Introduction Digital Health systems (DHS) have the potential to strengthen healthcare delivery, yet their adoption remains limited in many low-and middle-income countries. Despite progress in digital health implementation, Malawi continues to face challenges related to effective use of DHS. This study investigates the key factors influencing healthcare workers' intention to use DHS in Malawi. Methods This was a cross-sectional quantitative design that used a structured questionnaire to collect data from a sample of 615 healthcare workers across Malawi. Factor analysis and reliability testing were conducted to assess construct validity and internal consistency. Multiple linear regression was used to identify factors influencing intention to use DHS, while generalized structural equation modelling (GSEM) examined relationships involving categorical variables. Results The results indicated that healthcare workers' intention to use DHS is influenced by several factors including, perceived ease of use ((3 = 0.358, p <0.001), perceived usefulness ((3 = 0.284, p = 0.001), job relevance ((3 = 0.274, p = 0.001) and subjective norms ((3 = 0.127, p <0.001). These findings suggest that healthcare workers are more likely to use DHS when they perceive them as useful, relevant to their daily work, easy to use, and are supported by their peers. In contrast, computer anxiety indicated a significant negative effect ((3 = -0.061, p = 0.001), suggesting that higher levels of computer anxiety reduce the likelihood of DHS use. Demographic and contextual factors, including gender, age, and education level were not significant factors influencing DHS. Conclusion These findings highlight the importance of aligning digital health systems with healthcare workers' job roles, ensuring system usability, and leveraging social influence to promote adoption. Addressing computer anxiety through targeted training and capacity building may also enhance digital confidence and sustained system use.

Background Empirical studies examining healthcare professionals’ attitudes and behavioral intentions toward digital health systems remain scarce in Malawi. This lack of context-specific evidence limits the ability of policymakers and system developers to design and implement digital health solutions that align with users’ needs and professional realities. Addressing this gap requires an adapted context specific technology acceptance model (TAM) that integrates established theoretical constructs with factors relevant to healthcare practice in Malawi. This study aimed to develop and empirically validate context-specific adapted technology acceptance framework for digital health system (DHS) adoption among healthcare professionals in Malawi. Methods A cross-sectional quantitative study was conducted through a sample of 615 healthcare workers from public and private health facilities across Malawi. Data were collected using a structured questionnaire informed by TAM2 and TAM3 constructs which included, perceived usefulness, perceived ease of use, job relevance, subjective norm, descriptive norm, computer anxiety and intention to use DHS. The study also included context specific social factors including computer use and training. Structural Equation Modelling (SEM) was used to examine relationships among constructs and intention to use DHS. Results Results indicated that perceived usefulness (β = 0.154, p = 0.043) and perceived ease of use (β = 0.281, p < .001) were significant positive predictors of intention to use digital health systems. Computer anxiety (β = -0.129, p < .001) had a significant negative direct effect on adoption intention and an indirect positive effect through perceived ease of use (β = 0.015, p = 0.039). Social and task-related factors influenced adoption indirectly via perceived usefulness. The adapted model demonstrated good model fit (CFI = 0.979, TLI = 0.973, RMSEA = 0.046). The model also demonstrated adequate explanatory power, with R² values for the endogenous constructs ranging from 0.4 to 0.778. Conclusion The adapted TAM framework validates the original TAM and extends its explanatory power by providing a contextual relevant understanding that improve digital health system adoption in resource-limited settings. While earlier models acknowledge the role of computer anxiety, this study provides empirical evidence of both direct and indirect pathways, thereby extending existing adoption models. This study suggests that policies and digital health programs in low-resource settings should prioritize usability-focused system design and targeted capacity-building interventions to address computer anxiety, rather than relying solely on technology availability.

Introduction: Although Malawi has expanded various digital health initiatives under its National Digital Health Strategy, there is still limited research on how prepared frontline healthcare workers really are to adopt and use Digital Health Systems (DHS). Most previous studies have focused on system level improvements in data reporting rather than on the experiences and preparedness of the users themselves. This is a major gap as healthcare workers’ level of preparedness directly influences system performance, and data quality. This study assessed healthcare workers’ preparedness to adopt DHS in Malawi.Methods: A cross-sectional study was conducted using a structured questionnaire administered to 615 healthcare workers in selected districts across the three regions of Malawi. Key TAM constructs were analysed using descriptive statistics and binary logistic regression.Results: Overall preparedness levels among healthcare workers for DHS adoption were high. Behavioural intention (94.3%), job relevance (94.1%), and subjective norms (92.1%) recorded the highest scores. Significant predictors of adoption were behavioural intention (OR = 2.67, p < 0.001), job relevance (OR = 2.12, p < 0.001), perceived usefulness (OR = 1.85, p = 0.002), and subjective norms (OR = 1.58, p = 0.014). Majority of respondents from the Southern region reported having attended DHS training compared tothose from the Northern region (OR = 2.337, 95% CI:1.549-3.097, p < 0.001), while no significant difference was observed for the Central region (p = 0.330). A higher proportion of male respondents reported having previously attended digital health training compared to female respondents (OR = 1.496, p = 0.019).Conclusion: Motivational and social factors are the main predictors of DHS adoption in Malawi, while technical capacity remains a challenge. To ensure successful implementation and scale-up of digital health initiatives in Malawi, policymakers and health managers should focus on strengthening and improving user training, improving access to computers and reliable internet within health facilities, and promoting a supportive organisational culture.

[This corrects the article DOI: 10.1016/j.ssmqr.2025.100615.].

Introduction:While computer experience is often considered a key determinant of digital health adoption, psychological factors such as computer anxiety may play an equally important role. This study examined the relative contributions of computer experience and computer anxiety to digital health adoption intention among healthcare workers in Malawi. Methods:A cross-sectional survey was conducted among 615 healthcare workers in Malawi. The primary outcome variable was digital health adoption intention, while key explanatory variables included computer anxiety and Computer experience. Internal consistency was assessed using Cronbach's alpha. Bivariate associations were examined using Welch's t-tests and chi-square tests, while Pearson correlation analysis was used to assess relationships among key variables. Hierarchical linear regression models were estimated to evaluate the independent effects of computer experience and computer anxiety on digital health adoption intention. Results:Participants reported high digital health adoption intention (mean = 6.52, SD = 1.02) and relatively low computer anxiety (mean = 2.08, SD = 1.33). Compared with healthcare workers with low digital health system adoption intention, those with high adoption intention were more likely to have received DHS training (42.3% vs. 32.8%, p = 0.021), reported longer computer use experience (9.2 vs. 7.9 years, p = 0.010), and exhibited lower computer anxiety scores (1.77 vs. 2.49, p < 0.001). In hierarchical regression analyses, computer experience variables explained only 1.1% of the variation in adoption intention (R2 = 0.011), whereas computer anxiety alone explained 6.9% (R2 = 0.069). After adjusting for computer experience, age, gender, qualification, occupation, and experience, computer anxiety remained the only significant predictor of adoption intention (β = -0.212, 95% CI: -0.277 to -0.147, p < 0.001). Conclusions:The findings of the study suggest that interventions aimed at reducing computer anxiety play a critical role in improving the acceptance and sustainability of digital health systems in resource-constrained healthcare settings.

BackgroundIn Malawi, community health workers known as Health Surveillance Assistants (HSAs) can facilitate access to contraception through rural outreach. Self-injectable contraception also shows promise to facilitate contraceptive access, as women can store doses and re-inject on their own. We previously developed the Ndingathe ("I Can") intervention via human-centered design to strengthen contraception outreach by addressing HSAs' workflow challenges and enhancing self-injection (SI) counseling and support for interested clients. We piloted Ndingathe in two rural districts from June to December 2023.MethodsTo assess the feasibility, acceptability, and potential effectiveness of Ndingathe, we conducted: pre- and post-surveys with 60 HSAs; 450 surveys with clients at HSAs' community outreach clinics; interviews with 40 clients, 20 HSAs, four health system stakeholders, and 20 experienced SI users who supported clients; and 20 observations of outreach clinics. We analyzed quantitative data using descriptive and inferential statistics. We conducted a thematic analysis of qualitative data.ResultsIntervention components aimed at improving HSAs' workflow, including bicycles, lunch allowances, and workflow planning templates, were well-received by HSAs and health system stakeholders, and appeared to improve outreach clinic frequency and duration: the percentage of HSAs reporting conducting at least one outreach clinic per week rose from 65% to 95% after the pilot and observations suggested outreach clinic hours extended into the afternoon, instead of ending before lunch, which clients appreciated. HSAs' average scores on the Role Conflict and Ambiguity in Complex Organizations and Role Overload Scales decreased after six months (2.9 to 2.3, p < 0.0001 and 3.7 to 3.0, p < 0.001, respectively). Both HSAs and clients positively received Ndingathe's SI mnemonic, designed to aid memory of SI steps, and support from experienced SI users during counseling. Clients' median self-reported fear of needles decreased from 3 (of 4) to 1 after interacting with an experienced user (p < 0.001). Clients felt reassurance when experienced SI users visited their homes for follow-up visits, conducted without HSAs, to offer support for SI. Challenges during the pilot included delays in lunch allowance disbursement, which impacted HSAs' morale and ability to expand outreach clinic hours.ConclusionThe Ndingathe intervention was feasible and acceptable from the viewpoint of multiple stakeholders in rural Malawi. Pilot findings suggest the intervention has the potential to improve contraception accessibility and reduce fear of self-injectable contraception.

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.

Introduction:Self-injection (SI) for contraceptive use is recommended for its proven ability to empower women and overcome barriers to contraceptive access. The World Health Organization endorsed SI as a self-care approach in 2019. Despite the increase in Malawi's modern contraceptive prevalence rate from 38.1% in 2012 to 48.9% in 2020, it remains below the government's 60% target. Injectable contraceptives, including depot medroxyprogesterone acetate subcutaneous (DMPA-SC), introduced in 2018, are the most popular contraceptive method in Malawi, particularly among adolescents, representing 49.8% of the contraceptive method mix. However, utilization of SI remains limited, especially in rural areas where access challenges persist. This study explores the behavioral drivers influencing women's decision to use self-injectable contraception provided by community health surveillance assistants (CHSA) in rural Malawi. Methods:Using the capability, opportunity, motivation-behavior model, the study analyzed drivers of DMPA-SC SI adoption among 60 women aged 15-45 years in two rural districts, Mulanje and Ntchisi. Data were collected through in-depth interviews on women's experiences with contraceptives, including SI. Results:Women's capability was strengthened as CHSAs addressed initial hesitation through practical demonstrations. Opportunity improved through enhanced access, trust, and privacy. Motivation increased with counseling, reduced travel costs, and CHSAs' support, encouraging women to adopt self-injection confidently and consistently. Discussion:Women's decisions to adopt SI were shaped by capability, motivation, and opportunity, with CHSAs playing a pivotal role. Future family planning programs should prioritize CHSAs' training and deployment to improve SI uptake, fostering autonomy and accessibility for rural women.

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.

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.

Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

Potentially toxic metals and trace elements have been used in Malawi for a long time. However, data on exposure to these elements by susceptible groups like pregnant women and its associations with reproductive health outcomes in Malawi and southern hemisphere is limited. We investigated the concentrations of potentially toxic metals as well as trace elements in pregnant women and assessed the relationship between the levels these elements in maternal blood and sociodemographic factors, dietary habits and birth outcomes. Maternal data was collected from 605 pregnant women. Provider administered questionnaire was used to collect data on maternal sociodemographic factors, life style and immediate birth outcomes. Maternal venous blood samples were collected from 506 pregnant women in southern Malawi between August 2020 and July 2021. An inductively coupled plasma mass spectrometry (ICP-MS) technique was used to analyse maternal blood samples for concentrations of arsenic (As), copper (Cu), lead (Pb), mercury (Hg), nickel (Ni), selenium (Se) and zinc (Zn). Maternal age emerged as the primary predictor for Cu (p = 0.023), As (p = 0.034) and Hg (p = 0.013) blood concentrations, followed by area of residence, which had significant impact on Ni (p = 0.024) and As (p < 0.001) concentrations. High maternal blood concentrations of Ni were associated with increased birth weight (p = 0.047), birth length (p = 0.026), head circumference (p = 0.029) and gestational age (p = 0.035). Negative associations were observed between maternal whole blood total arsenic (combining organic and inorganic As) concentration and neonatal birth length (p = 0.048) and head circumferences (p < 0.001). Similarly, higher maternal blood Pb concentrations were associated with smaller head circumference (p = 0.002) and birth weight (p = 0.016). This study demonstrates the need to introduce biomonitoring studies in Malawi and countries with similar settings in the global south.

This is a good study that investigated knowledge, practices, and factors affecting the sunlight exposure of infants among women attending Debre Tabor Comprehensive Specialized Hospital in Ethiopia.The manuscript is fairly prepared but could be strengthened as follows;1: Topic -The topic and the study focus are different.The topic talks about maternal misconceptions… while the study has dealt with maternal characteristics or factors determining sunlight exposure of babies.This needs to be corrected. 2:The study design is cross-sectional, but the statement should be strengthened by also indicating that it followed the "quantitative research paradigm."3: On the results and the associated conclusion, overall knowledge was 77.8%, and 73% of the women practiced daily; and 67.5% and 62.1% had knowledge and practiced, respectively.However, the authors conclude that there was no good knowledge and practice

Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences—including those with and without experience using SI—view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

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.

Establishing and proving methodological rigor has long been a challenge for qualitative researchers where quantitative methods prevail, but much published literature on qualitative analysis assumes a relatively small number of researchers working in relative proximity. This is particularly true for research conducted with a grounded theory approach. Different versions of grounded theory are commonly used, but this methodology was originally developed for a single researcher collecting and analyzing data in isolation. Although grounded theory has evolved since its development, little has been done to reconcile this approach with the changing nature and composition of international research teams. Advances in technology and an increased emphasis on transnational collaboration have facilitated a shift wherein qualitative datasets have been getting larger and the teams collecting and analyzing them more diverse and diffuse. New processes and systems are therefore required to respond to these conditions. Data for this article are drawn from the experiences of the Innovations for Choice and Autonomy (ICAN) Research Consortium. ICAN aims to understand how self-injectable contraceptives can be implemented in ways that best meet women's needs in Kenya, Uganda, Malawi, and Nigeria. We found that taking a structured approach to analysis was important for maintaining consistency and making the process more manageable across countries. However, it was equally important to allow for flexibility within this structured approach so that teams could adapt more easily to local conditions, making data collection and accompanying analysis more feasible. Meaningfully including all interested researchers in the analysis process and providing support for learning also increased rigor. However, competing priorities in a complex study made it difficult to adhere to planned timelines. We conclude with recommendations for both funders and study teams to design and conduct global health studies that ensure more equitable contributions to analysis while remaining logistically feasible and methodologically sound.

BACKGROUND:Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi.METHODS:A descriptive cross-sectional study that used mixed methods was conducted in three hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part.RESULTS:From the qualitative data, three themes emerged around the following areas: experienced effects, support offered, and women's perceptions. Most women liked misoprostol and reported that the treatment was helpful and effective in expelling retained products of conception. Quantitative data revealed that the majority of participants, 376 (94%) were satisfied with the support received, and 361 (90.3%) believed that misoprostol was better than surgical treatment. The majority of the women 364 (91%) reported they would recommend misoprostol to friends.CONCLUSIONS:The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women.

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.

Aquaculture has the potential to supplement the dwindling fish catches from the wild sources to feed the ever-growing human population. This chapter describes the genesis of genetic improvement research in aquaculture. The biology of aquatic organisms, which shows high genetic variability and their high fecundity coupled with a short generation interval has facilitated rapid progress with genetic improvement programs. Initially the genetic improvement research concentrated on strategies that led to the exploitation of the additive genetic and heterosis components, as well as using techniques such as chromosome set manipulation, gene transfer, and molecular techniques. The target aquaculture species have been the major carps, rainbow trout, salmonids, tilapias, catfishes, and other marine species of aquaculture importance. The targeted traits in these species have been growth, age to maturation, disease resistance, and tolerance to extreme environmental conditions. Most of the progress in genetic improvement has been achieved with selective breeding which has exploited the genetic component of the species. However, all the other genetic improvement strategies have laid a foundation for genomics studies in aquaculture. This chapter discusses the various techniques in fish genetics, breeding, and genomics, from structural to functional genomics, and their application during marker-assisted selection. It is apparent that using a combination of the breeding strategies, the vast genetic variation in the aquaculture species can be exploited to increase and sustain aquaculture production.