Background Low birth weight continues to be a main cause of child morbidity and mortality. Low birth weight can cause complications in adult life, and is therefore a public health concern. In this study, we determined the maternal factors that contribute to low birth weight (LBW) deliveries in Tshwane District, South Africa. Methods We conducted a case control study of 1073 randomly selected mothers who delivered babies in four hospitals in the district. We reviewed antenatal and maternity registers to obtain information about the mothers and their offspring. We fitted a multiple logistic regression to examine relationships between possible factors associated with LBW. Results From the total sample of mothers (n = 1073), 77% (n = 824) were adult women, aged 20 to 35 years. Of the adult mothers, 38.54% (n = 412) delivered low birth weight (LBW) infants. The mean gestational age and weight of all infants at birth was 37.16 weeks (SD 2.92) and 2675.48 grams (SD 616.16) respectively. LBW was associated with prematurity, odds ratio (OR) 7.15, 95% confidence interval (CI) 5.18 to 9.89; premature rupture of membranes OR 7.33, 95% CI 2.43 to 22.12 and attending fewer than five antenatal care (ANC) visits OR 1.30, 95% CI 1.06 to 1.61. Male infants were less likely to be LBW, in this population. Conclusion Women who attended fewer than five ANC visits were predisposed to give birth to low birth weight babies. Mothers should be encouraged to attend ANC visits to detect adverse events like premature rupture of membranes and premature labour timeously.

BackgroundExploring barriers contributing to low utilization of Antenatal Care (ANC) during the first trimester of pregnancy is of national programmatic importance. We conducted an exploratory study in 2013 at Bilira Health Centre in Ntcheu district-Malawi with an aim of understanding barriers that prevent pregnant women from attending antenatal clinics in the first trimester of pregnancy.MethodThis was cross sectional exploratory study using qualitative approach. Data were collected from ANC clients, key informants, health services professionals and women of child bearing age (15–49 years) using an in-depth interviews and Focus Group Discussions (FGDs). Data were analysed manually by reading the transcriptions and memos several times inorder to be familiar with the themes emerged. The emerged themes were coded.ResultsMost of the women reported that they have a feeling of starting ANC in the early days of their pregnancies, however, they also reported several barriers ranging from cultural beliefs, social economic to service delivery barriers. On cultural barriers many women wait for marriage counselors from husband’s side to give them advice before starting ANC in the process called “Kuthimba”. Some women hide the pregnancy in early months to avoid being bewitched. On social-economic barriers, some of the women mentioned that they don’t start ANC early waiting for new clothes. Poor attitude of health workers also has an effect on ANC attendants. Most women pointed out that they started ANC late because some health workers were rude and do not observe confidentiality. Men’s refusal to accompany their spouses to antenatal clinic in fear of HIV test and some by-laws which restrict women who had pregnancy outside marriage to seek an authorisation letter first from Traditional Leaders for them to start ANC at the health facility were also mentioned as contributing barriers.ConclusionWomen should be oriented on the national guidelines on Focused ANC (FANC) which advocates for at least 4 visits. There should also be Information, Education and Communication (IEC) on ANC and interventions to deal with social-cultural issues while at the same time improving service delivery at the health facility so that ANC services can be accessible and responsive enough.

BackgroundMalaria is seasonal and this may influence the number of children being treated as outpatients in hospitals. The objective of this study was to investigate the degree of seasonality in malaria in lakeshore and highland areas of Zomba district Malawi, and influence of climatic factors on incidence of malaria.MethodsSecondary data on malaria surveillance numbers and dates of treatment of children <5 years of age (n = 374,246) were extracted from the Zomba health information system for the period 2012–2016, while data on climatic variables from 2012 to 2015 were obtained from meteorological department. STATA version 13 was used to analyse data using non-linear time series correlation test to suggest a predictor model of malaria epidemic over explanatory variable (rainfall, temperature and humidity).ResultsMalaria cases of children <5 years of age in Zomba district accounts for 45% of general morbidity. There was no difference in seasonality of malaria in highland compared to lakeshore in Zomba district. This study also found that an increase in average temperature and relative humidity was associated of malaria incidence in children <5 year of age in Zomba district. On the other hand, the difference of maximum and minimum temperature (diurnal temperature range), had a strong negative association (correlation coefficients of R2 = 0.563 [All Zomba] β = −1295.57 95% CI −1683.38 to −907.75 p value <0.001, R2 = 0.395 [Zomba Highlands] β = −137.74 95% CI −195.00 to −80.47 p value <0.001 and R2 = 0.470 [Zomba Lakeshores] β = −263.05 95% CI −357.47 to −168.63 p value <0.001) with malaria incidence of children <5 year in Zomba district, Malawi.ConclusionThe diminishing of malaria seasonality, regardless of strong rainfall seasonality, and marginal drop of malaria incidence in Zomba can be explained by weather variation. Implementation of seasonal chemoprevention of malaria in Zomba could be questionable due to reduced seasonality of malaria. The lower diurnal temperature range contributed to high malaria incidence and this must be further investigated.

BackgroundIn Malawi, children under the age of five living in different geographical areas may experience different malaria risk factors. We compare the risk factors of malaria experienced by children under the age of five from Zomba district, who reside in lakeshore and highland areas.MethodsWe conducted a case control study of 765 caregivers, cases being children under-five who were diagnosed with malaria, and obtained matched controls from local health facilities and communities. We used a multivariate logistic regression to identify individual and household risk factors.ResultsIn lakeshore areas, risk factors were households located one kilometer or less away from stagnant water (AOR: 2.246 95% CI: 1.269 to 3.975 P-value: 0.005); or if the household had obtained a mosquito bed net more than one year ago (AOR: 1.946 95% CI: 1.073 to 3.529 P-value: 0.028). In highland areas, risk factors were households which used a borehole/unprotected well (AOR: 1.962 95% CI: 1.001 to 3.844 P-value 0.050), communal standpipe (AOR: 3.293 95% CI: 1.301 to 8.332 P-value 0.012), and un-protected dug well in their yards (AOR: 16.195 95% CI: 2.585 to 101.464 P-value 0.003) as their drinking water sources. In highland areas, caregivers not attending health talks on malaria prevention messages was a risk factor (AOR: 2.518 95% CI: 1.439 to 4.406 P-value: 0.001).ConclusionChildren under the age of five living in highland areas experience different malaria risk factors compared to children living in lakeshore areas. Settling away from stagnant/open water source in lakeshore and encouraging caregivers to attend health talks on malaria prevention in highlands can help reduce malaria transmission. Nevertheless, using a mosquito bed net that is more than one year old is a common risk factor in both locations. Using new mosquito bed nets can significantly reduce the risk of contracting malaria in children under the age of five.