Protocols

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Exploring perceptions, occurrence and management of workplace sexual harassment among nurses at Mzimba District and Mzuzu Central Hospitals in the northern region of Malawi
(Kamuzu University of Health Sciences, 21-07-29) Phiri, Kate Ruth
Type of study The study will be a facility based cross sectional mixed methods study. Problem to be studied There is overwhelming evidence of sexual harassment (SH) reported in print as well as digital media globally, with noted devastating outcomes to the victims and organizations involved such as reduced confidence, morale and work performance, among others. According to WHO, workplace SH is reportedly more prevalent in the health sector than any other sectors. The extent of workplace SH, its effects and management in the health sector has not been thoroughly explored in Malawi. Objectives In this study, the main objective is to explore the prevalence, perception and management of workplace sexual harassment among nurses in Malawi. And the specific objectives are: to explore the perception of sexual harassment among nurses and hospital management team members; to determine the prevalenceof sexual harassment among nurses, to explore nurses’ reactions to sexual harassment; and to investigate the management of sexual harassment in the workplace. Methodology It is a quantitative and qualitative study, which will be conducted at two hospitals namely; Mzimba District and Mzuzu Central Hospitals. In depth interviews will be conducted on 10 nurses and 5 hospital management team members responsible for handling SH incidents from each site. Additionally 30 self-administered questionnaires will be distributed to nurses in each facility. Digital voice recorders will be utilized and transcribed verbatim. Codes and themes will be generated manually and content analysis will be applied. Self-administered questionnaires will also be utilized to assess prevalence of SH amongst nurses. Data will be displayed in charts and tables. Constraint 29-Jul-2021 Workplace sexual harassment among nurses, Version 2 Dated 07/06/2021 19 The major anticipated study constraint will be finding participants that are willing to discuss such sensitive information. In this regard, anonymity will be emphasized to all study participants. Study implication Expected findings of this study will help inform implementation of SH policies in the health facility, from tailor made measures identified in this research that would facilitate the reduction of SH incidents. Dissemination plans The results of the study will be disseminated to COMREC, Mzimba District and Mzuzu Central Hospitals’research and management teams as well as to local and international research dissemination conferences.
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Examining the use of case study teaching method among nurse educators in Malawi
(Kamuzu University of Health Sciences, 2020-10-08) Chiona, Burnett Chila
Title: Investigating the use of case study teaching method among nurse educators in Malawi: A case of CHAM nursing colleges Type of study: This study will be a quantitative descriptive cross-section study Problem to be studied: Case study is a powerful student-centered teaching method in imparting student nurses with the much needed critical thinking, communication, and interpersonal skills(Reimer &Berghoff, 2017). According to Nurses and Midwives Council of Malawi (NMC) (2018) the current 2018 national training syllabus for the Nursing and Midwifery Technician programme prescribed by Nurses and Midwives Council of Malawi(NMC), has a total of 36 courses, in 28 of these courses the council prescribed case study, as a teaching method of choice to be used by the nurse educators when teaching these courses (Nurses and Midwives Council of Malawi,2018). This represents 78% of the total courses in the programme. Even though Mbirimtengerenji and Adejumo (2015) indicated that some nurse educators in Malawi do use case study teaching method, however in their study they did not examine exactly how these nursing educators used the method during teaching as their study was just enquiring on the varieties of teaching method used by the nursing educators. Hence the conduct of this study will provide specific knowledge on how nurse educators in Malawi use case study teaching method during teaching Study Objective: The main objective of this study is to explore the use of case study teaching method among nurse educators in Malawi. The study will specifically assess knowledge of the Malawian nurse educators in using case study teaching method, identify factors that influence the use of case study teaching method among the nursing educators in Malawi and assess case study teaching practices among Malawian nurse educators. Methodology: This study will use a quantitative descriptive cross-sectional study design to explore and describe the use of case study teaching method by the nursing educators in Malawi through the use of descriptive and inferential statistics. This study will be conducted in eight (8) CHAM Nursing and Midwifery colleges involved in the training of nurse-midwives technicians. These eight CHAM colleges are Ekwendeni, Holy Family, Malamulo, Mulanje Mission, Nkhoma, St Joseph, St Lukes and Trinity. The total subjects to be recruited in this study is one hundred and seventy one (171) nurse educators from the selected eight CHAM Nursing and Midwifery Colleges. Data will be collected from the subject through the use of a self-administered questionnaire. The collected data will be analyzed through the “use the Statistical Package for Social Science (SPSS) version 23. In order to ensure that this study adheres to ethical standards of conducting a research, this research proposal will be submitted to College of Medicine Research and Ethics Committee (COMREC) for ethical scrutiny. Furthermore in the study three primary ethical principles of beneficence, respect for human dignity and justice will be strictly observed and adhered to throughout the conduct of the study. Dissemination of results: The research report will be prepared in order to communicate findings to the appropriate audience. Among the audiences include the colleges that will participate in the study. The results will be published in peer reviewed journal and other copies of the report will be left in KCN library, COMREC and CHAM colleges. The results will also be presented during conferences locally and internationally.
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Constraints to utilizing Pumani Bcpap treatment for respiratory distressed newborns in nursery wards from the perspective of nurses and clinicians at Chiradzulu District Hospital In Malawi
(Kamuzu University of Health Sciences, 2020-10-12) Kalembera Ngwala, Samuel
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Evaluation of a Practice Development Unit, Queen Elizabeth Central Hospital Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Watkins, Dianne
2.1 The type of research study This is a mixed methods research study utilising the Medical Research Council process evaluation framework to assess the outcome of quality improvement initiatives implemented as part of a multidisciplinary practice development unit (model ward) on ward 3B Queen Elizabeth Central Hospital. 2.2 The problem (to be studied) Does establishment of a multi-disciplinary practice development unit on a male medical ward at a hospital in Malawi facilitate quality improvement, multi-disciplinary team working and improve staff morale? 2.3 The Aim/ objectives To evaluate the effect of establishment of a practice development unit on staff morale and the implementation of multi-professional quality improvement measures in relation to ward cleanliness; admission and discharge processes for patients with diabetes; and multidisciplinary teamworking. Specific objectives 1. To measure the impact of implementing an evidence-based protocol for ward cleaning; 2. To evaluate the impact of implementing a standardised approach to multi-disciplinary ward rounds; 3. To explore the effects of establishing multi-disciplinary team meetings utilising an evidence-based framework; 4. To investigate the impact of implementing an evidence-based protocol for the admission and discharge of patients with diabetes; 5. To assess the effects of the practice development unit on staff morale and their understanding of audit and quality improvement methods. 2.4 Expected findings and their dissemination It is envisaged that improvements will be made in the quality of care provided to patients with diabetes; to ward cleanliness and multi-disciplinary team working and that these improvements will positively influence staff morale and patient outcomes. The findings will be disseminated through presentations to major stakeholders (Ministry of Health, QECH Senior staff; staff at the University of Malawi and Cardiff University); through local, national and international conference presentations and through publication in prestigious peer reviewed journals. 3.0 Background information and introduction Malawi is a low-income country with a GDP that represents 0.01% of the world economy and provision of healthcare is limited. Life expectancy is poor compared to western countries and access to quality healthcare represents a significant problem. In 2018 Cardiff University (CU), School of Healthcare Sciences (HCARE) was awarded Erasmus plus funding to establish a ‘practice development unit (PDU)’ in a hospital in Malawi, with an aim of improving person centred, evidence based, multi-disciplinary care provided to patients. This project built on previously established relationships between HCARE and Kamuzu College of Nursing, 11-Nov-2020 Version 7 – re-submitted to COMREC 4 th November 2020 (DW & JC) University of Malawi (KCN). Discussions took place regarded where the PDU would be located and a decision made for this to be Ward 3B, a male medical ward located within Queen Elizabeth Central Hospital Blantyre. Blantyre is the second largest city in Malawi with a population of approx. 1.2 million. Queen Elizabeth Central Hospital (QECH) is the largest hospital in Malawi with approx. 1100 beds. Average life expectancy for males in Malawi is 61.4 years and the probability of dying between 15-60 years for a male is 312 per 1,000 population (WHO 2018). Communicable diseases including HIV, tuberculosis and malaria are the major causes of morbidity and mortality but non-communicable diseases such as cardiovascular, respiratory diseases and diabetes are also now major healthcare issues. A decision was made to establish a practice development unit (referred to as a model ward at QECH) utilising quality improvement methodologies to help improve practice on Ward 3B. There are various definitions for the process and practice associated with a practice development unit. Bradd, et al (2017) describes it as a facilitated process with the aim of improving person-centred and evidence-based healthcare using an emancipatory change approach. It can help with enhancing clinical services, such as quality and safety, improve communication between multi-disciplinary teams and aid the development of shared values and priorities (McCormack, 2013).Competent facilitators are required to enable evidence based knowledge to be translated into practice and improve quality of care through supporting practitioners and teams in identifying areas for change and implementing this change (Heyns, et al 2017). Progress with establishment of the PDU includes workshops (undertaken in November 2019 and in February 2020) introducing the concept to Ward 3B staff; identification of areas for potential improvement on Ward 3B; agreement on areas to take forward for quality improvement; audit of current practice in relation to the areas for improvement; and rapid reviews of the evidence base to support change in the identified areas of practice which include: i) Admission and discharge processes in relation to the patient with diabetes. ii) Ward cleanliness iii) Multi- Disciplinary Team Working (examples of the initial audits which provided a baseline to current practice can be found in appendix 6) An evaluation of the effectiveness of interventions put in place is essential, and thus the School of Healthcare Science (HCARE) Cardiff University applied and were successful in achieving Global Challenge Research Funding to undertake an evaluation of the PCU and its associated areas for quality improvement. The Medical Research Council Framework for process evaluation was chosen as the methodology which is commonly used for evaluating and reporting complex interventions, defined as those that consist of multiple interacting components (Moore, et al 2015). Moore, et al (2015) argue that to understand how interventions work in practice, an understanding of the causal assumptions underpinning the process are essential. Process evaluations can test causal pathways based on a hypothesis using quantitative data and use qualitative methods to understand causal pathways or mechanisms that impact positively or negatively on the change. The process evaluation outlined in this proposal will enable us to evaluate the barriers and facilitators involved in setting up a practice development unit in a male medical ward in QECH and to determine which are the most effective measures to improve care. This project aligns to UN Sustainable Development Goals 3, 10 and 17, focusing on improving health and well-being for patients in an area with high mortality and morbidity who are cared for by a healthcare system which has significant staffing issues, along with shortage of equipment and supplies. 3.1 Rationale/justification for the research project The aim of this proposal is to evaluate the outcomes of the ‘practice development unit’, currently being established on a male medical/ HDU ward (Ward 3B) at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. The PDU is in the process of being established and measuring its effectiveness is essential to guide further quality improvement initiatives in Queen Elizabeth Central Hospital. Funding has already been invested via Erasmus Plus and Global Challenge Research funding and it is anticipated that this study will form the basis for further research where the impact on patient health outcomes can be measured. A rapid review of the evidence base has taken place in relation to the chosen areas, in line with improvement science. An audit of ward cleaning identified that no protocol is currently followed and roles and responsibilities are not clear (please see appendix 6 for base line audit). Evidence suggests it is vital to ensure ward floors, equipment and surfaces are cleaned effectively and efficiently to reduce cross infection (Royal College of Nursing (RCN) 2005). Similarly audits of the ward round found that they were primarily Doctor led with room for improvement; and multi-disciplinary team meetings were non-existent (please see appendix 6 for base line audit). The evidence suggests a checklist should be provided to underpin the ward round and decision making (Shetty 2018 and Krishnamohan 2019) and a communication tool such as SBAR can help enhance understanding (O’Learly et al, 2010; Randmar et al 2014). Research by Raine et al (2014) identify the characteristics of chronic disease MDT meetings associated with decision making and derived a set of feasible modifications to MDTs to improve decision making. This 21 point framework for effective multidisciplinary meetings which relates to a common purpose and function; team meeting processes; content of discussion; and the role of the patient will be implemented as part of the practice development unit, to enhance higher quality decisions that may lead to improved health outcomes. Improving the admission, care management and discharge of patients with diabetes is justified. Africa currently has 19 million suffering the disease and prevalence is expected to escalate to 47 million in 2045, representing a record-breaking increase of 143% (IDF, 2019). Sub-Saharan Africa is also a region with the highest proportion of undiagnosed diabetes; three out of five people who have diabetes are not aware that they have it (Assah & Mbanya, 2017; IDF, 2019; Nuche-Berenguer & Kupfer, 2018). Diabetes was projected to cause over 366, 200 deaths in Africa in 2019, and three out of four of these deaths were people below the age of 60years, the highest proportion among the IDF regions (IDF, 2019). As pointed out by Pastakia et al. (2017) and Nuche-Berenguer and Kupfer (2018), this mortality rate is largely attributed to late diagnosis and poor care for people living with diabetes. (Msyamboza et al., (DW & JC) 2014). Scaling up of health services in response to this increasing prevalence of diabetes is critical yet remains a challenge as the additional burden of managing complex co-morbidity is impacting significantly on hospital resources and ward routines (Atsalos et al., 2019). Public hospitals are under pressure due to increasing demands on services, economic constraints and imbalances in workforce supply, therefore, frontline health professionals such as nurses are facing challenges as they strive to maintain effective and safe health services (Dignam et al., 2012; Grosso et al., 2019). The complex and challenging nature of diabetes requires healthcare workers to have the capacity to provide optimal levels of care for patients (Atsalos et al., 2019; Molayaghobi et al., 2019; Navarro et al., 2019). Appropriate care and management interventions have proven to halt diabetes progression and minimise complications (Alotaibi et al., 2016). Evidence also demonstrates that nurses have an important role to play in diabetes care and have a major effect when supporting patients with self-management of their condition particularly using the proactive care management model and decision making support approaches (Olson & Rosenberg, 2019; Watts & Sood, 2016; Zupa et al., 2019). It is imperative that the practice development unit focuses on improving the care and management of patients with diabetes. A base line audit indicated that the admission and discharge of patients with diabetes was not in line with the evidence base for good practice (see appendix 6 for base line audit outcomes).
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Assessing the knowledge and attitudes of University of Malawi female undergraduate students on cervical cancer screening
(Kamuzu University of Health Sciences, 2021-01-05) Matola, Esmy; Kachitsamba, Yamikani; Katengeza, Kholiwe
Cervical cancer is the 4th most common cancer among women worldwide[1]. Once diagnosed, about 80% of the women die prematurely. This is mostly because they present to the hospital very late when the cancer is in its advanced stage when there is nothing much that medical practitioners can do. These are deaths that could be avoided if women went for cervical cancer screening. There are so many reasons why women do not go for cervical cancer screening one of which is lack of knowledge about cervical cancer and screening. University female undergraduate students are at a risk of developing cervical cancer later on in their lives due to the various risk factors that they are exposed to. Some of them being multiple sexual partners and early sexual debut. College education in Malawi does not offer a greater access to health education specifically about cervical cancer to the female students. Therefore, there is little knowledge about cervical cancer which may have an impact on cervical cancer screening. This study aims to assess the knowledge and attitudes that these female university students have about cervical cancer and screening. This is going to be a cross sectional quantitative study targeting female undergraduate students in the University of Malawi (College of Medicine, Kamuzu College of nursing, Polytechnic and Chancellor College) aged 21 to 29. Data will be collected using self-administered questionnaires where the participants will fill and resubmit to the researchers. The expectation is that this study will reveal the different levels of knowledge that these university female undergraduate students have on cervical cancer , and screening. The reasons for the variation in the levels of knowledge will be fully understood during data analysis. Data will be presented in tables, pie charts and graphs.
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Child development study: Evaluation of effectiveness of low cost, high frequency and high-quality data to identify the main constraints and drivers of childhood and adolescence development in Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Phuka, John
Background This a cohort study with multiple end point to evaluation impact of digital technologies of determinants of child growth and development. Problem: In developing countries like Malawi, children are trapped in a cycle that, from the getgo, offers them very limited opportunities to escape poverty and under-development. Malawian children will grow up in an environment without basic nutrients to properly develop and might potentially die from diseases that could have been otherwise prevented at low cost. This cycle can only be broken if the right interventions for each child reach them at the right time. Given hard resource constraints, this requires evaluating trade-offs based on what are the most cost-effective interventions to address each of the issues hindering child development in each setting. However due poor data collection in poor countries, programs targeted at children and adolescents often have to be scaled up or down in the absence of rigorous evidence about their impacts. Lately poor modelling data from reliable data has made it difficult to reliably model pattern of Malawian epidemics. High frequency social-behavioural data will enable Malawi make more accurate estimations and models based of unbiased data independently determined by digital sensors. Aim and Objectives Our study aims to assess impact of high frequent data collection using wearable digital technologies. Specifically our objective is to evaluate impact of real-time program evaluation through multiple; to assess effectiveness of high frequency data on children’s non-invasive biomarkers (from heart rate and variability to brain waves) and symptoms; and to determine social interaction between parents and children and other social contacts (including caregiver-child interactions); and impact of health promotion For example, we can analyse how handwashing habits can reduce the spread of infections like COVID-19. Further the study will evaluate the impacts of these messages on the behaviours and symptoms tracked by phone surveys, with the ability to understand trends and calibrate interventions in real-time. Methods The study is longitudinal prospective cohort with nested intervention study on health promotion. Data collection includes socioeconomic and behavioural data with end point non-invasive biomarkers. In combination with rapid experimentation, these data allows policies to be evaluated in real time. With the help of machine learning algorithms, the data also feeds early warning systems to empower community health workers to detect problems at an early stage – especially when it comes to epidemics like COVID-19 – and to implement immediate and preventive measures to address them. Last, combining experimentation with predictions allows for program personalization, such that each child and adolescent can benefit from the interventions most likely to benefit them. Expected Findings Like during the extensive pilot phase over the course of 2019, we have shown that this approach is able to collect high-frequency, high-quality and inexpensive data by adapting wearable sensors and phone surveys to the local setting specificities. Early results are encouraging, but further investigation to document how real-time program evaluation and personalization can be scaled up with the help of the right technologies and under the appropriate legal and ethical framework. The social-behavioural data based on contact sensors will likely model pattern of care for child stimulation as well as pattern of likely spread of diseases like diarrhoea, upper respiratory tract infection (like COVID 19 and common viral colds). This study will be especially important and beneficial under the current epidemic shock of COVID-19. Health promotion intervention through sending mobile nudges (reminders and encouragement messages) through SMS will allow us determine factors associated with behaviour output and help resolve compliance challenges to adherence to preventive behaviours to infections (lately we see decline in COVID-19 prevention measure irrespective awareness campaigns) Dissemination of Findings The findings will be disseminated through peer research conferences, publication in peer reviewed journals and COMREC. The data will be made public after peer reviewed journal are published for possible re-analysis and teaching.
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Knowledge, attitudes and perception on breast examination among women in rural Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Chikhwana, Horace; Shaban, Shukran; Sidira, Usemi
Breast cancer is one of the leading causes of morbidity of cancer among women in Africa (1). In Malawi many women present with an advanced disease as they are diagnosed with large tumors after long symptomatic period (1). Early and efficient diagnosis of breast cancer is a key feature of any strategy aimed at reducing breast cancer burden in developing countries (2). This research broadly explores the knowledge, attitudes and perception on breast examination among women in rural Blantyre. It’s not well known on what women in rural Malawi know about breast cancer and how their settings affect their perception and attitude on breast cancer. It is also not well known if the awareness campaigns for breast cancer have an impact on the rural settings This research will specifically assess the knowledge regarding self and clinical breast examination among rural women, determine association between knowledge of clinical breast examination and their willingness to go for routine screening and will describe their perceptions on the causes and prevention of breast cancer. The research will use a quantitative cross-sectional study. The sample size of 378 women will be selected using convenience sampling approach. The sample will be selected from women aged between 35 -65 years who reside in Chileka and Lunzu. Data is to be collected using a questionnaire and presented in proportions and percentages using appropriate graphs, tables and charts. We will seek permission from College of Medicine Research and Ethics Committee (COMREC) and the village heads of Chileka and Lunzu. This study is expected to bridge the gap on the knowledge, perception and attitude on breast examination among rural women, this will help when trying to implement better outreach method to the rural areas in regard to breast cancer awareness campaigns The results will be presented on the 4th year Research dissemination Day in 2020/2021 academic year through students’ presentations. Results will also be submitted to COMREC, The Health Sciences Research Committee, College of Medicine Library, Malawi Medical Journals and The University Research and Publications Committee (URPC).
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Assessing nursing students’ approaches to learning in selected nursing schools in Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Zolowere, Dalitso
Study type: This will be a quantitative cross-section study. Problem to be studied: Students’ approaches to learning are vital in nursing education. This is because nursing is a profession where classroom learning leads to clinical performance. Literature recognizes the student’s approaches to learning as a significant aspect affecting the quality of student’s learning. A student’s adopted approach to learning affects the student’s ability to acquire critical thinking, problem solving and lifelong learning which in turn aids nursing students and nurses to tackle various challenges in diverse clinical settings. Consequently, it affects positive health outcomes in health care consumers. In Malawi, nursing and midwifery technicians are a largest nursing workforce, however, there is scarcity of empirical data on learning approaches that Malawian nursing and midwifery technician students in nursing colleges employ. This study therefore, seeks to establish learning approaches that Malawian nursing and midwifery technician students employ. Study objective: The main objective of this study is to assess the different approaches to learning among nursing and midwifery technician students in selected Malawian nursing colleges. It will specifically identify approaches to learning adopted by nursing and midwifery technician students in selected nursing colleges in Malawi. It will also measure the association between demographic characteristics of the nursing and midwifery technician students and their adopted approaches to learning in selected nursing colleges in Malawi. The study will further specifically assess the association between the assessment the nursing and midwifery technician students pass through and the adopted approaches to learning in selected nursing colleges in Malawi. Methodology: This will be a cross- sectional study that will employ quantitative methods. The target population is nursing and midwifery technician students in year one, two and three from Nkhoma College of Nursing, Ekwendeni College of Health Sciences and Malawi College of Health Sciences. A total of 253 students will be sampled from the three nursing colleges. Data will be collected through a self-administered questionnaire and will be analyzed using SPSS version 22.0. To ensure adherence to ethical standards the research proposal will be submitted to COMREC for ethical approval. Furthermore, throughout the process of conducting the research, confidentiality, beneficence, respect for human dignity and justice will be strictly observed. Dissemination of results: The findings from this study will be disseminated at the selected colleges. In addition, the findings will be submitted to Kamuzu College of Nursing and COMREC in form of a report (thesis) and further be published in peer reviewed journals after authorization. Furthermore, the thesis will be shared with KCN libraries for both campuses so that it can be used for educational purposes.
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Assessing knowledge on factors associated with premature birth at Queen Elizabeth Central Hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-02-08) Mijoya, Precious; Kanyang’ama, Chancy; Thindwa, Robert M
Recent estimates indicate that there are 15 million preterm new-borns annually and the number is increasing each year. South Asia and sub-Saharan Africa accounts for almost twothirds of the world’s preterm new-borns and over three-quarters of the world’s new-born deaths due to preterm birth complications. In 2010, a review of reported preterm birth rates from 184 countries found Malawi to have highest rate at 18.1%. Preterm birth in Malawi has been found to be associated with adolescent pregnancy (age < 20), mother’s low mean body mass index (BMI), severe anaemia and Malaria at least once during pregnancy. Women with persistent malaria, previous preterm delivery and previous still birth had more proportion of preterm birth. However, this does not explain about the knowledge on factors associated with premature births in Malawi among mothers with premature babies, their guardians and health workers. This is a qualitative cross-sectional study on assessing knowledge on factors associated with premature birth at Queen Elizabeth Central Hospital. The participants in this study will be selected using cluster sampling technique. The main objective of this research study is to assess the knowledge of mothers with premature babies, their guardians, doctors, nurses and midwives on factors associated with preterm birth. Data will be collected using interview guides which will assess what people think are the factors associated with preterm delivery and how they get information about preterm delivery. The data will be analyzed using content analysis method. At the end of this study we expect to find out knowledge (as how much people know) on factors associated with pre mature birth. Dissemination of the results will be done at the research dissemination conference organized by the research coordinator at College of Medicine.
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Pre-service knowledge, perception and use of emergency contraception among undergraduate medical and nursing students in UNIMA in Blantyre
(Kamuzu University of Health Sciences, 2021-02-16) Munthali, Eddah; Dzunde, Mercy; Kadewere, Lughano
Background: Emergency contraception(EC) is one of the modern methods of preventing unintended pregnancies. It can be conveniently used due to several factors, one of them being the failure of other family planning methods among many others. However, EC is not a replacement of those family planning methods rather a temporary measure. Many health care providers are products of Kamuzu College of Nursing (KCN) and College of Medicine (COM), but little is known of their knowledge, perception and also use when it comes to ECs. Our aim in this study is therefore to explore the knowledge, perception and use of EC among medical and nursing students at those institutions. Objectives and methodologies: The broad objective is to determine the association of knowledge, perception and use of emergency contraception among medical and nursing undergraduate students in College of Medicine and Kamuzu College of Nursing in Blantyre. The specific objectives are; to estimate the knowledge level of medical and nursing students on emergency contraception, to measure the perception towards emergency contraception among medical and nursing students, to quantify the use of emergency contraception among medical and nursing students, to assess the association between knowledge and use of emergency contraception, to assess the association between perceptions and use of emergency contraception. This will be a quantitative cross sectional study. The study population will be MBBS and Pharmacy year 2 students at COM and Bachelor of Midwifery, Bachelor of Adult Health Nursing and Bachelor of Community Health Nursing year 2 students at KCN. The sampling methods purposive sampling and systematic sampling. Data will be collected using self administered questionnaires from 210 students. The sample size was calculated using epi info and was adjusted for refusal and losses. The data collected will be entered in Microsoft excel and will be extracted into and analysed using epi info software. The data will be analysed using descriptive statics and chi square to determine the association between factors associated with awareness and use of EC. Expected findings and dissemination: At the end of this study, we expect to find data on different aspects of knowledge, perception and use of EC and how these aspects relate to one another. This will help to determine if there is a need for provision of additional courses pertaining to family planning especially involving EC. The study findings will be organised and presented at the research dissemination organised by the COMREC in MBBS 4 and submitted for publication in the Malawi Medical Journal.
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Exploring lived experiences of male partners’ in the care of preterm newborns: A qualitative study
(Kamuzu University of Health Sciences, 2021-02-21) Mhango, Patani
Executive Summary Type of Study: This will be a phenomenological qualitative study which will use qualitative data collection methods. Background: Every year, it is estimated that 15 million preterm births occur globally contributing 3.1% of global disability-adjusted life years (DALYs) through 1.1 million deaths and long-term loss of human potential amongst survivors. The greatest risk of death is during the neonatal period (0-28 days of life). Malawi has the highest rate of preterm births in the world, estimated to be between 18%26% of live births causing almost 36% of neonatal deaths. Birth of a child in the family presents a new challenge into parenthood and comes with it a great change, responsibility and transition. However, for the fathers of preterm newborns, the transition is disrupted by the unexpected birth of the child, uncertainty about the baby’s survival and life to follow. Fathers have been for so long considered traditionally as the breadwinners of the family, providing the family with all the necessary support it requires and the mothers were responsible of caring for the children and the household. In the recent years, these roles have changed in several ways as men and women have become more equal. Fathers spend more time with their children and have better experience in taking care of their children. Male involvement has been advocated as a key to improve maternal and child health because fathers play a vital role in decision-making in the households. However, fathers’ thoughts, feelings, fears and experiences in the care of preterm newborns are not adequately explored. In Malawi, there is lack of literature despite having highest preterm birth rate globally. As such, there is need to explore the lived experiences of the fathers, which is critical to their involvement in the care of the preterm newborns. Objectives: The broad objective of the study is to explore lived experiences of male partners’ in the care of preterm newborns in Balaka District. Specific objectives are a. To identify practices male partners are involved in provision of care to preterm infants b. To assess perceptions of men on their involvement in the care of the preterm infants c. To explore barriers to male involvement in the care of the preterm infants d. To explore facilitators to male involvement in the care of the preterm infants Study design, population, sample size and sampling strategy: The study will use the phenomenological qualitative research design guided by the Theory of Planned Behaviour because its versatility will allow exploration of the dynamic and complex nature of male involvement. The proposed study will be conducted amongst fathers of hospitalised preterm neonates aged 7-28 day. Twenty participants will take part in the study. The number resonates with methodological literature on saturation of qualitative data. Participants will be sampled purposively using maximum variation technique to ensure rich data is collected. Study Site, Study period and data collection: The study will be conducted in Balaka district at Balaka District hospital, which is the referral hospital in the district. It is expected that this study will run for one year from July 2020 to June 2021. In-depth interviews will be used to collect data Data management and analyses: Data collection and analysis will partly be done concurrently and audio-recorded interviews will be translated and transcribed verbatim by trained transcribers. Before analysis, transcripts will be anonymised. Data will be analyzed using qualitative thematic analysis methods. Analysis will use a hybrid of the deductive and inductive approach Dissemination Plans: Findings from the study will be compiled in a comprehensive that will be submitted to the University of Malawi (UNIMA), College of Medicine (COM) for marking. Copies will be submitted to College of Medicine Research and Ethics Committee, College of Medicine Library, and other research institutions. Furthermore, feedback will be given to Balaka District Hospital. The results will also be presented at relevant regional and international conferences and published in relevant peer-reviewed journals. Anticipated challenges: Firstly, to most families, premature birth comes unexpectedly and brings with it a lot of stress and fathers may not be willing to share their experiences with the researcher. Secondly, due to the COVID-19, recruitment challenges are anticipated considering that visits to hospitals are restricted. Furthermore, some potential participants may have travelled long distances using various means and may wish to be travelling back as soon as they can. This may affect their willingness to participate in the study. Potential use of results: It is believed that findings from this study will help in developing interventions to increase male involvement in the care of preterm newborns, which is critical to the infants’ survival and development. The study will also help inform health care providers the need to encourage and welcome male partners in the care of preterm newborns, as they are in a key position to be influential to the infant’s health.
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Exploring the effects of pregnant women’s perceptions towards first trimester attendance at Area 25 antenatal clinic in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2021-03-04) Nyando, Modesta
Type of the study: This is a research project which will qualitatively explore the perceptions of pregnant women towards first trimester attendance at Area 25 antenatal clinic in Lilongwe, Malawi. Problem: Malawi is among countries with high maternal mortality ratio (MMR) in Sub Saharan Africa with 439 deaths/100,000 live births in 2016. According to World Health Organisation guidelines which are currently in use, antenatal care in the first trimester is one of the key interventions in reducing the maternal mortality ratio. Despite this being the case only 24% of the pregnant women in Malawi start antenatal care in the first trimester. Furthermore, only 15% of pregnant women at area 25 health centre attend antenatal care in the first trimester. Women who do not comply with first trimester attendance are at increased risk of poor pregnancy outcomes, maternal and neonatal mortality. Pregnant women’s perception towards first trimester attendance, crucially impacts utilization of the antenatal services and hence pregnancy outcomes. However, these perceptions are not clearly understood. Understanding of the pregnant women’s perceptions towards first trimester attendance and how such perceptions are linked to actual first trimester attendance is critical in finding appropriate strategies for preventing avoidable maternal and neonatal deaths. To my knowledge, no study in Malawi has been done which qualitatively explored pregnant women’s perceptions towards first trimester attendance using the Health Belief Model hence the need for the study. Objective: To explore the perceptions of pregnant women towards first trimester attendance at area 25 antenatal clinic in Lilongwe, Malawi. Methods A qualitative exploratory study design will be employed. The study setting is at area 25 antenatal clinic in Lilongwe, Malawi. Pregnant women attending antenatal clinic between the ages of 18 to 49 years will be purposefully sampled. In depth interviews and focused group discussions will be conducted using the topic guide. In depth interviews will also be done to key informants who will be midwives working at the antenatal clinic. Data will be analysed manually where by codes will be identified, merged and organised into themes. Possible constraints: The findings of the study will not be generalized due to small sample size which lack representability and comparability. However, qualitative methods aim at the depth and that findings can be applicable in similar setting. There will be little time to conduct the study because the investigator will also have to go through other program modules. The resources to conduct the study are also limited Expected findings: The study will establish interventions that may promote first trimester attendance Dissemination: The study findings will be disseminated to COMREC, management team of the study site through dissemination meetings. The dissertation will also be submitted for possible publication in the peer reviewed journals. Source of funding: The funding will be from the salary savings to make sure the research project is done looking at the significance of the study.
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Implementation research on the appropriateness, feasibility, acceptability, and effectiveness of delivery of comprehensive sexuality education to Young people with disabilities and young people living with HIV out-of-school.
(Kamuzu University of Health Sciences, 2021-03-04) Chipeta, Effie
Type of study: This is an implementation science research study that will employ different methods to test the appropriateness, feasibility, acceptability and effectiveness of approaches to train and support facilitators to deliver CSE in out-of-school settings to young people with disabilities (YPWDs) and young people living with HIV (YPLHIV) in Malawi. Background and rationale: In January 2018, six UN agencies launched a revised edition of the International technical guidance on sexuality education, which provides guidance on designing and delivering comprehensive sexuality education (CSE) to support young people’s (10-24 years) health and well-being. Through UNFPA HQ and regional offices, the 3-year initiative titled “Reaching those most left behind through CSE for out-of-school young people,” is being implemented in Malawi and other four countries. The program in Malawi focuses on delivering CSE in out-of-school contexts to young people with disabilities and young people living with HIV. Objectives: The overall objective of the implementation research is to determine whether the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling the facilitators to engage YPWD and YPLHIV, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. The specific objectives of the implementation research are: 1. To determine whether the activities used to train and support facilitators were appropriate for the delivery of comprehensive sexuality education to young people with disabilities and young people living with HIV. 2. To determine whether the plan for training and supporting the facilitators was feasible and whether it was implemented with fidelity. 3. To determine whether the training and support provided to the facilitators was effective in improving their competencies and attitudes. 4. To determine whether the facilitators: a. perceived that the training and support they received adequately enabled them to carry out their roles and responsibilities. b. effectively carried out their roles and responsibilities. 5. To determine whether the YPWD and YPLHIV: a. perceived the CSE as accessible, relevant, interesting, and useful. b. gained in terms of knowledge, attitudes, values, and skills related to sexuality and reproduction, and in terms of the use of relevant services. Methods: This is an implementation science research study that will employ different methods to test the appropriateness, feasibility, acceptability and effectiveness of training and supporting facilitators to deliver CSE in out-of-school settings to young people with disabilities and young people living with HIV in Malawi. Data will be collected at different time periods to measure and assess the implementation process and outcomes throughout the course of the intervention. We will use qualitative methods such as focus group discussions and in depth interviews and records review to measure the implementation processes and outcomes. Data management and analysis: The data will be secured. To ensure that the identities of participants are kept confidential, data will be anonymised and random identifiers will be generated for each file. The investigators will also go through audio files and transcripts to ensure quality. Quantitative data will also be cleaned. Qualitative data will be analysed using thematic content analysis approach while we will generate descriptive statistics with quantitative data. The qualitative and quantitative findings will be triangulated. By using various research methods (i.e. records review, qualitative interviews and quantitative data), we will eliminate some biases and shortcomings that may arise with using one method. Where necessary, qualitative data will provide explanations, justifications and validations to the findings from the quantitative data. Possible constraints: We anticipate no major constraints. However, due to the COVID-19 pandemic, study activities may be delayed or paused depending on the status of the pandemic. We will also adhere to all COVID-19 guidelines in conducting our research to ensure the safety of both researchers and study participants. Results To ensure that the research findings support efforts to improve CSE more generally, research findings will be disseminated through key stakeholders, peer reviewed journals, conferences and a copy will be sent to approving ethics committees (e.g. COMREC). Implications of the study: We anticipate that facilitators will become more competent in and more comfortable with delivering CSE in out-of-school settings to the targeted populations, that is, young people with disabilities and young people living with HIV. We anticipate that the facilitators will be acceptable to the young people and that delivery of the CSE will be feasible and more effective.
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Predictors of vesicovaginal fistula closure outcomes among women following surgery at Bwaila Fistula Care Centre
(Kamuzu University of Health Sciences, 2021-03-04) Chipapa, Smith
The type of research study: This is a quantitative retrospective cross-sectional study which will use data from the case management notes of women with obstetric fistula at the Bwaila fistula care centre from January 2019 to December 2019. The problem to be studied While the goal of repair is to achieve continence in women with obstetric fistula, a significant number of women experience avoidable failed repairs and remain incontinent even after the repair. As a result these women are continuously subjected to psychological, emotional, social and medical trauma from the urine. Information on the reasons for failed repairs of these women is scanty and mostly limited to the patient related factors. Factors that predict repair outcomes are arguably many and not only limited to patient related factors. If these factors can be considered preoperatively to determine the kind of surgery required for a specified fistula, incidences of failed repairs would be greatly minimized hence optimizing the quality of lives of these women. This study therefore seeks to assess predictors of Vesicovaginal fistula closure outcomes in women following surgery at Bwaila Fistula care Centre The objectives This study aims to assess predictors of Vesicovaginal fistula closure outcomes in women following surgery at Bwaila Fistula care Centre. Methodology Case files of women who underwent obstetric fistula repair from January 2019 to December 2019 will be identified from which 174 case notes will be randomly sampled foranalysis. A data abstraction tool will be used to extract labour, patient and hospital related variable information from the case notes which will be used to assess their association with closure outcome. Data will be analyzed using SPSS version 22. Expected findings and their dissemination. We expect to find labour, patient and hospital related factors that can predict repair outcomes of women with Vesicovaginal fistula. Based on the findings on these predictors, recommendations on how a specific fistula characteristic combination should be handled for optimum repair will be developed. The final copy of the findings will be made available at COMREC, Ministry of Health, and the fistula care Centre where the data will be collected. Findings will also be Presented at national and international conferences and the final copy will be published in a peer reviewed academic journal.
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Burden and associated factors among caregivers of people with mental illness receiving treatment at Saint John of God Hospitaller Lilongwe services
(Kamuzu University of Health Sciences, 2021-03-04) Mainjeni, Angella
Background/introduction: Mental, neurological and substance use disorders are major contributors to morbidity and premature mortality throughout the world. Over 10% of the global burden of disease, measured in terms of years of healthy life lost, can be attributed to these disorders. Family members play an important role in providing care to their relatives with mental illness. Family caregivers are responsible for adopting certain duties and responsibilities that are in excess of those normally associated with a family role at a particular stage of life hence this might be burdensome. Burden of caregiving is any unwanted or negative consequences experienced by caregivers of people with mental illness (PWMI) as a result of taking care of and the responsibility for PWMI. Studies have shown there is relationship between providing care to people with mental illness and experiences of different forms burden as a result of caregiving. Problem: severe and chronic mental illness has negative impact on the client himself and his family members. The longer the care giving the more burdensome it becomes and this might contribute to a lot of frustrations to those who are providing care to the mentally ill patients and this affect the care and recovery of mentally ill patients. Objectives: This study will determine the magnitude of the caregiver’s burden and establish the association of social demographic, clinical and personal characteristic associated with burden among caregivers of patients with mental illness receiving treatment at St John of God Hospitaller Lilongwe service in Malawi. Methodology: This will be cross sectional study recruiting 323 caregivers aged 18 years and above of patients receiving outpatient management for different kinds of mental illnesses at St John of God Hospitaller Lilongwe Service. Screening for caregiver burden will be done using involvement evaluation questionnaire (IEQ). 2.5 Constraints: Time may not be adequate for the researcher to collect the required data hence this may limit the study. Because of smaller sample size, it would be difficult for the findings to be generalized to other settings since the study will only be done at one facility. Participants may not be honest enough when responding to questions in fear of offending their ill relation hence this may affect study results. Expected findings: The study will establish if severe and chronic mental illness contribute to caregiver burden and also establish factors that associated with caregiver burden. Dissemination: Research findings will be disseminated to COMREC research dissemination conferences, St John of God Journal Presentations, annual Malawi -Scotland mental health conference, and will also be submitted for publishing in appropriate journals.
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Perceptions of community members on community maternal death reporting in Lilongwe, version 1
(Kamuzu University of Health Sciences, 2021-03-04) Telela, Ivy
Perceptions of community members on community maternal death reporting at Chiseka and Chadza villages in Mitundu, Lilongwe. ”Perceptions Of Community Members On Community Maternal Death Reporting In Mitundu, Lilongwe Background There is an increased attention to maternal health that brings the need for the demand for measures of maternal mortality at the national and subnational level (Stanton et al., 2001). Community maternal death reporting therefore is as important as hospital identification of maternal death because it helps the country to ascertain nation’s position on safe motherhood/ quality of healthcare provided. Suspected maternal deaths in the community may be reported by community members, community health workers (CHW), traditional birth attendants, or other community leaders within 48 hours to a health facility (World Health Organization, 2013). In Malawi most maternal death reporting are community members, community health workers but they take more than 48 hours and sometimes they are not even reported at all. Problem statement: Maternal deaths are not reported by the communities in Malawi (Bayley et al., 2015) despite efforts and incentives from the safe motherhood initiative. This is also evident from Lilongwe district health office where anecdotal notes from 2018 to 2019 reveals that there were 22 maternal deaths in 2019, out of which 19 were hospital maternal deaths in different health facilities in Lilongwe and 3 were community maternal deaths which were discovered but remained unreported by the community. These unreported deaths occurred in Chileka and Mitundu catchment areas. These were discovered when some family members brought neonates to the hospital to ask for help with milk following the deaths of their mothers during childbirth. Lilongwe district, like many other districts in Malawi has benefited a lot from research on maternal health and mortality which is focused on general issues like top causes of maternal deaths, landscape analysis of maternal health service delivery, causes and consequences of maternal HIV transmission, but there hasn’t been any known specific research work on exploring the community’s knowledge, attitudes and practices pertaining to maternal death reporting. The author therefore proposes to conduct a study on the perceptions of community members on community maternal death reporting. Research aim. To explore the perceptions of community members on community maternal deaths reporting in Lilongwe district. Methodology: A qualitative approach with a descriptive design is proposed to be applied to this study. A qualitative approach offers visions to different problems and helps in developing concepts or theories for potential quantitative research (carol, 2016). On the other hand descriptive design has the ability to gather insights regarding a concept that is not fully understood or previously researched in depth (Kim, Sefcik, & Bradway, 2017). So this study fits in very well because as more insight will be explored pertaining to community maternal death reporting will form a basis for concepts for a possible quantitative research. Key informant interviews and focus groups will be the tools which will be used for data collection. Significance of the study: Maternal death reporting contributes to maternal health policy making, health planning, and reasonable health resource allocation at all levels, and this helps to improve maternal survival (Du et al., 2012). Therefore understanding of the perceptions of community members on community maternal death reporting may contribute to informing the devising of appropriate interventions to improve reporting of maternal deaths. This will in the long run improve maternal deaths statistics and development of appropriate maternal health management policies to prevent further community maternal deaths, may be used as a platform for further research and contribute to the body of knowledge in maternal health in Lilongwe and nation as a whole.
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Provision of essential treatments in critical illness (POETIC)
(Kamuzu University of Health Sciences, 2021-03-15) Baker, Tim
of project: This is a pilot of the overall project which includes literature review and secondary analyses of existing datasets, interviews of health-workers and other stakeholders, group discussions, online surveys and hospital walk-throughs. The problem: Approaches to improving quality of emergency and critical care in Malawi have not been previously studies. Objectives: To assess approaches for improving the quality of care for critically ill patients in hospitals in Malawi. Objectives 1. To evaluate the hospital readiness for providing critical care in hospitals in Malawi 2. To describe the current policy environment for critical care in Malawi 3. To explore existing service delivery arrangements for critically ill patients in hospitals in Malawi and the challenges faced in providing good quality care 4. To model the cost-effectiveness of different approaches for the scale-up and provision of critical care. Methodology: Repeated internet-based group discussions with 12-15 participants will be held. In-depth, more open-ended, narrative interviews will be subsequently held with 8-10 key informants including frontline health workers. Data from online discussions, interviews, walk-throughs and process maps will be analysed and used to generate a general description of the hospital journey of critically ill patients and using thematic analysis. Expected findings and dissemination: The knowledge generated will enable evaluations of the quality of context-appropriate emergency and critical care, bottleneck analyses of the weaknesses in service provision and the underlying determinants of these weaknesses, benchmarking of health services, guide the targeting of qualityimprovement interventions, and assessments of the impact of implementation efforts to improve care for critically ill patients. The results will be disseminated to the Ministry of Health, specialty societies, the Wellcome Innovations Critical Care Flagship and other stakeholders and published in open access peer reviewed journals.
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Designing immunization interventions in urban settings to improve EPI coverage in under-five children using human-centred design thinking approach: A sub-study
(Kamuzu University of Health Sciences, 2021-03-17) Kapito-Tembo, Atupele
Type of Study: Cross-sectional sub-study using qualitative human-centred design thinking methods. Background: The Malawi Ministry of Health (MOH) Expanded program on Immunisation (EPI) program would like to develop a national urban immunization strategy. Prior background work is currently underway including analysis of program data, review of EPI program activities and research studies to inform development of the urban immunization strategy. The College of Medicine (COM) team is conducting one of the research studies to inform the strategy. The study aims to identify factors contributing to low or incomplete immunization in under-five children in urban settings and strategies that could address existing challenges. Preliminary study findings have identified some proposed strategies that have potential to improve immunization services in the urban settings in Malawi. However, there is further need and request by the immunization program implementers and policy makers to develop the proposed strategies into intervention packages that meet the needs of the urban population as well as the health services providers. Main objective: To design immunization interventions to improve vaccine uptake and coverage in under-five children targeting urban settings using human-centred design thinking approach. Methods: We propose to conduct a cross-sectional sub-study using human-centred design thinking methods to design immunization interventions for the urban settings. Human-centred design thinking is a process of creating and testing innovative ideas to improve a service or product or to solve existing problems with inputs from clients who will use the service or product. We will use the human-centred design thinking process framework that uses the following 6 steps: understand, observe, point of view, ideate, prototype and test. In the first 5 steps, we will interview and work with the following target urban groups or participants to design immunization interventions that would meet their needs: a) Child caregivers with under-five children including those with under-immunised children targeting groups such as working parents, small-scale or vending business operators, highly/tertiary educated and Indian community b) Males or husbands with under-five children and sc) health care workers. In the last step of the design thinking process, we will test the developed interventions from first stage with different participants from same population categories to validate and refine the developed intervention packages. For each target group, we will engage atmost 5 participants. The study will be conducted in urban areas of Blantyre district. We will work with the HSAs to guide the identification of the communities and target groups in their catchments areas. The final interventions products created with the participants will be presented to the key EPI stakeholders for their inputs. Expected findings and dissemination: We expect to develop immunization interventions tailored for urban settings that will contribute towards informing the national urban immunization strategy. In addition, this information may guide implementers and policy makers on the areas requiring improvement in the EPI service delivery to increase uptake and coverage in urban areas. It is planned that the findings from this study will be shared with College of Medicine Research and Ethics Committee, MOH and presented at college, national and/or international research dissemination conferences and will be published in peer-reviewed journals.
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Effectiveness of midwife led continuity of care (MLCC) caseload model: An interventional explanatory sequential mixed methods study at Mchinji District Hospital, Malawi
(Kamuzu University of Health Sciences, 2021-03-17) Zileni, Barbara Debra
Type of study: An interventional explanatory sequential mixed methods study that will utilize both quantitative and qualitative data collection methods and analysis. The problem: Worldwide, maternal and neonatal morbidity and mortality remain a public health concern and improving maternal and neonatal health is a key focus in most countries. The World Health Organisation (WHO) reports that in 2017 there were 295,000 women across the globe who died as a result of pregnancy related complications representing a maternal mortality ratio (MMR) of 211 deaths/100,000 live births. Similarly, 2.5 million neonates died, and the majority of these neonatal deaths were due to preterm birth (PTB) complications. Most of the maternal (66%) and neonatal (41%) deaths occurred in sub-Saharan Africa alone. Similar to other countries in sub-Saharan Africa, Malawi has high maternal and neonatal mortality ratios (439 deaths/100,000 live births and 27 deaths/1,000 live births respectively). In response, United Nations (UN) developed the 2030 Sustainable Development Goals (SDGs), to work with countries across the globe to improve development outcomes including maternal and neonatal outcomes. The SDG target 3.1 and 3.2 aim towards reducing global maternal deaths to 70 per 100,000 live births and neonatal deaths to 12 per 1000 live births by the year 2030. Similarly, the Malawi government developed strategies to improve maternal and neonatal health, however, barriers to accessing, utilising, and financing maternity services poses a challenge to improving these outcomes. To achieve these targets and end avoidable maternal and neonatal deaths, country specific interventions are needed. The antenatal period provides a first entry point within the childbirth continuum, to implement effective interventions aimed at improving maternal and neonatal health, through prevention, detection, and management of obstetric complications. Timely implementation of antenatal care (ANC) services could reduce maternal and neonatal deaths, however, statistics for sub-Saharan Africa, including Malawi, show underutilization and low attendance for ANC services. Of the 95% women who attend at least one ANC contact in Malawi, only 51% attend four or more ANC contacts, and only 24% attend the initial ANC contact during the first trimester of pregnancy. The low utilization of ANC services especially in regions with high maternal and neonatal deaths puts women at increased risk of adverse outcomes such as preterm births. The WHO developed recommendations on antenatal care for a positive pregnancy experience to help countries implement evidence-based interventions to improve maternal and neonatal health. One of the recommendation relevant to this study, is the WHO’s recommendation of Midwife Led Continuity of Care (MLCC) during pregnancy. In MLCC models women receive care from the same caregiver (caseload) or a small group of midwives (team) during the childbirth continuum. Use of MLCC models has been associated with improved ANC utilization and childbirth outcomes. Antenatal care in Malawi is based on a fragmented Standard Antenatal Care (SANC) model with care provision from different midwives and doctors. Evidence indicates that most of the current strategies, employed by Malawi in the SANC model, may not be optimal and there is a need to adopt and evaluate strategies that have worked effectively in other countries. A new modified service delivery model, the MLCC caseload model recommended by WHO, could be one strategy worth implementing and evaluating in Malawi. Although the MLCC caseload model is acceptable and effective in developed countries, no country in Africa has adopted this model to date. There is a lack of literature on the effectiveness of caseload model in developing countries and a thorough search of the literature did not return any study on caseload model in sub-Saharan Africa. Studies conducted in sub-Saharan Africa including Malawi on ANC models have concentrated on ‘group’ ANC model, a model different from WHO’s recommended caseload model. A thorough search of the literature could not find any study on caseload model in Malawi and sub-Saharan Africa. Aim and specific objectives: The main aim of the proposed study is to examine effectiveness of the caseload model in improving childbirth outcomes and explore experiences of midwives working in the model. The following specific objectives will be addressed: 1. Describe socio-demographic and obstetric characteristics of women who receive care through the caseload model with women who receive care through SANC model. 2. Examine whether a caseload model decreases rate of PTB among women when compared with SANC model 3. Compare women’s satisfaction with ANC in caseload model versus SANC model 4. Compare maternal outcomes (ANC attendance, admission to ANC ward, place of birth, labour onset, mode of birth, anaemia, malaria, antepartum haemorrhage, postpartum haemorrhage, hypertensive disorders of pregnancy, maternal death) of women who receive care in the caseload model with women who receive care in SANC model. 5. Compare other neonatal outcomes (birth weight, fetal and neonatal loss, Apgar score, admission to neonatal ward, initiation of breast feeding, initiation of skin-to-skin contact) among women who receive care in the caseload model and SANC model. 6. Explore midwives’ experiences of working in a caseload model. Methodology: An interventional explanatory sequential mixed methods study will be conducted at Mchinji District Hospital (MDH) in Malawi in two phases. In phase one, a post-test only parallel randomised clinical trial (RCT) will be conducted to test the intervention (caseload model). A sample of 1206 pregnant women aged 18 and above with a gestation of less than 20 weeks at initial ANC contact will be randomly allocated to caseload or SANC model. Data will be collected on primary and secondary outcome variables and analysed using descriptive and inferential statistical tests in Statistical Package for the Social Sciences (SPSS) version 26. Reporting of the data will follow the CONsolidated Standards of Reporting Trials (CONSORT) guidelines for reporting of RCT’s. In phase two, a qualitative descriptive design will be used to explore midwives’ experiences of working in the caseload model. All six midwives working in the caseload model will be asked to participate in individual in-depth interviews on completion of the study. NVivo software version 12 will be used to organise data using thematic analysis by identifying codes and common themes emerging. Ethical considerations such as privacy, anonymity, voluntary participation, doing no harm will be observed throughout the study period. The first ethics approval has been obtained from Curtin Human Research Ethics Committee (HRE2020-0752) and the second ethics approval will be obtained from Malawi College of Medicine Research Ethics Committee (COMREC). Permission to conduct the study at MDH has been granted by the Director of Health and Social Services, Mchinji District Health Office and the Director of Reproductive Health Services, Ministry of Health, Malawi. The RCT has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000008820p). Expected findings and dissemination: The study will provide evidence on the effectiveness of the caseload model in improving childbirth outcomes and experiences of midwives working in a caseload model at Mchinji District Hospital, Malawi. Based upon the evidence around caseload model, the anticipated outcomes could include, increased number of antenatal attendances, reduced rates of PTB, reduced prevalence of Low Birth Weight (LBW) neonates, fewer admissions to high risk ANC ward, increased proportion of spontaneous vaginal births, early initiation of breastfeeding within the first hour of birth, reduced admissions to neonatal ward, reduced proportion of fetal and neonatal deaths and greater maternal satisfaction with ANC. The caseload model in this study will provide women with more information and knowledge on pregnancy, birth and postnatal, through antenatal appointments with a known trusted midwife. Furthermore, increased engagement of women with a known midwife may improve the midwife-woman relationship, increasing job satisfaction for midwives. Exploring midwives’ experiences and views could also inform policy makers in Malawi on how the model can be adapted and expanded to other settings. Study results and findings will be disseminated through publication in journals, research conference presentations and dissertation publication at Curtin University online Library.
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Assessing factors associated with full immunization in under one children in Dedza District, Malawi
(Kamuzu University of Health Sciences, 2021-06-03) Zinkanda Banda, Rudolf
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 (fully immunized) 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. 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.