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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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We are indebted with Marnix Medema, Paul Straight and Sean Rovito, for useful discussions and critical reading of the manuscript, as well as with Alicia Chagolla and Yolanda Rodriguez of the MS Service of Unidad Irapuato, Cinvestav, and Araceli Fernandez for technical support in high-performance computing. This work was funded by Conacyt Mexico (grants No. 179290 and 177568) and FINNOVA Mexico (grant No. 214716) to FBG. PCM was funded by Conacyt scholarship (No. 28830) and a Cinvestav posdoctoral fellowship. JF and JFK acknowledge funding from the College of Physical Sciences, University of Aberdeen, UK.