Demographic response to environmental pressure in Malawi

The discussion in this paper uses Malawi as a case study to shed some light on the interrelationships between population growth and demographic responses to environmental pressure. It is noted that certain parts of the country that are experiencing extreme environmental stress have began to go through a rapid phase of demographic and social change and transformation. For example, the Southern Region of the country, which has some of the highest densities, is experiencing a fertility transition. There is a spontaneous internal migration pattern from densely populated rural areas to other sparsely populated rural areas. Other non-demographic responses to population pressures are also briefly discussed in this paper.     

Small-fiber neuropathy: answering the burning questions

Small-fiber neuropathy is a peripheral nerve disease that most commonly presents in middle-aged and older people, who develop burning pain in their feet. Although it can be caused by disorders of metabolism such as diabetes, chronic infections (such as with human immunodeficiency virus), genetic abnormalities, toxicity from various drugs, and autoimmune diseases, the cause often remains a mystery because standard electrophysiologic tests for nerve injury do not detect small-fiber function. Inadequate ability to test for and diagnose small-fiber neuropathies has impeded patient care and research, but new tools offer promise. Infrequently, the underlying cause of small-fiber dysfunction is identified and disease-modifying therapy can be instituted. More commonly, the treatments for small-fiber neuropathy involve symptomatic treatment of neuropathic pain.     

The role of "Theatre for Development" in mobilising rural communities for primary health care: the case of Liwonde PHC Unit in southern Malawi

The improved health conditions that are essential for development may depend more upon the self-help motivation of local people than upon the provision of Western-style health facilities. Such motivation can be created by the culturally-appropriate dissemination of health education at the community level. This article describes an effective health improvement strategy implemented in three villages in southern Malawi during the late 1980s. After an introduction, the paper presents an overview of current strategies used in Malawi for the dissemination of primary health care information and notes that these strategies have failed to reach the rural population. Next, the paper describes the health status of two of the villages, Mbela and Mwima, before the introduction of the Liwonde Agricultural Development Division Primary Health Care Program. None of the three village involved had access to modern health care facilities. This program involved the joint efforts of the community, a primary health care team, and the Chancellor College Theatre for Development. The paper continues by presenting a conceptual model of the process. Community involvement was assured by the election of the members of village health committees and the delivery of health training to two members of each committee. The Theatre for Development used interactive dramatic techniques and participatory research activities in Mwima and Mbela to help the communities assess their health needs and possible solutions in conjunction with the introduction of primary health care activities. The article also contrasts the Theatre for Development technique with the focus group approach and notes that the latter may not be successful in motivating self-help efforts. Finally, the relative success of the Theatre for Development methodology used in the two villages is described by comparing health indicators with those before the intervention and with those in the third village where this approach was not used in conjunction with introduction of primary health care services.     

Gender differences in knowledge and attitudes toward modern and traditional methods of child spacing in Malawi

This paper examines male-female differences in knowledge and attitudes towards traditional and modern methods of child spacing in Malawi, based on the survey on traditional methods of child spacing in Malawi which was conducted in 1988. The results show that most people in Malawi are knowledgeable about both traditional and modern methods of child spacing. In general more men than women report knowledge and practice of traditional methods. For modern methods, however, females are more knowledgeable than males of all the specific methods, with the exception of condoms. The greater knowledge by women of female-based modern contraceptives appears to be a manifestation of the exclusion of males from the family planning program. The high rates of knowledge do not translate into equivalent high rates of utilization for both modern and traditional methods of contraception. The study further demonstrates that, while women are involved in making decisions to use contraception, the proportion of men initiating such decisions is greater than that of women. This finding calls for family planning planners to think seriously about revising their target population to include men.