aim of assessing trial participants’ understanding of randomisation, double-blinding and placebo use. In the empirical study, the majority of respondents (61.1%; n= 124) obtained low scores (lower than 75%) on understanding of all three concepts under study. Based on these findings, an intervention based on a narrative which included all three concepts and their personal implications was designed. The narrative (...) used daily examples from the field of Agriculture because Malawi has an agro-based economy. Methods The intervention was tested using a sample of 36 women who had been identified as low scorers during the empirical study. The 36 low scorers were randomly assigned to control (n=18) and intervention arms ( n =18). The control arm went through a session in which they were provided with standard informed consent information for the microbicide trial. The intervention arm went through a session in which they were provided with a narrative in ChiChewa, the local language, with the assistance of a power point presentation which included pictures as well as discussions on justification and personal implications of the concepts under study. Results The findings on the efficacy of the intervention suggest that the 3 scientific concepts and their personal implications can be understood by low literacy populations using simple language and everyday local examples. The findings also suggest that the intervention positively impacted on understanding of trial procedures under study, as 13 of the 18 women in the intervention arm, obtained high scores (above 75%) during the post intervention assessment and none of the 18 in the control arm obtained a high score. Using Fischer’s exact test, it was confirmed that the effect of the intervention on understanding of the three procedures was statistically significant (p=0.0001). Conclusions Potential trial participants can be assisted to understand key clinical trial procedures, their justification and personal implications by using innovative tailored local narratives. (shrink)

There is currently a global shortage of nurses. Developing countries such as Malawi are among those hardest hit by this shortage. The demands on available nurses have increased and at the same time there is a lack of interest in becoming a nurse owing to the poor working conditions among those still employed in the service. It is questionable if developed nations should recruit nurses from countries such as Malawi, where severe human resource constraints are being experienced. We (...) argue in this article that the current phenomenon of nurses leaving developing nations for western countries is complex. Human rights issues of individual autonomy and public interest are at stake. (shrink)