Albert Dube

University of Malawi | UNIMA · Department of Community Health

Background: In northern rural Malawi, the majority of households cook using open fires and there is also a high burden of adverse birth outcomes. The use of open fires or highly polluting cookstoves is associated with low birthweight in babies. There is mixed evidence on whether implementation of cleaner burning cookstoves reduces the number of ba...

Multimorbidity (presence of ≥2 long term conditions (LTCs)) is a growing global health challenge, yet we know little about the experiences of those living with multimorbidity in low- and middle-income countries (LMICs). We therefore explore: 1) experiences of men and women living with multimorbidity in urban and rural Malawi including their experie...

Background As in many other countries across sub-Saharan Africa, Malawi’s commercial gambling sector has grown considerably in recent years. Driven by the widespread availability of internet through mobile devices, the industry has penetrated both urban and rural settings. In Malawi the model commonly implemented by gambling companies is similar to...

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve und...

Background As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting ch...

Background Trials of BCG vaccination to prevent or reduce severity of COVID-19 are taking place in adults, some of whom have been previously vaccinated, but evidence of the beneficial, non-specific effects of BCG come largely from data on mortality in infants and young children, and from in-vitro and animal studies, after a first BCG vaccination. W...

BACKGROUND Behavioral changes are needed to limit the spread and mitigate the impact of the COVID-19 pandemic. OBJECTIVE We measured knowledge and behaviors related to COVID-19 during the early stages of the pandemic in Malawi (Southeast Africa). METHODS Using lists of phone numbers collected prior to the COVID-19 pandemic, we contacted a sample of...

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve und...

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve und...

Background: Reaching the 90-90-90 targets requires efficient resource use to deliver HIV testing and treatment services. We investigated the costs and efficiency of HIV services in relation to HIV testing yield in rural Karonga District, Malawi. Methods: Costs of HIV services were measured over 12 months to September 2017 in five health faciliti...

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or...

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or...

Objectives We investigated whether self-reported disability was associated with mortality in adults in rural Malawi. Setting Karonga Health and Demographic Surveillance Site (HDSS), Northern Malawi. Participants All adults aged 18 and over residing in the HDSS were eligible to participate. During annual censuses in 2014 and 2015, participants wer...

Background: There are limited data on knowledge and behaviors related to COVID-19, and on the adoption of preventive behaviors, in sub-Saharan countries. Methods: Between April 25th and May 23rd, we contacted 793 individuals aged 18 and older, who previously participated in studies conducted in the Karonga Health and Demographic Surveillance Site i...

Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing...

Objectives: To assess the validity of self-reported HIV status, and investigate factors that influence accurate reporting of HIV-positive status, in a population tested and informed of their HIV test result. Design: Prospective cohort study. Methods: We compared self-reported HIV status to biomarker-confirmed HIV test status among participants...

The way persons interact when ill could profoundly affect transmission of infectious agents. To obtain data on these patterns in Africa, we recorded self-reported named contacts and opportunities for casual contact in rural northern Malawi. We interviewed 384 patients and 257 caregivers about contacts over three 24-hour periods: day of the clinic v...

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve und...

Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and communicating) to allow collection of comparable data on disability. We aimed to improve und...

Age at sexual debut is known to have implications for future sexual behaviours and health outcomes, including HIV infection, early pregnancy and maternal mortality, but may also influence educational outcomes. Longitudinal data on schooling and sexual behaviour from a demographic surveillance site in Karonga district, northern Malawi, were analysed...

Interviews were conducted with a small group of Malawians over the age of 60 in rural Karonga district and in Area 25 of the capital, Lilongwe. We asked their views on the changes in diet that had taken place over their lifetimes and also on the causes of 'noncommunicable' diseases, such as Type 2 diabetes and hypertension in their communities. The...

INTRODUCTION:Stunting or linear growth retardation in childhood is associated with delayed cognitive development due to related causes (malnutrition, illness, poor stimulation), which leads to poor school outcomes at later ages, although evidence of the association between the timing and persistence of stunting and school outcomes within the sub-Sa...

School outcomes associated with moderate/severe stunting at birth (0-4m), early (11-16m) and late childhood (4–8 years), including age at enrolment as a mediator. (DOCX)

Background School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events. Methods Data from 2...

Cumulative proportion ever sexually active, conditional on schooling status at landmark age. By landmark age and sex. (DOCX)

Cumulative proportion ever married, conditional on age-for-grade at landmark age. By landmark age and sex. (DOCX)

Rates of outcomes by different exposures and potential confounders at landmark age 14 in girls. (DOCX)

Cumulative proportion ever pregnant, conditional on schooling status at landmark age. By landmark age. (DOCX)

Cumulative proportion ever sexually active, conditional on age-for-grade at landmark age. By landmark age and sex. (DOCX)

Cumulative proportion ever married, conditional on schooling status at landmark age. By landmark age and sex. (DOCX)

Cumulative proportion ever pregnant, conditional on age-for-grade at landmark age. By landmark age. (DOCX)

Household air pollution from burning solid fuels is responsible for an estimated 2.9 million premature deaths worldwide each year and 4.5% of global disability-adjusted life years, while cooking and fuel collection pose a considerable time burden, particularly for women and children. Cleaner burning biomass-fuelled cookstoves have the potential to...

This article aims to assess multiple issues of resources, staffing, local opinion, data quality, cost, and security while transitioning to electronic data collection (EDC) at a long-running community research site in northern Malawi. Levels of missing and error fields, delay from data collection to availability, and average number of interviews per...

Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women’s fertility intentions and anthropometric data of children. Using the prospect...

Background Mass media is critical in disseminating public health information, improving health knowledge and changing health behaviours. However, most of the mass media public health interventions do not sufficiently engage the local people; they are externally determined. Due to this, very little is known about the effects of locally instigated ma...

Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa. We conducted a secondary analysis of seven ra...

Fertility preferences are an essential component of family planning program evaluation; however, doubts about their validity in sub-Saharan Africa exist and little methodological assessment has been carried out. This study investigates prospective fertility intentions in terms of their temporal stability, intensity, degree of spousal agreement, and...

Postpartum is the most risky period for both mothers and newborn babies. However, existing evidence suggests that utilization of postnatal care is relatively lower when compared to uptake of other similar health care services. Therefore, the aim of this study was to examine the perceptions of parents toward the postpartum period and postnatal care...

Men's participation in antenatal, childbirth and postnatal care is crucial to the health of the mothers and neonates. Nevertheless, very few men participate in maternal health, especially in developing countries. Mass media is one of the popular and effective tools for health promotion and behavioral change globally. However, this approach is rarel...

Knowledge of HIV status may influence fertility desires of married men and women. There is little knowledge about the importance of this influence among monogamously married couples and how knowledge of HIV status influences use of contraception among these couples. We carried out a cross-sectional analysis of interview data collected between Octob...

Summary There is now widespread agreement on the importance of men's role in reproductive decision-making. Several studies have argued that fertility preferences and their translation into behaviour differ between polygamous and monogamous unions. Studies investigating the dominance of men's preferences over women's preferences, in cases of couple...

Developing countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non-communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub-Saharan Africa. However, in recent years, HIV-associated mortality has been reduced with the introduction of wid...

Objective: To quantify refusal bias due to prior HIV testing, and its effect on HIV prevalence estimates, in general-population surveys. Design: Four annual, cross-sectional, house-to-house HIV serosurveys conducted during 2006-2010 within a demographic surveillance population of 33 000 in northern Malawi. Methods: The effect of prior knowledg...

The Karonga Health and Demographic Surveillance System (Karonga HDSS) in northern Malawi currently has a population of more than 35 000 individuals under continuous demographic surveillance since completion of a baseline census (2002-2004). The surveillance system collects data on vital events and migration for individuals and for households. It al...

Recent UNAIDS guidelines recommend measuring concurrency 6 months before the interview date, based on overlapping partnership dates. This has theoretical advantages, but little is known about how well it can be measured in practice. The assumptions underlying the UNAIDS measure were tested using data from a sexual behaviour survey conducted in rura...

Uptake of HIV testing in a sero-survey conducted 2007/8, and reported and subsequent uptake of ART, among individuals aged 15–59 years old. (0.01 MB PDF)

Four studies from sub-Saharan Africa have found a substantial population-level effect of ART provision on adult mortality. It is important to see if the impact changes with time since the start of treatment scale-up, and as treatment moves to smaller clinics. During 2002-4 a demographic surveillance site (DSS) was established in Karonga district, n...