Maternal & Child Health

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Browsing Maternal & Child Health by Author "Chimwaza, Angela"

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    Development, implementation, and evaluation of a respectful maternal and newborn care bundle: A mixed-methods study in Malawi and Tanzania, version 1.0
    (Kamuzu University of Health Sciences, 2022-06-15) Chimwaza, Angela
    Type of research study Prospective implementation study that will use mixed methods: Quasi experimental and Qualitative Problem statement In many settings, women and their babies fail to receive respectful care during pregnancy, labour and childbirth, and the postnatal period. Mistreatment presents as physical, sexual and/or verbal abuse, stigma and discrimination, poor standards of care, poor rapport between women and providers and health system conditions and constraints. Although condemned for decades, few studies have tested interventions to reduce disrespectful care. The broad objective To determine whether implementation of a sustainable Respectful Care Bundle, co-produced with stakeholders, including health workers, and service users across primary, secondary, and tertiary maternity facilities in Malawi and Tanzania, decreases woman-reported episodes of disrespectful care. Specific objectives The specific objectives of this study are to: evaluate the effectiveness of the care bundle by healthcare workers, women and managers; assess the acceptability, sustainability and impact of the maternal and newborn care bundle roll -out. Methodology We will use a positive organisational approach (appreciative inquiry) alongside the Behaviour Change Wheel (BCW), a theory-based method for the design of interventions. Our study has 3 related phases: pre-implementation, implementation and evaluation. We will use mixed methods, including an interrupted time series (ITS), community surveys, process audit, resource utilization questionnaires, in-depth interviews, and structured observations. TheITS will cover more than 30,000 births in each country. Six hundred women will be included in each community survey: before and following intervention implementation. This study will be conducted in Malawi and Tanzania with three sites per country. In Malawi, the study will be conducted at Bwaila, Ethel Mutharika and Mitundu Hospitals. Observations will be conducted at each of the six sites at five time periods. Approximately 80-120 interviews with women, healthcare workers and hospital managers will be conducted representing 60 in each country. A primary outcome (woman-reported episodes of disrespectful care) analysis will take an interrupted time-series approach to allow for possible underlying changes in the rate of respectful care over the course of the study. Disrespectful care rates will be compared between time points in a centrematched analysis. For the qualitative component, interviews and focus group discussions will be taped, transcribed verbatim and analysed through the framework approach. Observations will be analysed descriptively, providing information on occurrence of disrespect in relation to the different typologies. Routinely collected clinical data on pregnancy outcomes will be aggregated monthly and analysed using an analogous time series approach to the primary outcome. Expected findings and their dissemination It is expected that findings from this study will reduce the incidence of disrespectful care at in Mitundu, Bwaila and Ethel Mutharika hospitals with a high probability of successful roll-out at national level as well as to other lowand middle-income settings. Active dissemination will include conference presentations and publications in academic peer reviewed open access journals balanced with publicly accessible sources. The results will also be disseminated to the College of Medicine Research Ethics committee (COMREC).
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    Protocol for development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth, version 1.0
    (2022-07-11) Kikham, Jamie; Chimwaza, Angela
    Type of research study: Delphi survey for the development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth. Problem statement A stillbirth accounts for about 14 in every 1,000 births globally with the highest rates seen in Sub-Saharan Africa and South Asia. Stillbirth prevention and bereavement care following a stillbirth remains a challenge, particularly in Low and Middle Income Countries (LMiC). One approach to improvement is the prioritization of women/family-centered care. There is a large variety of outcomes measured in stillbirth studies but consensus on the outcomes that matter most to women and families is often lacking, which can impact on the ability to make informed decisions about improved care practices. Broad Objective The broad objective of this study is to develop standard sets of outcomes for stillbirth prevention and bereavement care in LMiC settings. Specific Objectives The specific objectives are 1. to identify outcomes used in current stillbirth research in LMiC settings relevant to stillbirth; 2. to solicit the importance of stillbirth outcomes from health care professionals, researchers and parents’ perspectives; and 3. to determine the outcomes important to all stakeholders in order to ratify a core outcome set (COS). Methodology This study will involve three stages in the development of the COS: (1) a list of outcomes will be identified from multiple sources, specifically existing reviews of outcomes, a search of trial registry data, a targeted qualitative literature review of studies that have interviewed parents who have experienced stillbirth and healthcare professionals working in this field across Sub-Saharan Africa and South Asia. (2) The list of outcomes will be scored by multiple stakeholder groups in a real-time online Delphi survey. (3) The results of the Delphi will be summarised and discussed at a face-to-face or Formatted: Font: Bold Formatted: Font: Bold11-Jul-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 2 16/06/2022 8 virtual consensus meeting with representation from all stakeholder groups. In Malawi, the study will be conducted at Bwaila, Ethel Mutharika and Mitundu Hospitals. Expected findings and their dissemination It is expected that two COS for use in a LMiC setting will be developed, one for stillbirth prevention and one for bereavement care following stillbirth. Both COS will be developed for research and clinical practice and will consider all interventions and care options for stillbirth care within this scope. The development of these COS will be reported according to the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines [16]. We will register the COS with CROWN (Core Outcomes in Women’s & Newborn Health) [17] and share our findings across the GHRU Network, College of Medicine Research Ethics committee (COMREC), the LAMRN (Lugina Africa Midwives Research Network) [18] and other relevant international societies and organisations for wider dissemination.11-Jul-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 2 16/06/2022