Implementing a WASH Package Within Prevention of Vertical Transmission of HIV Programming in Lilongwe, Malawi: A Program Evaluation
References
- United Nations General Assembly. The Human Right to Water and Sanitation: Resolution A/RES/64/292. 2010.
- United Nations Children’s Fund and World Health Organization. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2022: Special Focus on Gender. 2023.
- United Nations. Goal 6: Ensure access to water and sanitation for all. Accessed February 17, 2025.
https://www.un.org/sustainabledevelopment/water-and-sanitation/ . - World Health Organization Regional Office for Africa. Water. Published 2025. Accessed February 17, 2025.
https://www.afro.who.int/health-topics/water . - Deshpande A, Miller‑Petrie MK Lindstedt PA. Mapping geographical inequalities in access to drinking water and sanitation facilities in low‑income and middle‑income countries, 2000–17. Lancet Glob Health. 2020;8(9):e1162–e1185. doi:10.1016/S2214-109X(20)30278-3.
- Diarrhoeal disease. Accessed February 18, 2025.
https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease . - van Eijk AM Brooks JT, Adcock PM. Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya. Int J Infect Dis. 2010;14(3):e220–e225. doi:10.1016/j.ijid.2009.06.001.
- He Z, Ghose B, Cheng Z. Diarrhea as a disease of poverty among under‑five children in sub‑Saharan Africa: A cross‑sectional study. Inq J Med Care Organ Provis Financ. 2023;60:00469580231202988. doi:10.1177/00469580231202988.
- National Statistical Office, Utica International, and ICF. Malawi Demographic and Health Survey 2024: Final Report. 2024.
https://www.dhsprogram.com/pubs/pdf/FR398/FR398.pdf . - Graham JP, Hirai M, Kim SS. An Analysis of Water Collection Labor among Women and Children in 24 Sub‑Saharan African Countries. Plos One. 2016;11(6):e0155981. doi:10.1371/journal.pone.0155981.
- Wolf J, Hubbard S, Brauer M, et al. Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low‑income and middle‑income settings: A systematic review and meta‑analysis. Lancet. 2022;400(10345):48–59. doi:10.1016/S0140-6736(22)00937-0.
- Waddington HS, Masset E, Bick S, Cairncross S. Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta‑analysis. PLOS Med. 2023;20(4):e1004215. doi:10.1371/journal.pmed.1004215.
- Yates T, Lantagne D, Mintz E, Quick R. The impact of water, sanitation, and hygiene interventions on the health and well‑being of people living with HIV: A systematic review. J Acquir Immune Defic Syndr 1999. 2015. 68(
Suppl 3 ):S318–S330. doi:10.1097/QAI.0000000000000487. - Jones H, Wringe A, Todd J, et al. Implementing prevention policies for mother‑to‑child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013–2016. Bull World Health Organ. 2019;97(3):200–212. doi:10.2471/BLT.18.217471.
- Ministry of Health, Malawi. Malawi Population‑Based HIV Impact Assessment 2020‑2021 (MPHIA 2020‑2021): Final Report. Ministry of Health. 2022.
- Yotebieng M, Moracco KE, Thirumurthy H, et al. Conditional cash transfers improve retention in PMTCT services by mitigating the negative effect of not having money to come to the clinic. J Acquir Immune Defic Syndr 1999. 2017;74(2):150–157. doi:10.1097/QAI.0000000000001219.
- Xue J, Mhango Z, Hoffman IF, et al. Use of nutritional and water hygiene packages for diarrhoeal prevention among HIV‑exposed infants in Lilongwe, Malawi: An evaluation of a pilot prevention of mother‑to‑child transmission post‑natal care service. Trop Med Int Health. 2010;15(10):1156–1162. doi:10.1111/j.1365-3156.2010.02595.x.
- Herce ME, Mtande T, Chimbwandira F, et al. Supporting Option B+ scale up and strengthening the prevention of mother‑to‑child transmission cascade in central Malawi: Results from a serial cross‑sectional study. BMC Infect Dis. 2015;15:328. doi:10.1186/s12879-015-1065-y.
- WHO International Scheme to Evaluate Household Water Treatment Technologies: P&G Purifier of Water Product Evaluation Report. World Health Organization; 2015.
- Darvesh N, Das JK, Vaivada T, et al. Water, sanitation and hygiene interventions for acute childhood diarrhea: A systematic review to provide estimates for the lives saved tool. BMC Public Health. 2017;17(4):776. doi:10.1186/s12889-017-4746-1.
- MacroTrends. Lilongwe, Malawi metro area population | Historical Data | Chart | 1950–2025. Accessed December 4, 2025.
https://www.macrotrends.net/datasets/global-metrics/cities/21799/lilongwe/population . - Null C, Stewart CP Pickering AJ. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: A cluster‑randomised controlled trial. Lancet Glob Health. 2018;6(3):e316–e329. doi:10.1016/S2214-109X(18)30005-6.
- Humphrey JH, Mbuya MNN Ntozini R. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: A cluster‑randomised trial. Lancet Glob Health. 2019;7(1):e132–e147. doi:10.1016/S2214-109X(18)30374-7.
- Cumming O, Arnold BF, Ban R, et al. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: A consensus statement. BMC Med. 2019;17(1):173. doi:10.1186/s12916-019-1410-x.
- Luby SP, Rahman M, Arnold BF, et al. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: A cluster randomised controlled trial. Lancet Glob Health. 2018;6(3):e302–e315. doi:10.1016/S2214-109X(17)30490-4.
- Kalembo FW, Zgambo M. Loss to Followup: A major challenge to successful implementation of prevention of mother‑to‑child transmission of hiv‑1 programs in sub‑Saharan Africa. ISRN AIDS. 2012; 2012:589817. doi:10.5402/2012/589817.
- Tweya H, Gugsa S, Hosseinipour M, et al. Understanding factors, outcomes and reasons for loss to follow‑up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Trop Med Int Health. 2014;19(11):1360–1366. doi:10.1111/tmi.12369.
- Herce ME Chagomerana MB, Zalla LC. Community‑facility linkage models and maternal and infant health outcomes in Malawi’s PMTCT/ART program: A cohort study. PLOS Med. 2021;18(9):e1003780. doi:10.1371/journal.pmed.1003780.
DOI: https://doi.org/10.5334/aogh.5322 | Journal eISSN: 2214-9996
Language: English
Page range: 64 - 64
Submitted on: Apr 21, 2026
Accepted on: Jun 19, 2026
Published on: Jul 14, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Hillary M. Topazian, Skyler Noble, Innocent Mofolo, Gertrude Mwale, Twambilie Phanga, Irving F. Hoffman, Michael E. Herce, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.