Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with adverse pregnancy outcomes. The aim of the present study was to examine the determinants of different serum PFAS concentrations in late pregnancy and their relationship with birth outcomes in southern Malawi. The sample included 605 pregnant women with a mean age of 24.8 years and their offspring from three districts in the southern region of Malawi. Six PFAS were measured in serum from third-trimester women. The serum PFAS concentrations were assessed with head circumference, birth length, birth weight, gestational age and ponderal index. Participants living in urban areas had significantly higher serum levels of PFOA, PFNA and SumPFOS, while SumPFHxS concentrations were higher in women from rural settings. High PFOA, PFNA and SumPFHxS concentrations were generally inversely associated with head circumference. Birth length was negatively associated with PFOA and PFNA while SumPFHxS was negatively associated with birth weight. SumPFOS was inversely associated with gestational age. Urban area of residence was the strongest predictor for high PFAS concentrations in the maternal serum and was generally associated with adverse birth outcomes. The results highlight the need to investigate SumPFHxS further as it follows a pattern that is different to similar compounds and cohorts.

The use of untreated livestock manure in urban agriculture sustains soil fertility but risks disseminating antimicrobial resistance (AMR) in resource-limited settings. This study characterized antibiotic-resistant bacteria (ARB) prevalence across manure–soil–vegetable pathways in Blantyre, Malawi. Using a cross-sectional design, we collected 35 samples (poultry/pig manure, farm/home soils, Brassica rapa subsp. chinensis, Brassica rapa, and Amaranthus spp.) from five livestock farms. Microbiological analysis with API 20E identification and disk diffusion testing revealed clear differences in contamination: Escherichia coli dominated pig manure (52%) and farm soil (35%), with detection in vegetables suggesting possible transfer (e.g., 20% in Brassica rapa subsp. chinensis), while Klebsiella pneumoniae contaminated all sample types (peak: 60% vegetables and 67% home soils). All manure isolates exhibited sulfamethoxazole–trimethoprim resistance, with 50% of pig manure E. coli showing cefotaxime resistance. Soil isolates mirrored these patterns (100% ampicillin resistance in K. pneumoniae and 77% cefotaxime resistance in farm soil E. coli). Vegetables displayed severe multidrug resistance (100% E. coli and 80% K. pneumoniae resistant to ≥3 classes), including critical gentamicin resistance (100% E. coli). Composting for ≤6 weeks, as practiced on the studied farms, did not eliminate ARBs, suggesting that longer durations may be needed. Notably, this study provides the first phenotypic evidence of presumptive Pasteurella-like organisms on edible leafy vegetables, specifically 45% in Amaranthus spp. and 6.1% in Brassica rapa, suggesting a potential zoonotic transmission route from livestock farms that requires molecular confirmation. These findings demonstrate manure-amended farms as AMR reservoirs, necessitating extended composting and antibiotic stewardship to mitigate One Health risks.

Introduction: Globally, magnesium sulfate (MgSO₄) has been recognized as the drug of choice for preventing and controlling fits among women with severe pre-eclampsia and eclampsia, respectively. Improper use of magnesium sulfate has been reported globally. Therefore, actionable findings for improving magnesium sulfate use are needed. This study aims at understanding the views of midwives towards MgSO₄ use to inform an intervention whose objective is to improve MgSO₄ use among the midwives. Methods: An exploratory qualitative study was conducted from July to September 2018. We conducted 10 in-depth interviews and a focus group discussion with midwives. All the interviews were audio taped and transcribed verbatim. Data were managed by NVivo version 10.0 and analyzed thematically. Results: We identified one overarching theme: “Inadequate governing approaches on management of clients on MgSO₄” with corresponding subthemes; in adequate preparation on magnesium sulfate administration; inconsistent formula, regimen and guidelines/protocols on magnesium sulfate use and lack of resources. Conclusion: Midwives perceived MgSO₄ use as a demanding activity due to inadequate training, inconsistent tools, and lack of resources. While periodic in-service training should be intensified to improve MgSO₄ use, necessary resources should be provided, such as blood pressure machines, more midwives, and protocols.

Population exposure to persistent organic pollutants (POPs) may result in detrimental health effects, especially to pregnant women, developing foetuses and young children. We are reporting the findings of a cross-sectional study of 605 mothers in their late pregnancy, recruited between August 2020 and July 2021 in southern Malawi, and their offspring. The aim was to measure the concentrations of selected POPs in their maternal serum and indicate associations with social demographic characteristics and birth outcomes. A high level of education was the main predictor of p,p′-DDE (p = 0.008), p,p′-DDT (p < 0.001), cis-NC (p = 0.014), o,p′-DDT (p = 0.019) and o,p′-DDE (p = 0.019) concentrations in maternal serum. Multiparity was negatively associated with o,p′-DDE (p = 0.021) concentrations. Maternal age was also positively associated (p,p′-DDE (p = 0.013), o,p′-DDT (p = 0.017) and o,p′-DDE (p = 0.045) concentrations. Living in rural areas was inversely associated with high maternal serum concentrations of p,p′-DDT (p < 0.001). Gestational age was positively associated with p,p′-DDE (p = 0.031), p,p′-DDT (p = 0.010) and o,p′-DDT (p = 0.022) concentrations. Lastly, an inverse association was observed between head circumference and t-NC (p = 0.044), Oxychlordane (p = 0.01) and cis-NC (p = 0.048). These results highlight the need to continue monitoring levels of POPs among vulnerable populations in the southern hemisphere.

Urban and peri-urban farmers in Malawi increasingly use treated and untreated wastewater for vegetable production, but little is known about the extent of heavy metal accumulation in both exotic and indigenous vegetables, particularly with respect to differences between edible tissues (leaves vs. stems). This study addresses this gap by measuring the concentrations of cadmium (Cd), chromium (Cr), lead (Pb), zinc (Zn), and copper (Cu) in wastewater, soils, and six vegetables including three exotic and three indigenous irrigated with effluent from the Soche Wastewater Treatment Plant in Blantyre. Metal concentrations were determined using Atomic Absorption Spectrophotometry. Wastewater contained Zn (0.01 ± 0.001 mg/L) and Cu (0.02 ± 0.018 mg/L), both below World Health Organization (WHO) and Malawi Bureau of Standards (MBS) limits (Zn: 0.2 mg/L; Cu: 2 mg/L), while Cd, Cr, and Pb were below detection limit. In soils, Zn reached 56.4 ± 0.5 mg/kg, exceeding the WHO limit of 36 mg/kg; other metals remained within WHO permissible values. Vegetables showed species- and tissue-specific variation in metal accumulation: Cr reached 4.65 mg/kg in Cucurbita moschata stems, Cd up to 0.31 mg/kg in Amaranthus retro-flexus leaves, and Pb up to 4.09 mg/kg in Brassica rapa stems—all above FAO/WHO permissible limits (2.3, 0.2, and 0.3 mg/kg, respectively). Duncan’s post hoc analysis confirmed significant differences (p < 0.05) across matrices and plant parts, with leaves generally accumulating more Zn and Cu than stems. Principal component analysis (PCA) revealed that Zn, Cu, Cr, and Pb in the wastewater-soil-vegetable system largely share a common source, likely wastewater effluent and historical soil contamination, while Cd showed a more sporadic distribution, highlighting differential accumulation pathways. Health risk assessments revealed high Health Risk Index (HRI) values, with Brassica rapa stems (HRI = 92.3) and Brassica rapa subsp. chinensis leaves (HRI = 82.2) exceeding the safe threshold (HRI > 1), indicating potential chronic risks. This study reveals potential health risks associated with wastewater irrigation due to heavy metal accumulation in edible vegetables, and therefore recommends further research on metal speciation, seasonal variation, and bioaccumulation at different crop growth stages.

Background/objectives: Antimicrobial resistance (AMR) is a growing public health concern, and misuse of antibiotics in livestock farming contributes to its emergence. In Blantyre, Malawi, small-scale pig and poultry farming is widespread, but the knowledge, attitudes, and practices (KAP) driving antimicrobial use (AMU) remain poorly understood. This study aimed to assess the KAP regarding AMU and manure management among pig and poultry farmers in Blantyre, Malawi. Methods: This cross-sectional study surveyed 118 randomly selected farmers to assess AMU patterns, sources of antibiotics, adherence to withdrawal periods, disposal practices, and awareness of AMR and regulations. Data was collected using a structured questionnaire and analyzed with descriptive statistics and inferential tests (with statistical significance set at p < 0.05). Results: Antibiotic use was reported by 88% of farmers, primarily for therapy (93.3%) and prophylaxis (85.6%), including for viral diseases such as Newcastle disease in poultry and African swine fever in pigs. Oxytetracycline (91.5%), penicillin (50.8%), and trimethoprim-sulfamethoxazole (39.8%) were the most used antibiotics, predominantly sourced from agrovet shops (73.7%). While 61% of farmers knew antibiotic misuse could lead to AMR, significant gaps were observed: 68.6% had no formal training, 55.9% were unaware of regulations, and 42% sold/consumed products before the end of the withdrawal period. Most farmers disposed of expired antibiotics (80.5%) and packaging (92.4%) in household waste. Higher education and prior training were significantly associated with good knowledge. Conclusions: This study reveals significant knowledge–practice gaps and high-risk behaviors, such as misuse for viral diseases and unsafe disposal, that exacerbate AMR risks. Interventions must prioritize targeted farmer education, strengthening of veterinary extension services, and stricter regulation of agrovet shops to promote antimicrobial stewardship and support Malawi’s National Action Plan on AMR.