A framework to explore micronutrient deficiency in maternal and child health in Malawi, Southern Africa Natalie Dickinson1,2,3, John Gulliver1, Gordon MacPherson1, John Atkinson1, Jean Rankin1, Maria Cummings1, Zoe Nisbet1, Andrew Hursthouse*2, Avril Taylor3, Chris Robertson4 and Wolfgang Burghardt5 Address: 1School of Health Nursing & Midwifery University of the West of Scotland, Paisley, PA1 2BE, UK, 2School of Engineering and Science, Unviversity of the West of Scotland, Paisley, PA1 2BE, UK, 3School of Social Sciences, University of the West of Scotland, Paisley, PA1 2BE, UK, 4Department of Statistics & Modelling Science, University of Strathclyde, Glasgow G1 1HX, UK and 5Soil Technology, Department of Biology & Geography University Duisburg-Essen, 457 Essen, Germany Email: Natalie Dickinson - [email protected]
; John Gulliver - [email protected]
; Gordon MacPherson - [email protected]
; John Atkinson - [email protected]
; Jean Rankin - [email protected]
; Maria Cummings - [email protected]
; Zoe Nisbet - [email protected]
; Andrew Hursthouse* - [email protected]
; Avril Taylor - [email protected]
; Chris Robertson - [email protected]
; Wolfgang Burghardt - [email protected]
* Corresponding author
from Joint Environment and Human Health Programme: Annual Science Day Conference and Workshop Birmingham, UK. 24-25 February 2009 Published: 21 December 2009 Environmental Health 2009, 8(Suppl 1):S13
Sciences Research Council
Proceedings (BBSRC), Engineering of the Jointand Environment Physical Sciences and Human Research Health Council Programme: (EPSRC)Annual and Health Science Protection Day Conference Agency (HPA). and Workshop Proceedings Michael N Moore http://www.biomedcentral.com/content/pdf/1476-069X-8-s1-info.pdf and Pamela D Kempton Publication of this supplement
was made possible with support from the Natural Environment Research Council (NERC), Environment Agency (EA), Department of the Environment & Rural Affairs (Defra), Ministry of Defence (MOD), Medical Research Council (MRC), The Wellcome Trust, Economic & Social Research Council (ESRC), Biotechnology and Biological
This article is available from: http://www.ehjournal.net/content/8/S1/S13 © 2009 Dickinson et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Global food insecurity is associated with micronutrient deficiencies and it has been suggested that 4.5 billion people world-wide are affected by deficiencies in iron, vitamin A and iodine. Zinc has also been identified to be of increasing concern. The most vulnerable are young children and women of childbearing age. A pilot study has been carried out in Southern Malawi, to attempt to link the geochemical and agricultural basis of micronutrient supply through spatial variability to maternal health and associated cultural and social aspects of nutrition. The aim is to establish the opportunity for concerted action to deliver step change improvements in the nutrition of developing countries. Results: Field work undertaken in August 2007 and July/August 2008 involved the collection of blood, soil and crop samples, and questionnaires from ~100 pregnant women. Complex permissions and authorisation protocols were identified and found to be as much part of the cultural and social context of the work as the complexity of the interdisciplinary project. These issues are catalogued and discussed. A preliminary spatial evaluation is presented linking soil quality and food production to nutritional health. It also considers behavioural and cultural attitudes of women and children in two regions of southern Malawi, (the Shire Valley and Shire Highlands plateau). Differences in agricultural practice and widely varying soil quality (e.g. pH organic matter, C/N and metal content) were observed for both regions and full chemical analysis of soil and food is underway. Early assessment of blood data suggests major differences in health and nutritional
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status between the two regions. Differences in food availability and type and observations of life style are being evaluated through questionnaire analysis. Conclusion: The particular emphasis of the study is on the interdisciplinary opportunities and the barriers to progress in development support in subsistence communities. Engaging at the community level and the balance of expectations from both study subjects and research team highlight the merit of careful and detailed planning and project delivery.
Introduction Micronutrient malnutrition is a national health problem in Malawi, a small, land-locked sub-Saharan African country [1-4]. In many developing countries numerous agricultural as well as social factors are constraints that contribute to food insecurity and malnutrition . A review of the context for Malawi  highlights the scope for interdisciplinary research to investigate the acknowledged gap between knowledge and successful implementation of interventions to address nutritional inadequacy. This pilot project established a protocol for research in Malawi, incorporating bottom-up participatory approaches through the construction of a dynamic and engaged interdisciplinary research team.
Developing a methodology Ethical permission for this study was granted both by the University of Paisley (now UWS); Research Ethics Advisory Group and the College of Medicine, University of Malawi; Research Ethics Committee (COMREC). All participants were recruited after extensive sensitisation activities and signed agreement to participate. The study targeted pregnant women (~100) from two geographically different regions close to Blantyre in S. Malawi, where diet is determined by home grown food (dominated by maize). Samples of blood, crop and soil were collected for analysis and a lifestyle questionnaire completed. Many confounding factors are recognised but it was considered that focusing efforts to collect evidence across all components would provide important observational data and understanding in the two regions: a. The Shire Highlands, a plateau region to the east of the Shire River (Chiradzulu district). Relatively densely populated, good agricultural productivity, 900-1100 m elevation, experiencing relatively cool temperatures and regional average rainfall [7,8]. b. The low-lying Shire Valley (Chikwawa district), ~100 m elevation, higher average temperatures and lower rainfall , although the area floods every year and farmers struggle to produce enough food to last the year .
ties, and 'sensitization' of the communities who would be involved (important for new or unusual actions). Sensitisation messages provide essential information to the community about what is being done, why, when and by whom, and who will be involved . It follows traditional hierarchy of the local community and is necessary for communities to stand the best chance of accepting interventions and involvement from outside, providing the opportunity for research teams to disseminate project aims and collect preliminary feedback. The process is shown as part of Figure 1, which reveals the extensive interactions required. A locally based team was built working with AGLIT (a local NGO in Chikwawa), two Village Field Assistants (VFAs) in Chiradzulu, and a locally trained Malawian Research Assistant (RA). A UK member of the team was resident in Malawi, providing logistical support, recording dialogue within the research group and observational data on human behaviour and government policy issues relevant to the project. This included findings concerning agriculture, eating habits, family life, and health care. The women recruited to participate had all sought permission from their husbands and had signed consent forms. Blood sampling and clinics Blood sampling clinics were run over two weeks and the height, weight and Estimated Delivery Date (EDD) of each participant was recorded within the questionnaire along with participant identification (ID) number.
Venepuncture (blood-taking) and clinical examination (including fundal height, a measurement to approximate the stage of pregnancy) were carried out by local nurses hired to assist in the study, and supervised by a nurse or midwife from the project team. Approximately 15 ml of blood was drawn and decanted into three specific blood bottles and split for analysis in Malawi and the UK. Field visits - soil, food and questionnaires Soil sampling, food collection and lifestyle questionnaire were undertaken simultaneously. Each participant was visited at her home; a GPS location was recorded at the participant's house, and photographs were taken.
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Permission of District Health Office (DHO) sought and granted
Preparation UWS ethical approval
Presentation to District Executive Committee (DEC)
Scoping visit to Malawi
Recruitment of local investigators/partners - University of Malawi (UNIMA) - AGLIT (local NGO) - Village Field Assistants (VFAs) - Graduate Research Assistant
Traditional Authority’s permission sought and granted
Group Village Heads (GVHs) and Village He...