Leveraging Stakeholder Engagement for Adolescent School Journeys in Malawi: An Exploration of Road Safety and Air Pollution Interventions.

Road traffic injuries (RTIs) and air pollution present dual burdens that disproportionately affect school-going children in low-income urban settings like Malawi. Despite availability of evidence-based interventions, their implementation often overlooks local contexts and perspectives. This study aimed to elicit stakeholder input on interventions addressing RTIs and air pollution exposure among children in urban Blantyre through stakeholder engagement. It used a mixed method Delphi technique combining expert consultations with community focus groups to achieve consensus on interventions. Successive rounds of prioritization and qualitative discussions explored contextual barriers and facilitators to implementation. Stakeholders identified 40 interventions, 23 for road safety and 17 for air pollution. Measures prioritized by experts included speed limit enforcement, pedestrian infrastructure improvements, and emission controls. Contextual barriers identified by experts and the community included socio-political and financial constraints. Community perspectives emphasized behavioral interventions, while experts highlighted systemic and legislative changes. The study underscored the value of combining expert and community perspectives to design context-sensitive interventions. Synergies between road safety and air pollution interventions offer opportunities for dual benefits but require careful adaptation to urban Malawi's realities. This study provides a model for participatory design in low-income settings, emphasizing stakeholder engagement for tailored solutions.