University of Malawi

Abstract HIV vaccines and antibody-based prevention strategies targeting Env have shown limited efficacy. Here, we identify a Tat-dependent mechanism of HIV transmission and immune evasion mediated by extracellular Tat (eTat), a viral protein expressed early after infection and abundantly released into tissues. Extracellular Tat binds heparan sulfate proteoglycans and, when immobilized, mimics extracellular matrix proteins. We show here that immobilized eTat efficiently captures HIV virions from multiple clades and tiers. Although only a small fraction of virions is retained, Tat-bound virus displays enhanced infectivity, particularly at low virus inputs, a process we term Tat-assisted infection. Notably, both first- and second-generation anti-Env broadly neutralizing antibodies (bnAbs) fail to prevent virion capture and show strongly reduced neutralization potency against Tat-captured viruses, irrespective of epitope specificity. In contrast, polyclonal and monoclonal anti-Tat antibodies efficiently block both virus capture and infection. These findings reveal that eTat establishes an extracellular pool of highly infectious, neutralization-resistant virions, providing a mechanistic explanation for the limited efficacy of current Env-focused interventions. Our work identifies Tat as a critical and targetable determinant of HIV infectivity and immune evasion, supporting the inclusion of Tat in next-generation preventive and therapeutic vaccine strategies and in passive immunization approaches combined with bnAbs.

This paper examines the relevance of Karl Marx’s theory of commodity fetishism in African postcolonial contexts, using Malawian reggae artist Evison Matafale’s 1999 song, “Olakwa Ndani?” (“Who is to Blame?”) as a case study. Developed initially to critique European industrial capitalism, commodity fetishism explains how social relations and labour become hidden behind a commodity’s perceived intrinsic value. In urban African settings, this shift towards alternative ways of knowing, including religion, spirituality, kinship, and culture, expresses resistance that aligns with Africans’ lived experiences. Matafale’s lyrics challenge the fixation on wealth, status, and foreign goods, asking “who is to blame” when communities suffer poverty and marginalisation despite the circulation of commodities. By depicting social and moral decline as connected to misplaced value on material objects, the song shows how fetishised commodities mask the exploitation of the poor and the corruption of leaders. Therefore, Marx’s concept provides a strong framework for understanding the cultural, political, and economic critique present in Matafale’s reggae resistance. This paper argues that Matafale’s music acts as a counter-hegemonic narrative, revealing the material and spiritual alienation caused by capitalism and colonialism. Drawing on Rastafarian ideology and theoretical contributions from scholars such as James Ferguson, Jean and John L. Comaroff, and Achille Mbembe, the study situates Matafale’s song within broader critiques of Babylon, the Rastafarian allegory for a morally corrupt and exploitative global system. By asking the haunting question “who is to blame?”, Matafale rejects individualised explanations of poverty and marginalisation, instead advocating for systemic analysis of the unseen forces that sustain oppression. The paper concludes that although Marxist theory needs adaptation to local realities, it remains a powerful tool for analysing how commodities mediate suffering, identity, and resistance within African societies.

This study aims to examine the concept of bayani theory and its application in Islamic legal philosophy. This study uses a qualitative approach with a library research method. Data collection techniques were conducted through reading, collecting, and analyzing literature from books and journals. The results of the study indicate that Islamic legal philosophy demonstrates that this theory is a central pillar in classical Islamic legal epistemology. The philosophical roots of bayani theory lie in prioritizing revealed texts (nash) as the absolute source of truth and law. Bayani reasoning is based on the belief that all of God's commands and prohibitions contain meanings that can be understood through Arabic linguistic tools. Therefore, this method positions language as a central medium for understanding Sharia law. Bayani theory should be maintained as the core of Islamic legal epistemology, but it must be revitalized through reinterpretation and integration with modern social sciences to provide answers to complex legal problems in the global era.

ABSTRACT Background Most births worldwide (>80%) occur in health care facilities, yet 2.3 million newborns die annually. If the know – do gap between evidence and implementation was closed, an estimated 752,000 newborn deaths could be prevented per year. To bridge this gap, we describe the co-design of the Implementation Toolkit for Small and Sick Newborn Care (Newborn Toolkit), a web platform and linked community of global implementers, facilitated by NEST360 and UNICEF. The Newborn Toolkit enables access to practical, curated resources, including tools for peer learning and adaptation to country contexts. Methods A systematic three step process was followed. Step 1) Structure: We used an organising framework of WHO and UNICEF ten core components for health systems strengthening. We then reviewed relevant knowledge management platforms to identify elements facilitating user engagement. Step 2) Content: >300 implementers collated publications and tools for ten core components. Step 3) Refining and building community: User data analytics and surveys plus direct feedback from the global communities of practice provided data to improve website and webinar content. Results Step 1) Structure: In 2020, the Newborn Toolkit website structure was co-designed based on the ten core components. Step 2) Content: Working groups, organised by core components, collated over 1,100 resources in 15 languages. Step 3) Refining and building community: Cross-country learning was facilitated through 45 webinars with multi-disciplinary speakers from all continents including caregivers, clinicians, non-governmental organisation representatives, engineers, and data scientists. French language translation and engagement was added between 2023-2025. Unique user counts increased with 28,146 in 2023 to 62,561 in 2025 from 198 countries and territories. The most viewed content includes WHO guidelines, neonatal floor plans, the ABC device costing tool, and data tools. Conclusions Given the urgency for accelerated progress for newborn survival by 2030, rapid implementation of proven solutions is needed. It is crucial that implementers can access evidence and tools to adapt for their specific context, rather than “reinventing the wheel”. Systems change is complex, requiring novel approaches to make it doable, such as standard, simplified action pathways available on the Newborn Toolkit. Gaps to address include evidence availability in multiple languages. KEY FINDINGS WHAT WAS KNOWN? 2.3 million neonatal deaths are estimated annually and 65 countries are at-risk of missing Sustainable Development Goal 3.2 of reducing the number of neonatal deaths to less than 12 per 1,000 live births by 2030 There exists a know–do gap in global newborn health referring to the inability to translate evidence, what is known to work, into practice to improve health outcomes for WHO-UNICEF level-2 Small and Sick Newborn Care Frameworks based on country experiences have been created to guide health systems strengthening such as the WHO/UNICEF core components; however, operationalisation is needed Evidence, guidelines, and resources for Small and Sick Newborn Care were available; however, there existed a gap in knowledge management platforms dedicated to enabling evidence-based implementation of health systems strengthening interventions in low-resource settings WHAT WAS DONE THAT IS NEW? We co-designed a knowledge management platform for resources including tools, readings, and case studies to bridge the know–do gap for Small and Sick Newborn Care in low-resource settings Content and resources on the site were organised according to the ten WHO/UNICEF core components for health systems strengthening plus infection prevention and control This platform was operationalised and scaled by linking to, and engaging with, a global community of practice We applied a continuous learning and feedback integration approach to develop and refine content, enable accessibility including by language, and tailor engagement initiatives to implementer needs informed by website user and webinar data analytics WHAT WAS FOUND? The platform hosts over 1,100 tools and readings with resources available in 15 languages Between 2021–2025, this platform had 157,452 unique users, from 198 countries and territories 45 webinars were hosted between 2022–2025 showcasing implementation case studies and facilitating cross-country learning Knowledge management and targeted engagement can enable uptake of information by organising content in practical, digestible, and feasible formats WHAT NEXT? The know–do gap in Small and Sick Newborn Care needs to be closed. Providing up-to-date, relevant evidence that adapts to emerging knowledge and local learning, alongside leadership and financial inputs, could facilitate quality care delivery through data-driven decision making Bridging language barriers, through content translation, is a priority and crucial to enable wider access to up-to-date evidence

Agricultural extension systems (AES) in developing countries face mounting pressure to reform, driven by chronic underfunding and institutional inefficiencies that hinder responsiveness to smallholder farmers’ needs. Advocacy for pluralistic and demand-driven extension services has grown significantly, mainly advocating for financing mechanisms based on the principle of those who benefit must pay. This study investigates smallholder farmers’ Willingness to Pay (WTP) for agricultural extension and advisory services (AEAS) with focus on those provided through Malawi’s public agriculture extension service (PAES). It aims to understand farmer demand for AEAS within a cost-sharing framework in a developing country context. Using cross-sectional survey data from 351 randomly selected respondents, the study employed an open-ended contingent valuation method to estimate WTP, explored preferences for designing a cost-sharing PAES, and utilized Ordinary Least Squares (OLS) regression with robust standard errors to identify determinants of WTP. The findings reveal that a majority (86.32%) of smallholder farmers are willing to pay for AEASs, with services such as disease and pest control, crop husbandry, livestock breeding and on-farm input production being the most demanded. Farm mechanization, livestock breeding, and farm mapping emerged as the most valued in terms of WTP price. The majority of the smallholder farmers would prefer to pay for AEASs through agricultural extension worker (45%) and mobile money transfers (40%) and receive the paid-for services in face-to-face interactions, with near even preferences between individual consultation (47.2%) and group-based sessions (38.7%). Key factors influencing WTP include gender, marital status, education, family size, landholding, and enterprise type. There is strong support among smallholder farmers in Malawi for cost-shared AEASs, provided delivery and payment systems are accessible and tailored to their socio-economic realities. Policymakers should design equitable financing models aligned with farmers’ capacities and preferences.

Abstract The global pursuit of sustainable development highlights the urgent need for clean, renewable, and decentralized energy systems, especially in the built environment. This study examines the potential of decentralized green hydrogen technologies to foster sustainable green building practices in Africa. The study combines a comparative analysis of stakeholder perspectives in Malawi and Nigeria with a technical sizing assessment of Solhyd, solar-to-hydrogen systems. A mixed-methods approach was used in the study. First, a cross-sectional survey was conducted among 200 professionals, policymakers, and residents in both countries to evaluate perceived benefits, barriers to adoption, and driving factors towards adoption. Additionally, a technical analysis was conducted to determine the optimal system sizing of the panels to meet a minimum energy demand of three major types of residential buildings: rural, semi-urban, and urban. The respondents comprised 48.2% from Malawi and 51.8% from Nigeria. The results show that the highest-ranked perceived benefits, most critical barriers, and driving factors were “reducing reliance on diesel generators,” “high initial installation cost,” and “availability of infrastructure for production, storage, and distribution,” with mean scores of 3.93, 3.92, and 4.18, respectively. The technical analysis reveals that between 6 and 27 Solhyd panels can meet the typical daily electricity demand (2.5–10 kWh) of households in rural, semi-urban, and urban areas. This energy transition provides substantial environmental benefits, with a single urban home saving up to 5.77 metric tons of CO 2 annually. The study concludes that although the integration of decentralized green hydrogen is still in early stages, its potential remains significant. This study lays a foundational roadmap for policymakers and developers to create a scalable solution that powers Africa's sustainable urban growth, enhances energy independence, and achieves climate resilience goals.

In Malawi, adolescents and young people face significant health system barriers when accessing sexual reproductive health services, including post-abortion care. Overall, 60% of all abortion cases result in complications requiring medical treatment, a burden that disproportionately affects young girls. This study aimed to explore the lived experiences of adolescent girls and young women receiving post-abortion care at Thyolo district hospital, a secondary hospital located in southern Malawi. An interpretive phenomenological design was employed with 15 participants selected through purposive sampling. Data was collected through in-depth interviews and analysed using inductive thematic analysis. The social ecological model was adopted as a conceptual lens for discussing the results. Participants described intense emotional responses such as shame, fear, confusion, and relief upon recognising the need for post-abortion care. Family and social support, healthcare referral systems and guidance, transportation, and socioeconomic status significantly influenced the decision to seek care. In addition, community bylaws, perceived benefits, and prior experiences also shaped their decisions to utilise care. Adolescent girls and young women’s interactions with their environment shape their experience of post-abortion care. Therefore, aside from strengthening referral and diagnostic systems, improving young women’s experiences of post-abortion care necessitates multilevel interventions that combine community and healthcare provider sensitisation.

Background:Chancroid, a sexually transmitted infection (STI) caused byHaemophilus ducreyiresulting in genital ulcer disease (GUD), is now considered rare in many parts of the world. However, chancroid has remained highly prevalent in Malawi since the 1990s.Methods:We combined data fromtwo recent studies conducted in Malawi (2019-2022, 2021) that screened and enrolled patients>18 years of age presenting to a STI clinic with GUD. Polymerase chain reaction (PCR) was conducted forH. ducreyiand other STIs from ulcer swabs. We evaluated demographic, sexual and clinical characteristics of participants with positiveH. ducreyiPCRs to describe the epidemiology of chancroid using descriptive statistics.Results:Among 618 participants with GUD, 137 (22%) tested positive forH. ducreyiby PCR. Of these, most were male 85 (63%), the median age was 27 years (interquartile range [IQR]: 23, 33) and 19 (17%) had HIV co-infection. About a third (n=42, 31%) were co-infected with other STIs. Among 15 (11%) enrolled participants with additional clinical data, most reported one sexual partner in the past month (median = 1 [IQR: 1, 1). However, a history of prior transactional sex was reported by 5/15 (33%). The clinical presentation of the ulcers varied and over half presented with multiple ulcers (53%). Most ulcers (89%) were associated with pain, but few (20%) had associated inguinal lymphadenopathy.Conclusions:This review confirmed the high prevalence and persistence of chancroid in Malawi. However, additional investigations are needed to further characterize the epidemiology of chancroid and determine the reasons for its persistence in Malawi.