Overview (Nsanje)

The goals of this analysis are:

For given travel times (60, 90, 120 minutes) or geographical distances (5, 8, 10 km), estimate the proportion and number of PLHIV that can reach their closest ART facility. This is done on a district and traditional authority (TA) level.
Produce a gridded PLHIV prevalence map of Malawi using the WorldPop population density map and Naomi PLHIV estimates that supports the identification of locations that may be underserved.
Incorporate travel time maps that indicate the time and distance needed to reach the closest ART facilities, based on a combination of digital elevation and land cover maps as well as road layouts in Malawi.
Identify and propose new candidate facilities and locations for ART treatment scaling-up activities.

For the detailed methodology on how these maps were created, please refer to the supplementary material provided.

Download the full district report here.

Nsanje Maps

Population, PLHIV and Travel Times

Malawi Overview Map

Each pixel on the map corresponds to an area of 1km x 1km. Below we display a map of Malawi with some general information:

Population: population density using the WorldPop population density map, adjusted to the 2018 census numbers.
PLHIV: gridded prevalence estimates of the number of people living with HIV (“PLHIV density estimates”).
HIV Prevalence: estimated gridded HIV prevalence.
Geographical distance: direct distance (in km) to the closest ART facility.
Walking time: estimated travel time (in minutes) to the closest ART facility at a given pixel.

Additionally, it is possible to add markers with facility locations to the map:

ART Facilities: health facilities that provide ART services and had at least one patient on ART in 2020 (based on the DHA-MIS database).
- “Private for profit” facilities are excluded from the analysis.
- The number of ART patients in Q3/2020 is provided in the brackets.
Non-ART Facilities (Static): other (nonprofit) health facilities that do not currently provide ART facilities. (These include facilities that have indicated that they have capacity to provide ART services).

Time Thresholds

By comining the travel time maps with the gridded PLHIV prevalence, the number of PLHIV that is not reached within a certain time limit or distance (km) is computed. This is visualised in the below two maps, stratified by geographical distance and walking time.

Example interpretations:

Walking 15 minutes: this gives a map of the regions with PLHIV for which the closest facility is more than 15 mintues (walking time) away.
5km distance: this gives a map of the regions with PLHIV for which the closest facility is more than 5km (geographical distance) away.

TA analysis

To support the analysis, we have computed the proportion and number of PLHIV that are not reached within a given time or distance. Higher percentages correspond to a larger proportion of PLHIV that is not reached within the relevant area.

Candidate Facilities (60 Minutes)

Below we provide proposed facilities for scaling-up activities, illustrated on the maps. Green areas indicate additional PLHIV that can be reached through the proposed facilities within 60 minutes. Note: facility labels were aligned to district reports that were disseminated.

Summary Information

Summary estimates for Nsanje, September 2020.
Total PLHIV (all ages)	23,911 (20,112–28,392)
HIV prevalence, age 15-49 years	12.0% (10.1%–14.3%)
Total patients receiving ART	30,743
Average walking time to nearest ART (minutes)	47 (44–50)
Number PLHIV > 60 minutes walking time	5,944 (4,819–7,175)
Percentage PLHIV > 60 minutes walking time	25.5% (23.1%–28.0%)

Facility List

ART Facilities

List of active ART facilities that had at least 1 registered ART patient in September 2020. The column “ART” indicates how many ART patients are registered at the ART facility. Facilities outside the district boundaries that may be accessible to residents within the district are marked with “*“.
ID	District	TA	Name	Type	Authority	Long.	Lat.	ART
A1	Nsanje	Nsanje Boma	Nsanje District Hosp.	District hospital	Government	35.26	-16.92	5208
A2	Nsanje	TA Mlolo	Trinity Mission Hosp.	District hospital	CHAM	35.17	-16.42	2798
A3	Nsanje	TA Mbenje	Kalemba Community Hosp.	Health centre	CHAM	35.11	-16.58	2476
A4	Nsanje	TA Ndamera	Ndamera HC	Health centre	Government	35.22	-17.10	2075
A5	Nsanje	TA Mlolo	Masenjere HC	Health centre	Government	35.10	-16.34	1532
A6	Nsanje	TA Mbenje	Sorgin HC	Health centre	Government	35.01	-16.54	1504
A7	Nsanje	Nsanje Boma	Tengani HC	Health centre	Government	35.27	-16.92	1485
A8	Nsanje	TA Ngabu	Mbenje HC	Health centre	Government	35.22	-16.99	1365
A9	Nsanje	TA Mlolo	Makhanga HC	Health centre	Government	35.17	-16.52	1222
A10	Nsanje	TA Mbenje	Phokera HC	Health centre	Government	35.17	-16.63	860
A11	Nsanje	TA Mlolo	Sankhulani HC	Health centre	Government	35.26	-16.46	700
A12	Nsanje	TA Tengani	Nyamithuthu HC	Health centre	Government	35.20	-16.68	547
A13	Nsanje	TA Malemia	Chididi HC Nsanje	Health centre	CHAM	35.17	-16.92	419
A14	Nsanje	TA Ndamera	Lulwe HC	Health centre	CHAM	35.11	-17.09	396
A15*	Thyolo	TA Nsabwe	Thekerani HC	Rural/Community	Government	35.21	-16.32	2746
A16*	Thyolo	TA Changata	Changata HC	Health centre	Government	35.15	-16.23	1421
A17*	Thyolo	STA Mbawela	Zoa HC	Health centre	Government	35.20	-16.24	1219
A18*	Thyolo	TA Changata	St Martins Molere HC	Health centre	CHAM	35.14	-16.22	1011
A19*	Thyolo	STA Mbawela	Mapanga Mat.	Special	CHAM	35.20	-16.28	875
A20*	Thyolo	STA Thukuta	Gombe HC	Health post	Government	35.23	-16.38	784
A21*	Thyolo	TA Kwethemule	Makwasa Estate Clinic	Health centre	Private	35.11	-16.19	100

Non-ART Facilities

List of non-ART facilities considered in the analysis. The column “PLHIV” indicates the number of PLHIV that currently need more than 60 minutes to walk to the closest ART facility but less than 60 minutes to the listed health facility in the table. Facilities outside the district boundaries that may be accessible to residents within the district are marked with “*“.
ID	District	TA	Name	Type	Authority	Long.	Lat.	PLHIV	95% CI
F1	Nsanje	TA Tengani	Mkango HP	Health Post	Government	35.30	-16.82	510	(326-734)
F2	Nsanje	TA Makoko	Ching’oma HP	Health Post	Government	35.11	-17.00	503	(304-752)
F3	Nsanje	Mwabvi Game Reserve	Misamvu HP	Health Post	Government	35.05	-16.76	114	(57-197)
F4	Nsanje	TA Ndamera	Kamphata HP	Health Post	Government	35.22	-17.05	57	(39-79)
F5	Nsanje	Mwabvi Game Reserve	Kanyimbi HP	Health Post	Government	34.97	-16.69	66	(30-125)
F6	Nsanje	TA Ndamera	Nkhande HP	Health Post	Government	35.16	-17.11	43	(30-61)
F7	Nsanje	TA Mlolo	Mchacha HP	Health Post	Government	35.16	-16.49	37	(26-51)
F8	Nsanje	TA Mlolo	Mlolo HP	Health Post	Government	35.15	-16.42	19	(14-24)
F9*	Thyolo	TA Nsabwe	NKHATAOMBERE	Health Post	Government	35.26	-16.32	345	(234-487)
F10*	Thyolo	TA Nsabwe	Nsabwe HC	Dispensary	Government	35.20	-16.34	40	(31-51)
F11*	Thyolo	STA Mbawela	Mbalanguzi HC	Health Centre	CHAM	35.17	-16.25	15	(11-19)
F12*	Thyolo	STA Thukuta	THUKUTA	Health Post	Government	35.26	-16.39	9	(6-13)
F13*	Thyolo	TA Changata	Molere HC	Special	Government	35.14	-16.22	0	(0-0)
F14*	Chikwawa	TA Makhwira	Mitondo HP	Health Post	Government	35.06	-16.27	1118	(770-1570)
F15*	Chikwawa	STA Masache	THENDO	Health Post	Government	34.88	-16.67	161	(80-291)
F16*	Chikwawa	TA Ngowe	MWANAWANJOBVU	Health Post	Government	35.03	-16.52	59	(40-82)

Distances and travel times to ART facilities for PLHIV

March 2022