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- ItemRestrictedAcceptability of covid-19 vaccine and its associated factors among the elderly aged 65 and above in Machinga district(Kamuzu University of Health Sciences, 2022-02-02) Mbukwa, KettieThis is a cross-sectional study aimed at exploring the acceptability of COVID 19 vaccine and its associated factors among elderly aged 65 years above in Machinga and it will employ qualitative methods. For its thematic analysis, the study will use a Health Belief Model to analyze the factors that influence the acceptance of COVID 19 vaccine among elderly and which beliefs should be targeted in communication campaigns to cause positive health behaviors. Problem: COVID 19 remain a crucial global pandemic and leading cause of high morbidity and mortality rate among higher risk population. With the development of multiple effective vaccines, reducing the global morbidity and mortality of COVID-19 will depend on the distribution and acceptance of COVID-19 vaccination, while studies generally indicate a low uptake of COVID 19 vaccine among various population, Vaccine hesitancy and refusal are global concerns. According to World Health Organization (WHO) it has been identified as one of the top 10 threats to global health in 2019. Available data for Machinga District by July 2021 it shows that only 3637 received COVID 19 vaccine and only 408 elderly 65 years and above received the vaccine, since the roll out however the vaccine acceptance among elderly is still low. The correct and comprehensive beliefs of the target groups regarding the benefits and barriers of the vaccination must be raised. Various effective social strategies must be adopted to trigger the intention of COVID-19 vaccination. Objectives. – The main objective is to explore the acceptability of Covid 19 vaccine among elderly (aged 65 years above) in Machinga district. Specifically, the study seeks to assess the perceptions, attitude towards Covid 19 vaccine, to assess contextual factors that facilitate and impede the acceptance of Covid 19 vaccine, to assess the health system factors that influence the acceptance of Covid 19 vaccine. Methodology. - A qualitative study design will be used to explore the acceptability of COVID19 vaccine and its associated factors among the elderly people of 65 years above in Machinga District. Study population will include the elderly 65 years and above, residing in both urban and rural communities, both male and female. The sample size will be 36 and the study participants will be purposively selected. The study will collect data in participants own setting using in depth interviews (IDIs) and Key informant Interviews (KII). Collected data will be stored securely in computer data base that have a pass word and only limited access to key study team will be provided. Data analysis will be done using deductive and inductive thematic content analysis. Informed consent will be obtained from each and every study participant before enrollment in the study. Confidentially will be ensured throughout the study and thereafter. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC). Expected findings. –The study anticipates to identify the factors that act as barriers as well as factors that act as facilitators to the uptake of COVID -19 vaccine among the elderly at individual, social as well as health system levels. Dissemination of Expected findings: Research results will be disseminated in writing and presentations as feedback made to the District Health Management Team (DHMT) for Machinga and to COMREC. Recommendations will be made to various level of decision makers, DHOs office and key implementing partner on improvements that need to be made to optimize uptake of COVID 19 vaccine.
- ItemRestrictedThe African Covid-19 critical care outcomes study (ACCCOS)(Kamuzu University of Health Sciences, 2020-10-08) Kachitsa, Clement PreciousTYPE OF STUDY Multi-centre prospective observational cohort study. PROBLEM The infectious disease COVID-19, caused by coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has been declared a pandemic and an international healthcare emergency by the World Health Organization (WHO). It has spread across the globe, overwhelming healthcare systems by causing high rates of critical illness. Mortality from COVID-19 exceeds 4%, with older people with comorbidities being extremely vulnerable. It is expected that between 50-80% of the world’s population may contract SARS-CoV-2 over the next two years. In Africa there is a limited workforce and there are limited intensive care facilities and critical care resources across to provide sufficient care. It is important therefore to establish what resources, comorbidities and interventions are potentially associated with either mortality or survival in patients with COVID-19 who are referred for critical care in Africa. Rapid dissemination of these findings may help mitigate mortality from COVID-19 in critical care patients in Africa. These points provide the rationale for the African COVID-19 Critical Care Outcomes Study (ACCCOS). STUDY OBJECTIVES The main objectives of this study are to identify critical care resources associated with survival, identify patient comorbidities and other risk factors associated with in-hospital mortality and to identify in hospital interventions associated with in-hospital survival in patients with suspected or known COVID-19 in Africa. METHODS An African multi-centre retrospective and prospective observational cohort study of adult (≥18 years) patients referred to critical care or high-care units with suspected or known COVID-19 infection. Patient follow up will be for a maximum of 30 days in-hospital. The intention is to provide a representative sample of the mortality and the risk factors associated with mortality in adult patients with suspected or known COVID-19 referred for critical care in Africa. This study will run between Aprils to December 2020. EXPECTED FINDINGS AND DISSEMINATION We expect the outcomes to be potentially worse in Africa, because firstly, there is a limited workforce, and secondly there are limited intensive care facilities and critical care resources across Africa to provide sufficient care. A report of the research findings will be submitted to the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences research committee, the University research and publication committee, the Lancet Commission and the Ministry of Health.
- ItemRestrictedAn analysis of enteric pathogens among HIV infected individuals with and without diarrhea at Queen Elizabeth Central Hospital(Kamuzu University of Health Sciences, 2022-08-17) Nyirenda, JamesEastern and Southern Africa bears the blunt of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Virus Syndrome (AIDS) pandemic having about 54% of world’s HIV/AIDS infected individuals coming from this region. Diarrhea is one of the most common complications of HIV with 80% of all HIV/AIDS infected individuals developing this condition. There is an association between CD4+ T cell count and presence of opportunistic infections. Management of diarrhea in developing countries including Malawi depends on empirical administration of drugs, mostly antibiotics. This is often times due to lack of proper diagnostic capability to determine full profile of enteric pathogens that are likely to contribute to diarrhea for particular patients. Objective: To identify and determine entero-pathogens which are likely contributors of diarrhea among HIV infected individuals in Malawi. Specific Objectives: Determine the profile of enteric pathogens across HIV infected individual with and without diarrhea. To identify pathogens detected in diarrheagenic amounts among HIV infected individuals with and without diarrhea. To determine if the antibiotic prescribing pattern among clinicians covers enteropathogens detected using TaqMan array card. To determine if there is an association between CD4 T cell count and type of pathogens detected in HIV positive individuals with and without diarrhea. Methods: This study will be nested in a phase 2A clinical Trial investigating the safety and efficacy of Clofazimine for treatment of Cryptosporidiosis among HIV+ adults. Two arms of study participants will be used to answer our questions; 22 HIV infected individuals with diarrhea and 10 infected individuals without diarrhea. TaqMan array based polymerase chain reaction (PCR) was used to detect multiple enteric pathogens from stool samples in the main study. In this study threshold cycle (Ct) values and pathogens detected from each group will be analyzed and used to determine the mostly likely pathogen contributing or causing diarrhea. In addition CD4 T cell values and profile of identified entero-pathogens will be analyzed to determine if level of an individual’s immunity plays a role in profile of enteric pathogens among HIV infected individuals. Furthermore, antibiotics that were administered to manage diarrhea will be analyzed to determine whether it necessary for treating the type of pathogens detected. Study Place: Data analysis and investigations will be conducted at the College of Medicine Department of Pathology and college of medicine Library. Expected outcome: We expect to identify enteric pathogens that are more likely than others to contribute to diarrhea among HIV infected individuals. We will identify pathogens and make profile of pathogens in relation to CD4 T cell values. This data will be essential for policy formulation for management of diarrhea in HIV infected adults since treatment is mostly empirical in developing countries such as Malawi due to poor diagnostic capacity.
- ItemRestrictedAssessing determinants of access to HIV and STI preventive services among female sex workers in Mwanza district, Malawi(Kamuzu University of Health Sciences, 2021-05-21) Kasom, StevenType of the study The study is a cross-sectional, it will employ quantitative methods. Problem In Malawi studies on factors influencing the access to HIV/STI preventive services using provider and facility-based approaches have been done. In response to these studies Hybrid approaches on service provision have been employed and yet only around 30% of FSWs are currently accessing the preventive services in Malawi including Mwanza district. This study will use the Client centered conceptual framework to identify the gap in determinants from the client‘s perspective. Objectives The broad objective; To assess the determinants of access to STIs and HIV prevention services among female sex workers in Mwanza district. The specific objectives include; To determine approachability of HIV and STI prevention services among female sex workers in Mwanza district. To measure acceptability of HIV and STI prevention services among female sex workers in Mwanza district. To determine availability of HIV and STI prevention services among female sex workers in Mwanza district. To assess affordability of HIV and STI prevention services among female sex workers in Mwanza district. To assess appropriateness of HIV and STI prevention services among female sex workers in Mwanza district. Methodology This study is a cross-sectional study. Time-location sampling will be done and 309 female sex workers who have lived in Mwanza district for at least 3 months will be included. Face to face interviews using structured questionnaire will be employed. Logistic regression analysis will be done using SPSS. And results will be presented in graphs and tables. Expected findings and dissemination The study is expected to reveal the factors that influence the access to HIV/STIs preventive services among FSWs in this district. With the involvement of COMREC the results will be disseminated through College of Medicine research conference, publication in a journal, the report will also be presented and handed over to Mwanza district assembly.
- ItemRestrictedAssessing factors associated with attrition among older adults on antiretroviral therapy in Malawi(Kamuzu University of Health Sciences, 2021-10-18) Londo, MathiasType of research study: This quantitative study will employ a retrospective observational cohort design. The problem: Access to HIV services among adults aged ≥50 is compromised due to the stereotypes surrounding their perceived low susceptibility to HIV. This leads to minimal interventions targeting them as well as low follow-up for them after ART initiation. In SSA, attrition after ART initiation ranges from 23.4% to 57% and is mainly due to either death or loss to follow-up. Polypharmacy, drug toxicities, and co-infections increase the risk of attrition among older adults. However, most HIV interventions primarily focus on populations aged 15-49 and children neglecting those aged ≥50. There is still inadequate information on levels of attrition and associated factors among these adults, hence the need for this study. Broad objective: To assess attrition after antiretroviral therapy initiation among adults at Nkhatabay district hospital. Specific objectives • To compare levels of attrition between older and younger adults 24 months after ART initiation • To determine the predictors of mortality and loss to follow up among older adults 24 months after ART initiation. Methodology: The study will be a quantitative retrospective observational cohort design. The study will analyze outcomes of adults aged 15-49 and those aged ≥50 initiated on ART between 2015 and 2019 at Nkhatabay District Hospital. The sample size will be 208 and participants will be selected using a simple random method. Data will be collected using patients' master cards and ART registers. Data analysis will be done using STATA 14.0. Attrition post ART initiation will be determined by the Kaplan-mier survival function. Cox proportional hazard model will be used to measure factors associated with attrition. Expected findings and their dissemination: It is expected that there will be variations in attrition levels post ART initiation between older and younger adults. Predictors of attrition among older adults will be ascertained. The study findings will be shared with the College of Medicine Research. Committee (COMREC), Nkhatabay District Office, the library of COM, and the Department of HIV/AIDS at the Ministry of Health. The results will also be published and presented at research conferences.
- ItemRestrictedAssessing factors associated with full immunization in under one children in Dedza district, Malawi(Kamuzu University of Health Sciences, 2021-06-03) Banda, Rudolf ZinkandaExecutive Summary Type of Study This is a community based cross-sectional study which shall employ a quantitative research approach. The study targeting mothers or caregivers with children aged 12 to 23 months will be conducted in Dedza. Problem Statement / Rationale In Malawi, 76% of children under two years received all basic vaccinations and 70% received basic vaccinations by age of 12 months and fully immunized coverage in under one children in Dedza district is at 49% which is far below the national target of 85%. Studies on the factors associated with full immunization coverage in under one children have been conducted elsewhere. However, there is need to conduct this study since the areas where the studies mentioned here could have different cultural beliefs, setting and socio-economic status. Therefore, this study is aimed at assessing factors associated with fully immunized under one children in Dedza. Methodology Primary data will be collected from mothers or caregivers with children aged 12 to 23 months using a structured questionnaire, processed and analysed using STATA 14.0. Numbers and percentages will be used to estimate the proportion for each indicator. The main outcome variable will be the full immunization (children that received all the basic vaccines in a correct schedule and within the first year of life) and the independent variables are the socio demographic factors like age, children birth order, level of education, time taken to reach the clinic, occupation, tribe and place of delivery, income, knowledge and the vaccination reminders. Percentage and Means and Logistical Regression for binary outcome (fullyimmunized) will be used. Pearson’s Chi-square test and T-test will be used for categorical and continuous variables respectively. to assess the relationship between the explanatory variables and the outcome variable. Logistic regression will be used to establish the effects of a variable on the outcome and minimizing the effects of potential confounders. Multiple regression analysis will be used to explain the variations of the many factors with the outcome and determining the relationship between the independent factors and the outcome variables. Commented [U3]: Response to Q 4 03-Jun-2021Rudolf Zinkanda Banda MEP Student Research Proposal, May 10, 2021, Third Version 15 | P a g e Expected Findings It is expected that Mothers with children 12-23 months will indicate factors that hinder immunization coverage in the district. Dissemination The results will be shared with COMREC for them to have a record on the findings of the proposed study and to check if ethical and scientific procedures. The findings will also be shared with the Malawi Medical Journal, Malawi Ministry of Health, through the Director of Health and Social Services. A presentation will be made to the College of Medicine through the Research Dissemination Meeting to share the findings.
- ItemRestrictedAssessing factors that influence the uptake of youth friendly HIV testing and counselling services in Blantyre district(Kamuzu University of Health Sciences, 2021-03-04) Phiri, Kate ChimwemweType of study This is a cross-sectional study Study Problem Youth Friendly Health services have existed in Malawi since 2007, yet uptake of the HIV Testing and counselling services among young people in Blantyre district remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their uptake from the perspective of young people, youth friendly health personnel, parents and community leaders. Broad objective To assess factors that influence uptake of Youth Friendly-HIV Testing and Counselling services in Blantyre urban Specific objectives i. To identify individual specific factors that influence uptake of HTC services in Blantyre urban ii. To determine health service factors that influence the uptake of HTC services among young people aged 18-24 in Blantyre urban. iii. To identify community factors that influence uptake of HTC services among young people aged 18-24 in Blantyre urban Methodology Qualitative research methods will be used. It will invove having six focus group discussions with young people aged 18-24, parents and community leaders, 20 in-depth interviews and 4 key individual interviews from Ndirande and Chilomoni health facilities in Blantyre urban. The study findings will be analyzed using thematic framework method whereby codes and themes will be identified in line with study objectives as well as inductively from the data. Study constraints The possible constraints of the study include the refusal of individuals to participate in the study and inability to meet the required sample size of study participants at study areas. Expected findings and their dissemination The study anticipates to discover- Individual, community and health system factors influencing HIV testing and counselling uptake among young people in Blantyre urban. The study findings will be disseminated to COMREC and College of Medicine. Copies of research will also be submitted to Ndirande and Chilomoni health facilities as study sites. The research findings will be published and shared with different HIV and AIDS stakeholders for policy, strategy review and plans reprogramming.
- ItemRestrictedAssessing prevalence and determinants of routine viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy at Dedza District Hospital.(Kamuzu University of Health Sciences, 2021-07-15) Chinthola, WellingsStudy type: This will be a descriptive quantitative cross-sectional study. Background Increased maternal viral load poses a serious health risk of mother to child transmission of HIV and increased morbidity and mortality to both pregnant and breastfeeding women. As part of prevention of mother to child transmission of HIV, both WHO and UNAIDS recommend vial load monitoring to all eligible client on ART at six months, 12 months and then every 12 months thereafter if the patient is stable on ART. Viral load monitoring plays a pivotal role in assessing treatment outcome, early detection of treatment failure and determining treatment failure. Currently, Malawi is using 4th edition of clinical management of HIV in adults and children of 2018. This is being used hand in hand with 2019 policy updates addendum to the 4th edition which came into force from April, 2019. The updated guidelines on routine monitoring of viral load recommends viral load testing at six months after starting ART, at 12 months and then every 12 months from the last test if the patient is stable on ART. This is different from the previous edition that was recommending routine monitoring of viral load at 6 months, 2years, 4yrs and then every 2years from the previous test. Problem Dedza District Hospital is one of the facilities that offers a wide range of ART and PMTCT services. It is estimated that more than 800 women are enrolled in PMTCT programme annually. Despite the reported positive progress on the increased number of pregnant and breastfeeding women enrolled in PMTCT programme at the facility, there is insufficient evidence suggesting the extent of routine viral load monitoring implementation and factors influencing it following introduction of 2019 new guidelines. This therefore calls for urgent need for a research to establish the magnitude of routine viral load monitoring among PMTCT women. Objectives The main objective of the study is to assess prevalence and determinants of Viral Load Monitoring among HIV Positive Pregnant Women on First Line Antiretroviral Therapy in Dedza District. The specific objectives include; To establish social demographic characteristics of HIV positive pregnant and breastfeeding women receiving PMTCT services at Dedza district hospital To ascertain the proportion of pregnant and breastfeeding women receiving routine viral load monitoring. To determine factors associated with viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy Methodology A quantitative cross sectional design will be used on randomly selected master cards of clients enrolled in PMTCT from April 2019 to April 2020. Data will be collected using a structured data collection sheet and will be organized on a spread sheet for cleaning before actual analysis using Statistical Package for the Social Sciences (SPSS) version 20. Strength of association will be measured using odds ratio and 95% confidence intervals and the p-value <0.05 will be set for statistical significance. Expected findings This study is expected to reveal the prevalence of routine viral load monitoring among pregnant and breastfeeding women at Dedza district hospital and factors that determine it. Dissemination of results The results of this study will be disseminated at Kamuzu College of Nursing Research Conference. Copies will be sent to Dedza District Hospital where study will be conducted, Kamuzu College of Nursing Library where the researcher is pursuing his studies, College of Medicine Research Ethics Committee (COMREC) where ethical clearance will be obtained and all research supervisors who are providing academic support. Relevant findings of this study will also be sent for possible publication in peer-review journals through KCN.
- ItemRestrictedAssessing the association of COVI-19 with under-five children malnutrition in Namphungo and Chambe rural Health Centers of Mulanje District by Carolyn Kang’ombe(Kamuzu University of Health Sciencies, 13-07-21) Kang'ombe, CarolynXECUTIVE SUMMARY Background: Malnutrition contributes significantly to child morbidity and mortality. While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. In this study, we generate information about the burden of Covid-19 towards under-5 child nutrition resulting from the potential disruption of health systems, economic system and decreased access to food. Objectives: The broad objective of the study is to assess the association of covid-19 with underfive child malnutrition in rural health centers of Mulanje District.. To achieve the broad objective, the study will achieve the three specific objectives outlined; 1. To conduct a comparative description of accumulated cases of malnutrition in under-five children cases admitted on Outpatient Therapeutic Program and Supplementary Feeding Program during and before onset on COVID-19 pandemic. 2 To assess the food situation and income security in households of malnourished under five children during and before onset of COVID-19 pandemic. 3 To compare the health services delivery in under five clinics before and during the COVID-19 pandemic in the rural areas of Mulanje. Methods: The study will be conducted at Namphungo and Chambe Health centers. A mixed method design will be used where cross-sectional qualitative and quantitative study design will be employed. For quantitative data, secondary data will be used to address the first objective. Health center under-five clinic registration will be used to extract data. Participants will be care givers to the admitted under five children under Out-patient Therapeutic Program and Supplementary Feeding Program (n=71) that will be randomly sampled from the secondary data in the respective health centers registry. Qualitative data will be collected through in-depth interview with care takers (n=10) that have under-five children on out-patient therapeutic program and supplementary feeding program on food situation analysis. Key informants (n=4) at the respective health centers will be interviewed to understand the working modalities that were applied as COVID-19 response measure. Expected results and dissemination: This study expects to enlighten any association and impact on food production and access, provision of health services and changes in practices and behavior due to the COVID-19 and its contribution towards exacerbation of malnutrition among under five children in the communities. The results will assist in informing policy and advocacy which may 13-Jul-2021 Version 3, revised 22nd June,2021 2 | P a g e lead to the refinement and improvement of maternal and child nutrition preparedness in emergencies. The findings will be disseminated to COMREC, college of medicine school of public health and family medicine, Department of Nutrition, HIV and AIDS (DNHA), Mulanje District Health Office, Mulanje Agriculture Office as well as research dissemination conferences. Results will help to advocate for under-five nutrition measures that will assist in coping with the COVID- 19 pandemic and hence reducing under-five malnutrition.
- ItemRestrictedAssessing the effectiveness of extending Malaria Community Case Management (MCCM) to all ages in Malawi: a mixed methods study(Kamuzu University of Health Sciences, 2021-11-19) Phiri S, Kamija5.1 Background and rationale The burden of malaria is high in Malawi, where access to care remains a challenge. Integrated community case management (iCCM) has been shown to be effective in reducing morbidity and mortality among children less than five years of age for pneumonia, diarrhea, and malaria. Some countries, including Malawi, have expressed an interest in extending malaria community case management (mCCM). Rigorous studies to scale up mCCM for all ages are necessary prior to introducing and scaling up this strategy in high-transmission settings.5.2 Objectives 5.2.1 Broad Objective To analyse the effectiveness of extending community case management of malaria to all age groups over a 12-month period in the districts of Neno, Ntchisi and Salima, MalawiSpecific Objectives1.2.To assess analyze the effectiveness of extending mCCM to all ages on the proportion of children aged 2 months to <5 years, 5 to <15 years, and those aged 15+ years with febrile illness in the previous 2 weeks who: 1) sought care for that illness; 2) sought care within 24 hours; 3) were tested for malaria; and 4) were treated with an appropriate antimalarial if they tested positive for malaria 3.To describe the effectiveness of extending mCCM to all ages on the prevalence of malaria parasitaemia among children aged 2 months to <5 years, and among children 5 to <15 years 4.To evaluate the effectiveness of extending mCCM to all ages on the proportion of illchildren aged 2 months to <5 years seeking care for pneumonia and diarrhea. 5.To assess the acceptability, feasibility, perceptions and experiences of extending mCCM to all ages, according to community members, HSAs, and health facility in charges. 6.To estimate the implementation costs of extending mCCM to all ages from provider perspective. 7.To describe the incremental cost-effectiveness of extending mCCM to all ages for 12 months compared with standard CCM from societal perspective (provider and household). 5.3 Study Design Cluster-randomized trial with two arms (intervention and control) taking place in the catchment areas of a minimum of 24 health facilities (12 per arm) over a period of 12 months. ● Control arm: Case management of malaria by health facilities and HSAs in line with current national recommendations (iCCM for children <5 years) ● Intervention arm: Case management of malaria by health facilities and HSAs in line with current national recommendations (iCCM for children <5 years), with an extension of community case management of malaria to all ages To achieve the objectives of the study, three types of data collection will take place: 1. Cross-sectional household surveys, pre- and post-intervention (0 and 12 months, respectively) 2. Qualitative in-depth interviews and focus groups 3. Data abstraction of routine service use from HSAs and health facilities and periodic costs from project documents and reports 5.3.1 Study Interventions Screening with malaria rapid diagnostic test and treatment of malaria positive cases with firstfist line antimalarial therapy Artemether-Lumefantrine (AL). 5.3.2 Primary outcome The primary outcome is the proportion of individuals two months of age or older, reporting a fever in the previous 2 weeks who were tested with a malaria RDT by an HSA or at a health facility by a health worker. This outcome will be measured by cross-sectional household surveys. 5.3.3 Sample size 1. Enrollment in each cross-sectional household survey will be offered to 66 households in each health facility cluster (2 EAs per health facility with 33 households each EA), giving a total of 794 per arm (12 health facilities), or 1,588 households in total (24 health facilities). 2. The qualitative component will include in-depth interviews with 30-40 individuals in the intervention and control arms (HSAs + beneficiaries/care-seekers/community members + Facility in-charges) and 6 focus group discussions with care-seekers, HSA in the intervention and control arms. 3. Routine data abstraction will include the 24 study facilities and all HSAs in their catchment areas. 4. The cost data abstraction will include 2 district coordinators visited quarterly from the three study districts. 5.3.4 Data Analysis 1. Household Survey Data: A mixed effects logistic regression model will be fitted to the data to estimate the difference in odds of the outcome between the intervention and the control. Odds ratios and corresponding 95% confidence intervals will be reported. Tests of significance will be performed at a level of 𝛂 = 0.05 with corrections for multiple comparisons when needed. 2. Qualitative data: Translation from Chichewa to English will occur during transcription into Word and will be kept secure until the analysis is complete. Translation and transcription will be verified by the research assistant and the scientific lead (social science) for quality assurance. Data will be coded and entered into NVivo 12 for the extraction themes will be identified using a content analysis approach. The analysis will be carried out according to the thematic analysis method, which consists of dividing the text into basic units for assessment. Each interview and focus group participant will be assigned a code or participant ID number, which will be used in presenting quotes. 3. Cost-effectiveness data: Cost and cost-effectiveness analyses will be undertaken to assess the financial and economic impacts of mCCM for all ages compared to the standard iCCM strategy (without extension of malaria treatment). The budget impact analysis will help determine if the expanded strategy is feasible given existing amounts in the national budget for malaria. 5.4 Expected findings and dissemination of results 5.4.1 Expected findings We hypothesize that the expansion of mCCM to all ages will lead to an increase in a) care seeking by patients with fever, b) the proportion of subjects with fever who received a malaria RDT, and c) the proportion of cases of malaria confirmed by RDT who received adequate antimalarial treatment. More specifically, we hypothesize that the proportion of individuals with recent fever for whom a malaria RDT was performed (main indicator) at the beginning of the study will be 40% in both arms, and will increase to 62% in the intervention arm by the end of the study. We assume that this proportion will remain constant at 40% in the control arm (see sample size section). 5.4.2 Dissemination of results A mid-term report will be submitted to the MoH NMCP and other study partners (WHO, PMI, USAID) in 2022. The report will include results of the baseline survey, and details on challenges and successes during study implementation. The mid-term report will also highlight key elements for planning the extension of mCCM to all ages for the country.
- ItemRestrictedAssessing the effectiveness of HIV and AIDS service delivery models for key populations in Malawi(Kamuzu University of Health Sciences, 2021-07) Ngulube, Maria ChinokoThis is a mixed methods study that will use both quantitative and qualitative data. The quantitative part will use secondary data collected as part of the Centre for the Development of People’s (CEDEP) routine monitoring process for the periods – 2018/19 and 2019/20 focusing on five key variables (Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed). The data will be collected using an excel template presented in Annex 5. Qualitative data will be collected directly from men who have sex with men (MSM) and health service providers (HSPs) that work with CEDEP in the delivery of HIV and AIDS services for MSM ). The HSPs include CEDEP staff. The problem: Globally, Men who have sex with men (MSM) are at high risk of contracting and transmitting HIV but have the least access to HIV prevention, care, and treatment services because their behaviours are often stigmatized, and criminalized. In sub-Saharan Africa, same-sex behaviours have been largely neglected by HIV research up to now. In Malawi, 7 % of MSM live with HIV and yet are also arrested if their sexual orientation is exposed when seeking healthcare, causing many to shun HIV and other sexual health services(1). Different models have been used to reach out to MSM with HIV and AIDS services. However, the effectiveness of these models have not been fully investigated to guide KP programing. This study therefore, will examine the different service delivery models currently being used to provide HIV and AIDS services to MSM. The objectives: The broad objective of the study is to assess the effectiveness of the service delivery models employed by CEDEP in reaching out to MSM with HIV and AIDS services (outreach, hybrid-public and private facilities and drop-in centres). Specifically, the study will focus on the following objectives: 1. To identify Service delivery models that are high yielding. 2. To explore factors that contribute to high yielding in the identified service delivery models 3. To identify bottlenecks associated with the use of the different models employed by CEDEP; 4. To explore potential solutions for improving uptake of HIV and AIDS services by MSM. Methodology The study will use a mixed method approach. The quantitative part will use secondary data collected as part of CEDEP’s routine monitoring process for periods - 2018/19 and 2019/20. CEDEP’s routine monitoring data will be filtered to extract five key variables (Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed). Quantitative data will be requested from CEDEP using the excel template present in Annex 5. Only routine monitoring data for Lilongwe district will be used for this study. On the other hand, the qualitative partNgulube_P.04/21/3307_Version 2.0_20210610_Expedited 11 will rely on primary data to be collected directly from MSM using MSM interview guide (See Annex 1) and health service providers (HSPs) including CEDEP staff that support MSM service delivery using the HSP interview guide (See Annex 2). The study will be done in Lilongwe targeting MSM accessing services at CEDEP service delivery points, health service providers including CEDEP staff. Qualitative data will be collected from 49 MSM using MSM interview guide (See Annex 1) and eight health service providers and five CEDEP staff using the health service provider interview guide (See Annex 2). A combination of purposive and snowball sampling techniques will be used to select 49 MSM who will respond to the MSM interview guide while purposive sampling will be used to select 13 key informants to participate in the study (8 health service providers, and 5 CEDEP staff). Qualitative data will be collected once the protocol receives approval from COMREC. Two data collectors will be hired to collect qualitative data from MSM using the MSM interview guide while the principal researcher will collect qualitative data from key informants using interview guides. Quantitative data will be analyzed using the Statistical Package for Social Sciences (SPSS). A Chi-Square test will be used to test if there is any relationship between service delivery model and service uptake by MSM. The test will focus on the three service delivery models (outreach, hybrid and DIC) on one side and five service uptake indicators on the other side which include; Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed. The reach data for the different services accessed at each service delivery point (outreach, hybrid-public and private facilities and drop-in centres) will be plotted to show the trends over time (2018/19 and 2019/20). Qualitative data will be summarized in word to extract the key themes and issues coming out of the discussions which will then be analyzed to inform the findings and report writing. Expected findings and their dissemination. In recent years, the government has acknowledged the existence of MSM and the need to make health services available to them. This study therefore is expected to identify the key service delivery models that are high yielding and effective in reaching out to MSM with different HIV and AIDS services. This will significantly contribute to the limited body of knowledge on MSM and provoke the debate on which approaches could be cost-effective in reaching the MSM with the much need health services in an environment where they are stigmatized and criminalized. The findings of the study will be shared with key stakeholders (such as CEDEP, NAC, COM, MoH) who are actively involved in HIV service delivery for MSM. The findings will also be submitted for consideration to be presented at local and international HIV and AIDS dissemination conferences.
- ItemRestrictedAssessing the effectiveness of Multi Month Scripting of Anti Retroviral Therapy amongst stable patients: A comparative case of Bwaila Martin Preuss Center and Kapiri In Malawi(Kamuzu University of Health Sciences, 2021-03-17) Longwe Matupa, ElinatType of research: A quantitative multiple retrospective study aimed at evaluating the effectiveness of multi-month scripting (MMS) on ART amongst stable adult patients living with HIV under care using a comparative case of Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji, Malawi. Secondary data will be used. The problem: The United Nations Programme on HIV/AIDS (UNAIDS) and WHO promote adoption of the Differentiated Service Delivery (DSD) approach with its 95-95-95 targets by 2030. Malawi adopted the multi-month scripting (MMS) among other models to relieve the burden of frequent 28 September 2016. National Health Sciences Research Committee (NHSRC) number 15/11/1513”. The study population will include stable adult patients living with HIV on Regimen 5A TDF/3TC/EFV (300/300/600mg) at Bwaila Martin Pruess Clinic and Kapiri Health Centre. A total of 3,565 patient records receiving three months (90days) dispensing intervals in these two health facilities will be used for the study. Data used will be secondary quantitative data collected routinely as part of clinic Electronic Medical Records (EMR) at the two health facilities. Collected data will be stored securely in computer data base that have a password and only limited access to key study team will be provided. Stata version 15 will be used for analysis with summary statistics including percentages, medians and ranges calculated and presented for quantitative variables. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC). Expected findings and their Dissemination: It is anticipated that the study will generate findings that are well enriched with adequate information that provides a deep understanding of the subject and contribute meaningfully to the body of knowledge on Differentiated Service Delivery. We expect to determine the effectiveness of MMS on ART among stable patients and if patient characteristics are associated with retention. Research results will be disseminated in writing and presentations. The report will be submitted to College of Medicine, University of Malawi being the institution to award the degree. Research findings will be presented to health care workers and senior management teams the participating health facilities. The researcher will be available to share the results from the study through local dissemination conferences, seminars and workshops organized by the College of Medicine’s Research Support Centre (RSC) and Research and Ethics Committee (COMREC). An abstract will be developed for submission to conferences and publication in journals. appointments of patients and providers, freeing up resources to provide more intensive care to complex patients where HIV mortality is high. Since 2016 all government health facilities in Malawi have implemented 3 months multi- month scripting for stable patients on ART. However, there is no evidence on the comparative effect of MMS on improved patient outcomes in terms of adherence to ART and the influence of the captured patient characteristics on the adherence to ART. Objectives: The aim of the study is to evaluate the effectiveness of multi-month scripting (MMS) on ART amongst stable adult patients living with HIV under care using a comparative case of Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji, Malawi. The study specifically seeks to determine the effect of MMS on patient retention; assess the patient characteristics that are associated with the degree of compliance to ART treatment and assess the influence of patient characteristics on retention in care for patients on MMS. Methodology: A quantitative multiple retrospective study will be used to evaluate the effectiveness of multi month scripting (MMS) on ART amongst stable adult patients living with HIV under care at Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji. Secondary data analysis will be done on data collected from the study titled “Assessing Implementation of Models of Differentiated Care for HIV Service Delivery in Malawi: A Process Evaluation dated
- ItemRestrictedAssessing the effectiveness of the anti-drug theft interventions on the availability of Malaria drugs at Ntcheu District Hospital(Kamuzu University of Health Sciences, 2021-03-21) Kachala Nkhoma, PriscillaType of study: This will be a longitudinal and cross sectional type of study where both quantitative and qualitative methods will be used. It will be longitudinal because observations will be made for a specific period of time, that is, one year before and after the drug audit was conducted. We will conduct structured in-depth interviews of health care workers eligible for the study and community members. Problem statement: Drug theft has been a concern especially in public health facilities in Malawi. Essential drugs such as malaria have been stolen by the health workers and other members of the community. Several measures or interventions have been put in place starting from the MoHP and every health facility has their own in order to reduce or eliminate drug theft. The anti-drug theft interventions range from expensive to cheaper ones. Since the implementation of these interventions in the health facilities as well as the DTIU intervention from 2016, at Ntcheu District Hospital, seven people were convicted of drug theft and these included health workers and some chiefs [1]. Although antidrug theft interventions are implemented and some individuals have been convicted, drug theft still occurs in the health facilities despite the implementation of anti-drug theft interventions. Assessment on these interventions to determine their effectiveness have not been carried out hence the need to conduct this study. This study will also assess the availability of malaria drugs since the implementation of these interventions at the hospital. Study objectives: The purpose of study is to assess the effectiveness of anti-drug theft interventions on the availability of medicines and medical supplies at Ntcheu District Hospital. The specific objectives are: To determine the availability of anti-malarial drugs before and after the anti-drug theft interventions at the hospital. To explore factors that influence theft of malaria drugs at the hospital To explore the impact of malaria drug theft to the health workers and the community surrounding the hospital. Methodology This study will employ mixed method where quantitative and qualitative methods will be used. Quantitative method will be used to determine the availability of anti-malarial drugs before and after the DTIU drug audit and the implementation of the anti-drug theft interventions. Quantitative data will come from the Logistical Management Information System (LMIS), District Health Information System (DHIS2), and audit reports from the DTIU in the Ministry of Health and Population (MoHP). The qualitative method will be used to explore factors that influence drug theft and anything to be done to improve availability of malaria drugs as well as the impact of malaria drug theft at the hospital as well in the community. The participants will be 20 in total, 12 Health Care Workers (HCW) and 8 community members from the catchment area of the hospital. Data will be collected by conducting In-Depth interviews and will be securely stored in a computer and a password will be used. Thematic content analysis for the interviews and time analysis for the quantitative data will be used. Quantitative data will be entered in Excel and analysed using STATA and will be presented in graphs. Consent form will be sought verbally from the study participants and ethical approval from the College of Medicine Research and Ethics Committee (COMREC). Expected Findings and Dissemination of Results In this study, we expect to determine the effectiveness of the anti-drug theft interventions in the availability of malaria drugs. Bound copies of the dissertation will be submitted for examination to College of Medicine, the Health Systems and Policy Department, School of Public Health and Family Medicine. Furthermore, the findings will be disseminated in writing as a report to the DHMT for Ntcheu District Hospital as well as the DTIU. Manuscripts of the results will be submitted to peer reviewed journals for publication. The final dissertation document will be submitted to: College of Medicine’s Office of the Dean of Postgraduate Studies and Research, College of Medicine Library, and the College of Medicine Research and Ethics Committee (COMREC).
- ItemRestrictedAssessing the perception and knowledge of voluntary medical male circumcision among middle aged men in peri-urban, Blantyre(Kamuzu University of Health Sciencies, 18-10-21) Khuliwa, Innocent; Singano,Nomsa; Chivunga, ConstanceAdequate sleep contributes to a student’s overall health and wellbeing. Getting proper amount of sleep helps one to stay focused, improve concentration and academic performance. Studies have shown that most youths who do not get enough sleep have a high risk of having many health problems including, obesity, DM type 2, poor mental health and injuries. They are more likely to have attention and behavioral problems which can contribute to poor academic performance. College students are among the most susceptible group of people to poor sleeping habits due to the increased academic pressure. Recent studies have shown that students with medical related majors are more likely to have poor quality of sleep in comparison to those with a humanities major. Despite the established evidence on how important sleep is, no studies have been conducted here in Malawi to assess quality of sleep among college students. This study seeks to bridge this gap by assessing quality of sleep and its associated factors among undergraduate medical students at Kamuzu University of Health sciences, Blantyre campus, Malawi. This research will be a cross sectional study design. Our problem objectives will be to establish the association between quality of sleep and other factors such as gender and mental health. A sample size of 428 will be used and participants will be systematically selected from the classes. Questionnaires will be used to collect data on both sleep quality and mental health. A Pittsburgh sleep quality index (PSQI) and patient health questionnaire (PHQ 9) will be used respectively. Data will be entered into excel and analyzed using epi info software. By the end of the study we expect get data on quality of sleep among medical students as well as its associated factors. This assessment will help us evaluate the extent of the burden of poor sleep among college students and how much this burden is affecting their life more especially academic performance. In the end we will be able to develop proper interventions such as proper sensitization on good sleep health. This will ensure that students get good quality sleep and in turn reduce the complications associated with poor sleep. The results of this study will be presented in a full report to COMREC. We will also present our study findings at an annual College research dissemination conference. The results will also be made available on medical research journal websites
- ItemRestrictedAssessing the relationship between Adverse Childhood Experiences (ACE) and high HIV risk behaviours among male and female adolescents: A cross sectional study in Balaka district.(2020-06-15) Kaponda, AliceExecutive Summary Type of research study This will be a Cross Sectional Study to done in Balaka district. The problem Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) refers to a range of events (such as physical, emotional and sexual abuse, bullying, etc) that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours such as sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks. Some of the high HIV risk behaviours include having multiple sexual partners and infrequent condom use. This study seeks to assess the relationship between adverse childhood experiences and high HIV risk behaviours specifically having multiple sexual partners and infrequent condom use among adolescents that may lead to increased HIV incidences in Balaka district. Objectives This study will assess the relationship between adverse childhood experiences and high HIV risk behaviours specifically having multiple sexual partners and infrequent condom use among female and male adolescents’ in Balaka district. Methodology This will be a cross sectional study involving a total of 314 adolescents aged between 10-18 years who were interviewed in the Malawi Longitudinal Study of Families and Health (MLSFH) study during the 2017/2018 data collection wave. The parent MLSFH study, collected data for a number of variables among which some will be used in this study. These variables include: Age, gender, tribe, religion, caregiver, caregiver change over time, school attendance, household size, family income status, sexual activities, infrequent condom use and exposure to different types of ACEs. This study will analyse secondary data from Balaka district under the parent MLSFH study which was collected in 2017/2018 data collection wave for adolescents’ cohort. Logistic regression analysis will be performed using STATA v14 to assess the association between adverse childhood experiences (ACEs) and HIV risk behaviours (multiple sexual partners and infrequent condom use) among male and female adolescents.
- ItemRestrictedAssessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas
- ItemRestrictedAssessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi, a case of Thyolo District(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor Goldon1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas.
- ItemRestrictedAssessing Viral Load suppression in clients receiving 6 Multi Month Refill at Dedza District Hospital(Kamuzu University of Health Sciences, 2022-01-19) Chibwana, ChikaikoType of Study This will be retrospective cohort study design. Problem Human Immunodeficiency Virus (HIV) positive clients taking Anti-Retroviral Therapy (ART) put on newly introduced Service Delivery Model (DSD) of 6 Multi Months Refill (6MMR) take about 6 months before they are seen at a clinic for clinical assessment including adherence counselling by a professional health worker. Studies done in some countries have associated this long period to have negative effect on Viral Load (VL) suppression. High viral load is associated with increased risk of opportunistic infections, treatment failure and death. Broad Objective To assess viral load suppression among clients on 6 MMR enrolled at ART clinic at Dedza District Hospital. Specific Objectives 1. To establish viral load suppression rate in clients on 6 MMR enrolled at Dedza District Hospital ART clinic. 2. To compare viral load suppression rates among clients on 3 Multi Months Refill (3 MMR) to those on 6 MMR enrolled at Dedza District Hospital ART clinic 3. To identify factors associated with viral load suppression in clients receiving 6 MMR enrolled at Dedza District ART clinic Methodology Study Place The study will take place in Dedza district at Dedza District Hospital. Data will be collected at Dedza District Hospital ART clinic. Study Population Participants to the study will be HIV positive clients enrolled at Dedza ART clinic, 18 years old and who were given 3 or 6 MMR from September 2019 to July 2021. Study Period The study period will be 12 months (from April 2021 to May 2022) including time for developing protocol, data extraction tools, obtaining all appropriate approvals, training of study assistants, data collection, data analysis, writing dissertation and dissemination. Data collection Procedures The study will utilize secondary data that will be extracted from ART, HIV Testing Services (HTS), appointment registers, client master cards and Electronic Master Record (EMR) using a designed data collection tools. The following variables will be collected: Demographic data, type of employment, distance from the hospital, place of residence (rural, urban or semi urban), type of relation with guardian, months on ART regimen, pill count, comorbidity with Tuberculosis (TB), viral load result after receiving either 3 MMR or 6 MMR. Data analysis Multivariate binary logistic regression will be used to test if each of explanatory variables is associated with Viral Load Suppression among clients on 6 MMR. Constraints Being a retrospective study that will use secondary data, some data valuables like employment status, pill count and viral load results might be missing. However, the researcher plans to be looking for the missing data in Electronic Master Record (EMR), in paper based master cards and Laboratory registers for viral load loads results. Expected Findings The study will establish rates of viral suppression and identify factors associated with viral load suppression in clients receiving 6 MMR. The findings will inform policy makers in deciding the right clients to be put on 6 MMR basing on the factors that will be associated with viral load suppression. Dissemination Research finding will submitted to College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and Dedza District Hospital. Manuscript will be prepared for peer Journal publication.
- ItemRestrictedAssessing viral load testing adherence and coverage and the related client outcomes in the 90:90:90 era(Kamuzu University of Health Sciences, 2020-06-05) Kholomana, ThokozaniThe type of research study This will be a retrospective quantitative cohort study. The problem to be studied: Viral load (VL) testing is one of the essential measure of HIV client progress in regards to ART where suppression shows treatment success. So this study intends to find out the level of VL coverage and adherence to protocol and describe the relationship between those clinical factors and the development of Tuberculosis (TB), infantile deaths and miscarriages. Main objectives: To assess the viral load testing adherence and coverage and the related client outcomes Specific objectives 1. To assess the level of clinical adherence and coverage in regards to viral load time frames 2. To measure the prevalence of Tuberculosis in HIV care enrolled clients and the related VL adherence and coverage before diagnosis 3. To estimate the rate of miscarriages in HIV clients and the related VL adherence and coverage prior to incident 4. To determine the prevalence of infantile deaths and the related VL adherence and coverage prior to the incident Methodology Study design: The study will employ a retrospective quantitative cohort design. Study place: This will be conducted in Ntchisi district. Respondents will be recruited from Ntchisi district hospital ART clinic. Study population: HIV reactive clients attending Ntchisi district hospital ART clinic will be eligible for this study. Study Period: The study will run from April 2019 to July 2020. This is a 16-month period which conceptualization of the proposal to thesis submission will be done. Data collection procedures: This study will utilize a checklist to extract data following the subjects consent. The checklist will look at such variables as age, sex, marital status of HIV positive patients, TB status, infantile deaths status, miscarriages, the number of VL tests and the times when their viral load testing was done. Mainly the clients master cards, and the prevention of mother to child transmission (PMTCT) registers utilized will be used to extract such data. Data management and analysis: All data will be kept in Microsoft excel with a passcode for safety. So, these data will be exported to Stata wherein cleaning and analysis will occur. Moreover, respondents’ identities will not be identifiable since they will be represented by codes. Data analysis will involve both descriptive and inferential statistics. Constraints: The researcher supposes there might be missing VL results in other study participants. In regards to this, the researcher plans to rectify this by following up with the central laboratory. Implications of the study: Results from this study are expected to contribute knowledge to the body of research in HIV medicine. For that cause, this information will be important when developing interventions for HIV clients’ care, providers protocol, including mentorship and supervision schedules. Expected findings and their dissemination: This study will find the period prevalence of Tuberculosis, miscarriages, and infantile deaths in people living with HIV (PLHIV). Moreover, this will show coverage and adherence frequencies in regards to VL testing in PLHIV and the relationship and association between the dependent and independent variables. Moreover, the results be contained in the author’s Master of Global Health thesis that will be submitted to COMREC and college library.
- ItemRestrictedAn assessment of gender and intersectionality in disease exposure, care seeking behaviour and treatment pathways in malaria prevention and control in Kenya and Malawi: a case of Migori county and Chikwawa district(2022-04-13) Kumwenda, MosesType of study This project will adopt a longitudinal study design with embedded mixed methods to allow for translational research and long-term in-depth exploration. This study design will be a multidisciplinary integration among basic, clinical, practice, population, and policy-based research enabled by a multidisciplinary team of clinical and social scientists. Problem The burden of malaria persists despite the ongoing prevention and control interventions over the last two decades with the different malaria endemic and epidemic zones being strategically targeted with a view to eradicate this infectious disease. In Kenya and Malawi, malaria remains a major cause of morbidity and mortality with more than 70 percent of the population at risk of the disease. Kenya has four main malaria epidemiological zones with diversity in risk and intervention determined largely by altitude, rainfall patterns, and temperature, as well as the prevalence of malaria. Further, access to and uptake of health services for prevention and treatment knowledge of malaria and health outcomes experienced throughout the life course are influenced by the foregoing life stratifiers often overlooked in intervention programmes and policies. Objectives Main objective The aim of the study is to assess the gender and intersectionality of exposure to mosquito bites, care seeking and treatment pathways for Malaria in Migori County, Kenya when compared to Chikwawa district in southern Malawi Specific objectives 1. To assess the intersection between the risk of exposure to mosquito bites with gender and other social determinants (sex, age, occupation, level of education/class, place of residence (urban/rural), and religion) of Malaria. 2. To describe how gender power relations, the prevailing gendered social inequalities, and the culturally dominant constructions of masculinity and femininity intersect with each other in shaping people’s understanding of ill-health and influence Malaria health seeking behaviours. 3. To audit Malaria programme delivery and Malaria control interventions including research and access to Malaria and disease management services using the intersectional gender lens. 4. To identify the gender dimensions in Malaria programme delivery and control interventions in the emerging COVID-19 pandemic context. 13-The study will be conducted in Migori County, Kenya and Chikwawa district in Malawi to target health facilities and community members to explore gender and intersectionality of malaria etiology, health and health seeking and treatment pathways and inform the specific study objectives. The research will employ participatory , qualitative and quantitative methods to explore gender and intersectionality of malaria etiology, health seeking and treatment pathways. This study will be carried out in two phases: Phase one - the formative phase and will entail mainly the document reviews and piloting of the study tools and; Phase Two - mixed methods studies, the longitudinal comparative approach will include quantitative and qualitative studies to assess malaria etiology, health and health seeking and treatment pathways through a gender and intersectionality lens. Expected findings and dissemination The research protocol will be published after all ethical approvals have been received. Findings from the study will be presented through community engagement mechanisms such as community engagement meetings and science cafe’s. Advocacy work through various mechanisms at county and national level based on the findings of the study will be conducted. Results will be shared with the wider scientific community through presentations at national and international conferences, and through open-access peer-reviewed journal publications. In addition, we can submit the report of our findings to COMRE and national open data platform.