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Acknowledgements This article was based on the first author’s PhD which was financed by the Malawi Health Research Capacity Strengthening Initiative. We thank Mr Patrick Naphini formerly of the Ministry of Health and Mrs Mafase Sesani at CHAM Secretariat for helping with the data. We also thank Mr Jacob Mazalale for useful comments on the article.

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K.S.N. wishes to thank the Council of Scientific and Industrial Research [No. 03(1264)/12/EMR-11] Government of India for the financial support.

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