Monica Nzanga

Road traffic injuries (RTIs) and air pollution present dual burdens that disproportionately affect school-going children in low-income urban settings like Malawi. Despite availability of evidence-based interventions, their implementation often overlooks local contexts and perspectives. This study aimed to elicit stakeholder input on interventions addressing RTIs and air pollution exposure among children in urban Blantyre through stakeholder engagement. It used a mixed method Delphi technique combining expert consultations with community focus groups to achieve consensus on interventions. Successive rounds of prioritization and qualitative discussions explored contextual barriers and facilitators to implementation. Stakeholders identified 40 interventions, 23 for road safety and 17 for air pollution. Measures prioritized by experts included speed limit enforcement, pedestrian infrastructure improvements, and emission controls. Contextual barriers identified by experts and the community included socio-political and financial constraints. Community perspectives emphasized behavioral interventions, while experts highlighted systemic and legislative changes. The study underscored the value of combining expert and community perspectives to design context-sensitive interventions. Synergies between road safety and air pollution interventions offer opportunities for dual benefits but require careful adaptation to urban Malawi’s realities. This study provides a model for participatory design in low-income settings, emphasizing stakeholder engagement for tailored solutions.

Healthcare associated infections (HAIs) are a burden in many countries especially low-income countries due to poor hand hygiene practices in the healthcare settings. Proper hand hygiene in the healthcare setting is an effective way of preventing and reducing HAIs, and is an integral component of infection prevention and control. The objective of this study was to determine adherence to hand hygiene guidelines and associated factors among nurses and clinicians. A quantitative cross-sectional study was conducted at Chiradzulu District Hospital (Malawi) where stratified random sampling was used to obtain the sample of 75 nurses and clinicians. Data were collected using self-administered questionnaires (n = 75), observation checklists (n = 7) and structured observations (n = 566). The study findings confirmed low adherence to hand hygiene practice among healthcare workers (HCWs) in Malawi. Overall, higher hand hygiene practices were reported than observed among nurses and clinicians in all the World Health Organization’s (WHO) five critical moments of hand hygiene. This calls on the need for a combination of infrastructure, consumables (e.g., soap) and theory driven behavior change interventions to influence adoption of the recommended hand hygiene behaviors. However, such interventions should not include demographic factors (i.e., age, profession and ward) as they have been proven not to influence hand hygiene performance.