Maternal & Child Health

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Assessment of prescription patterns and cost analysis of oncology drugs used in the Paediatric Unit of Queen Elizabeth Central Hospital, Malawi
(Kamuzu University of Health Sciencies, 6-09-21) Kilowe, Carlos Edwin
Background: Cancer is one of the global leading causes of childhood morbidity and mortality. High childhood cancer mortality rates in developing countries have been linked to irrational chemotherapy prescribing patterns. Irrational prescribing leads to ineffective treatment, occurrence of adverse events, prolonged hospitalization and increased economic burden to patients and their community. Children are more vulnerable to effects of irrational prescribing owing to their underdeveloped pharmacokinetic and pharmacodynamic profiles. Therefore, it is important to follow principles of rational prescribing as well as study prescribing patterns in order to ascertain how drugs are being used. Despite the need for periodical assessment of prescribing patterns and cost analysis, Malawi has a paucity of data on prescribing patterns and cost analysis of pediatric anticancer drugs. Objectives The objective of this study is to assess prescribing patterns and costs analysis of anticancer drugs used in paediatric cancer patients at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methodology A retrospective cohort study will be conducted in pediatric oncology unit at Queen Elizabeth central hospital (QECH). The study will review and abstract data from patients’ files of children aged 0-18 diagnosed with cancer between January 2017 and December 2020. Rationality of prescribing patterns will be assessed using WHO rational prescribing indicators. The WHO indicators include: average number of drugs per encounter, percentage generic prescribing and drugs prescribed from national formulary. Quantity of drugs dispensed from the patient files will be used to compute cost of the drugs using current market prices obtained from Central 21-Aug-9 Version 6 xii Medical Stores catalogue and private wholesale supplier. Descriptive data analysis will be conducted where continuous variables will be summarized as mean and standard deviation. Frequencies and proportions will be computed for categorical variables. Regression analysis will be carried out to summarize possible relationships between anticancer prescribing patterns and predictor variables such as patient’s demographic data, cancer type and stage, and type of medications used. The level of significance will be set at 0.05. Expected findings The study is expected to shed light on rational chemotherapy prescribing patterns and cost of chemotherapy prescription in Malawi. Rational chemotherapy use improves childhood cancer clinical outcomes, reduces occurrence of adverse reactions, and optimizes health expenditure on chemotherapy drugs. Dissemination The findings of this study will be shared with University of Nairobi, Kamuzu university of Health sciences and Queen Elizabeth central hospital. The findings will also be published in peer reviewed journal.
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Long-term outcomes of severe childhood malnutrition study
(Kamuzu University of Health Sciencies, 7-07-21) Kirolos, Amir
Type of research study This study is a cross-sectional follow-up of an existing cohort of adolescents/young adults who suffered from severe malnutrition as children. The problem Childhood malnutrition is widespread in Malawi and has health impacts which are often life long 1. Severe wasting in childhood is particularly deadly 2, and the ‘double burden of malnutrition’ (undernutrition of nutritionally rich foods and oversupply of foods with low nutritional value) is being increasingly recognised as a major health problem globally 3. Current malnutrition treatment programmes have a major focus on preventing acute mortality. While the acute risk of death in early childhood is well described, there is a need for further research on the medium- and long-term outcomes of survivors to understand the long-term disease burden and tailor treatment interventions 4. Children exposed to severe malnutrition may be at higher risk of adult noncommunicable diseases due to impaired organ development, altered body composition, rapid catchup growth through high calorie feeding and exposure to an obesogenic environment. Severe childhood malnutrition is also associated with developmental delay 5, and early insults to the developing brain from malnutrition may impair cognitive potential in later life 6. Mental health and behavioural problems may be also be more common in survivors due to damage to the developing brain, environmental factors and adverse life events 7. However, mental health and behavioural outcomes in severe malnutrition have been poorly researched thus far. Objectives Our main objective is to investigate factors that influence the medium- and long-term health outcomes of children with severe childhood malnutrition. We aim: 1. To quantify the long-term survival after discharge from treatment for severe childhood malnutrition in comparison to controls 2. To measure long-term growth and body composition following severe childhood malnutrition 3. To measure the prevalence of early markers of chronic cardiovascular or metabolic disease in those previously treated for severe childhood malnutrition in comparison to controls 4. To measure the effect of severe childhood malnutrition on cognition, behaviour and mental health 5. To explore predictors of favourable or adverse long-term health outcomes
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Determinants of timely access to care for prenatal and postnatal services in Malawi by Liness Kataika
(Kamuzu University of Health Sciencies, 11-08-21) Kataika, Liness
EXECUTIVE SUMMARY Type of study This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi,” 2018-May 2020 Background Problem Timely access to prenatal and postnatal services is a key to maternal health services that can significantly help reduce maternal mortality. However, timely access to maternal and neonatal care services has always been a challenge in Malawi due to several factors. Understanding the factors that hinder timely access to service utilization helps to design appropriate strategies and policies towards improvement of services utilization and thereby reduce maternal mortality. Objective The objective of this study is to determine factors that affect timely access to prenatal and postnatal services in Malawi. Methodology This is the cross sectional qualitative study that will use secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). Data will be taken from the primary owner and will be analyzed thematically. Measures to ensure confidentiality will be followed throughout the period and there after Ethical approval will be sought from ethics committee COMREC Dissemination of expected find. Study design This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). The qualitative study was employed to fully gather the information from parents and guardians of neonates who are receiving care using the interventions under observation. Study Place This was a qualitative study conducted in 3 public Health facilities (Mulanje, Chikwawa and one central hospital in Blantyre Urban (Queen Elizabeth Central Hospital) and one private health facility (Mission hospital) Holy family hospital in Phalombe in Malawi from May 2018- May 2020. Study Population, Study Period, Sample Size, Data collection and management The study targeted Health Care workers, Mothers of Neonates, Fathers of Neonates, and Elderly Women or grandmothers in the southern rejoin of Malawi. The study from Nov 2020- June 2021. Participants were sampled purposively using maximum variation. Data will be taken from primary owner and permission already granted. Data will be managed manually Data analysis Data will be analyzed thematically. The extraction of data from primary data will be done guided by the coding guide which has been developed guided by the conceptual framework of the study [32]. Both inductive and deductive approach to the analysis will be employed.
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Rapid assessment to evaluate the defaulter tracing program for under five children immunization services in Rumphi district
(11-11-21) Tembo, Atupele Kapito
EXECUTIVE SUMMARY Type of Study:Amixed methods study where retrospective data will be used and prospective data will be collected as well.Mixed quantitative and qualitative methods will be used.Secondary analysis of Ministry of Health(MOH)routineExpanded Programme on Immunisation (EPI)administrative datawill be conducted. Background:The MOHwith funding fromUNICEF has been implementing acommunity-based defaulter tracing program in Rumphi districtto improveequity and effectiveness of the immunization program.Thedefaulterprogramhas two approaches, one usingmother care group volunteers(MCGs)andthe other one usesreligious institutionsin the communities.It is anticipated that the defaulter program willincreaseproportionof fully immunized children and vaccination coverage in under-five childrenin the district. However,after implementing the program since August 2019,there is need to systematically evaluate theperformanceof the defaulter programin the districtregardingits impactand toinformtheimplementersand policy makerson areas requiring improvementsand strengthening. Main Objective:Evaluatethe performanceand impactof theMOH community-baseddefaulter programfor routine immunization in under-five childrenbeingimplemented byMCGs volunteers and religious institutionsinRumphidistrict. Methods:Wepropose toconductsecondary analysis of MOH routine EPIquantitative administrative data from 2018 to date toestablishthe immunization coverage trendsin the districtbefore and after the defaulter tracing program.We will also conductcross-sectional quantitative and qualitativeevaluation assessments.Theassessmentswill be conductedin4 randomly sampled health facilities, 2 from each of the implementation approaches(MCGs and religious institutions).Based on vaccination coverage performance,2 health facilities(one best EPI performing and one poor EPI performing health facility)will be randomly chosen from the listof facilitiesfor each approach.For the quantitative component, we willconduct exit interviews with child caregivers.We willenrol30 participants using simple randomsampling from each of the 4 selected facilities.For the qualitative component, we will conduct10focus group discussions (FGDs).The FGDs will be conducted as follows: a)Twowill be with child caregivers of under-immunised children attending therandomly sampled2low performing facilities, one from each approach b) Two will be with child caregivers of under-immunised children from communities of the 2low performing facilities, one from each approach c) One will be with MCGs who will be randomly sampled from a list of MCG volunteers d) One will be with religious volunteers who will be randomly sampled from a list of religious groups volunteersand e) Four will be with health workers from each of the 4 sampled health facilities.Each FGD will be comprised of 6-8participants.Wealso propose to conduct 8in-depth interviews (IDIs)with key informantsselectedpurposively.These will includedistrict EPI and community health coordinators,DEHO orAEHOs,health facility EPI focal personsor seniorHSAs. The exit interviews,FGDs and IDIs with key informants will be employed toobtain information ondefaulter program includingknowledge of the program,it’sstructure and systems, best practices,lessonslearnt, implementation strengths, challenges and recommendations.All qualitative interviews will be digitally-recorded and transcribed verbatim, coded and thematic analysis will beconducted.Quantitative data will be analysed using statistical software packages. Expectedfindings and dissemination: Weexpect thisevaluationtoprovide information on vaccinationcoveragetrends before and after the defaulter tracing program for immunization in Rumphi district to assess impact. In addition, the evaluation will document andprovide information on the currentimplementationstructuresand systems, best practices,lessons learnt, strengths and challenges of the defaulter tracing program. Theinformationwillguide implementers and policy makerson the areas requiringstrengthening andimprovementforthe program.It is planned that the findingswill be shared with College of Medicine Research and Ethics Committee, MOHand presented at college, national and/or international research dissemination conferences and will be publishedin peer-reviewed journals.
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Prevalence and Factors Associated With Puerperal Sepsis among Postnatal Women at Queen Elizabeth Central Hospital, Blantyre by Priscabell Ndasauka Kalumbi
(Kamuzu University of Health Sciencies, 15-07-21) Kalumbi, Ndasauka
Executive Summary Study Type: An analytical cross-sectional study of hospital records. The problem: Globally 6 million women developed puerperal sepsis and around 77,000 mothers died from it in 2017(Atlaw et al,2017). Puerperal sepsis is the fifth common cause of maternal mortality worldwide. In Malawi a confidential inquiry into maternal deaths indicated that puerperal sepsis is the leading cause of maternal death (MOH, 2019) and it contributes to 9.3 % of all maternal deaths in the country. Anecdotal statistics from Queen Elizabeth Central Hospital(QECH) in 2019 showed there are 12.2 % puerperal sepsis cases out of 30 % caesarean section deliveries performed (QECH, HMIS ,2019). Despite its great impact on maternal mortality and morbidity, there is not enough literature on the prevalence and associated factors of puerperal sepsis among postnatal mothers in Malawi. With this backdrop, the aim of this study is to estimate prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital - a tertiary referral hospital in Malawi. Objectives Main Objective To determine prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital. Specific Objectives 1. To describe the demographic and clinical characteristics of women with puerperal sepsis during the postpartum period at Queen Elizabeth Central Hospital. 2. To determine factors associated with puerperal sepsis in postpartum women at Queen Elizabeth Central Hospital. 3. To assess relationship between puerperal risk factors and poor maternal outcomes at Queen Elizabeth Central Hospital. Methodology This study will deploy an analytical cross-sectional design with a non-predetermined sample size of postnatal women records in Chatinkha postnatal ward. Purposive total sampling technique will be used to select the study participants into the study. Data will be extracted from files of patients admitted from January 2020 to June 2020 and analysed using SPSS version 20. The data will be presented in form of percentages, frequencies through tables, graphs and charts. Logistic regression will be used to establish relationship between maternal factors and poor outcomes. Possible Constraints The major constraint in the study is missing data from the use of medical records. Multiple imputation will be done where data is missing. Expected Findings This will study will describe the burden of puerperal sepsis in postpartum women in QECH and Identify factors associated with it. The generated data will help health care providers and policy makers to develop interventions that focus on the primary causes of sepsis and prioritise the factors that will be associated with Sepsis. . It will also enable policy-makers and managers to consider integrating puerperal sepsis education with emphasis on factors that have shown to have poor maternal outcomes. Expected findings and dissemination: The results will be presented in tables showing summary statistics and odds ratios. A final master’s dissertation will be written and presented to the post graduate committee at the Kamuzu College of Nursing. The final dissertation will be shared with the Kamuzu College of Nursing library and The College of Medicine Research and Ethics Committee. Results from this research will be published in an open access peer reviewed journal and presented at research dissemination conferences. Background information and introduction Introduction Puerperal Sepsis has been defined by the World Health Organization as the infection of the genital tract occurring at any time between the onset of labour, rupture of membranes and the 42nd day postpartum. The Puerperal sepsis presents commonly with fever (oral temperature of 38.5 degrees Celsius or higher on any given occasion) and other symptoms such as pelvic pain, abnormal vaginal discharge, abnormal smell/foul odour discharge or delay in uterine involution (less than 2cm/day) during the first eight days (WHO, 2015). Puerperal sepsis accounts for a substantial contribution to the Maternal Mortality Rate (MMR). Global estimates suggest that direct (obstetric) infections are the third most common cause of maternal mortality, representing about 10.7% of deaths, a majority of which occur in Low- and Middle-Income Countries (LMIC) (WHO, 2020). The toll is higher in LMICs compared to high income countries (HICs) (Say et.al., 2014). In sub-Saharan Africa, maternal sepsis is one of the leading causes of over 70% of maternal deaths, others include: haemorrhage, hypertension disorders, unsafe abortion, and obstructed labour (Dillen et.al., 2010). Maternal sepsis, specifically, contributes 10.3% of all cause maternal deaths in SSA (Bonnet et.al., 2018). The Global Burden of Diseases Study reported a 30 % prevalence of maternal sepsis (James et al., 2018). A WHO maternal sepsis cohort study conducted in 713 health facilities found that 70.4 out of 1000 live births reported to health facilities with an infection (puerperal sepsis) (Group, 2020). Recent estimates suggest that in sub–Saharan Africa (SSA) the burden is highest compared to other regions with sepsis accounting for up to 45% (Rudd et.al., 2020). However, reliable estimates of the incidence and mortality of maternal sepsis in sub-Saharan Africa are incomplete (Otu et.al., 2020). In Malawi, a confidential inquiry showed that puerperal sepsis is the leading cause of maternal mortality accounting for 9.3 % of maternal deaths (MOH, 2019). Nevertheless, there is no programmatic interventions focused on prevention of puerperal sepsis. Malawi participated in the WHO-led Global Maternal Sepsis Study (GLOSS) and Awareness Campaign umbrella of the “Global Maternal and Neonatal Sepsis Initiative” the aims of which were to assess the burden of maternal sepsis, validate the identification criteria and raise awareness of maternal sepsis among health care workers. However, there is no evidence of Malawi’s implementation of this study following the campaign (GLOSS, 2017). According to Brizuela et.al., (2020), evaluation of countries that implemented the campaign shows improvements in service provision, reduced overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries. The Malawi Emergency Obstetric and New-born Care Needs Assessment results showed that puerperal sepsis contributes to 18.9% of direct maternal deaths (MOH,2015). Nevertheless, there is paucity of evidence with regards to the epidemiology (when, where, who, what and why) of sepsis in maternal mortality and morbidity burden. As in many developing countries many cases of puerperal infections can go undiagnosed and underreported (Panelope et al., 2013). Hospital-based anecdotal evidence suggests that puerperal sepsis potentially carries the biggest morbidity burden at Queen Elizabeth Central Hospital, a tertiary hospital in southern Malawi. According to 2019 hospital records, there were over 2911 caesarean section deliveries performed at Queen Elizabeth Central Hospital (QECH), comprising 38 % of the total deliveries; 12.2% of these deliveries developed puerperal sepsis within 42 days of post-delivery (QECH HMIS, 2019). Given that puerperal sepsis significantly contributes to preventable maternal morbidity and mortality, combating sepsis is an integral part of realizing the Sustainable Development Goals (SDGs) targets 3.1 and 3.2 relating to maternal wellbeing, as well as target 3.3 on infectious diseases (WHO, 2020). Indirectly, sepsis is relevant to other targets in SDG 3 such as 3.8 on quality of care for all, and its prevention and management is inherently linked with vaccination, efforts to combat antimicrobial resistance (UN, 2020). For Malawi to achieve this lofty goal, reduction of maternal mortality rate must set targets that need urgent achievement. Consequently, identifying potential contributors or determinants to maternal mortality would assist in having focused interventions that respond to the specific causes of the problem. Sepsis is an ever-changing problem. The patterns of sepsis have been shown to differ in time. One of the factors related to the changes in patterns has been the increasing antimicrobial resistance. While several attempts have made to quantify the burden of sepsis by estimating the prevalence, not many have studied the factors associated with it at the individual level in Malawi. Hence the need for this study to bring evidence for developing of policies and guidelines to address the problem. Background Puerperal sepsis is a preventable postpartum complication, and has the potential to quickly progress to septic shock, which can eventually result into death (GLOSS, 2017). The global incidence of puerperal sepsis is 4.4 per 100 live births (Taskin et. al., 2016) and case fatality as high as 30-50 % has been reported in Low- and Middle-Income Countries (UNFPA, 2012). Regional disparities in the prevalence of puerperal sepsis exist. According
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Factors associated with utilization of ITNs following immunization with RTS,S/AS01E malaria vaccine in underfive children in Nchalo-Chikwawa
(Kamuzu University of Health Sciences, 19-01-22) Mangani, Milness
Type of study The study will be an embedded mixed method cross-sectional study. Problem Malaria is the leading cause of mortality and morbidity in children below the age of five. The pandemic continues to increase morbidity in Africa. The use of RTS, S/AS01E RTS, S malaria vaccine helps to prevent 39% of malaria cases and 29% cases of severe malaria in young children. Since the vaccine is only partially effective, the Ministry of Health (MoH) recommends the use of additional preventive measures, such as indoor spraying, proper diagnosis and the use of ITNs. However, it is not known as to what extent caregivers adhere to these preventive measures after their children have received the malaria vaccine, and whether the use of RTSs will reduce demand for or utilization of ITNs under the assumption that the vaccine is highly protective. Broad objective To determine factors associated with utilization of ITNs in under-five children following RTS’S Malaria Vaccine in under-five children in Nchalo- Chikwawa. Specific objectives: 1. To determine prevalence of ITN use in under five children following malaria vaccination 2. To identify social and economic factors associated with ITN use among malaria vaccinated children. 3. To explore mother’s/guardian views regarding the use of ITNs after their children have received malaria vaccine. An embedded mixed method cross-sectional study. The study will be conducted in Nchalo –Chikwawa District. The study will run from August 2021 to May 2022. Data collection will be in October and December 2021. The plan is to enroll 280 children who have received three or four doses of malaria vaccine, and 24 women (3 FGDs, 8 participants in each group) of women coming to the under-five clinic. One research assistant trained in research ethics and good clinical practice will be recruited to help in data collection. Written informed consent will be sought from all eligible study participants. Data will be collected from perspective of caregivers of children who have received 3 or 4 doses of malaria vaccine on Qualitative data will be collected through FGD with the care givers, face to face while observing Covid -19 preventive measures. Data will be transcribed and imported into NVivo 12 for windows a qualitative data analysis software. Quantitative data will be collected through structured questionaries. STATA will be used for analysis.
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Survival of low birth weight babies admitted at Chiradzulu District Hospital (public) and St. Joseph Mission Hospital (private) in Malawi
(Kamuzu University of Health Sciences, 2020-05-13) Zgambo, Austin Chibisa
The type of research study This will be a hospital based retrospective cohort study collecting quantitative data from Nursery ward registers on Low birth weight babies. Low birth weight is defined as a birth weight of less than 2,500 g regardless of gestational age. This practical cut-off for international comparison is based on epidemiological observations that babies weighing less than 2,500 g are approximately 20 times more likely to die than those born with a weight of over 2, 500 g. Globally, it is estimated that 12 to 17% of all births are Low birth weights. However, the great majority (91%) of Low birth weight babies occur in low and middle-income countries. Malawi, being part of low-income countries, has nearly 12% of babies born with Low birth weight. Both the public and private sectors are responsible for the provision of healthcare services in the country. The problem Losing a baby is a devastating experience and every parent experiences grief in his/her own way. The World Health Assembly endorsed targets to reduce Low birth weight prevalence by 30% by 2025. Despite the availability of interventions to improve survival of Low birth weight babies, it still remains a challenge in low resource settings. People have a perception that quality of care is better in private hospitals than public hospitals partly due to differences in resource base. Consequently, better patient outcomes are expected in private than in public healthcare facilities. However, research analysis revealed that private sector health facilities had poorer patient outcomes compared to public sector health facilities. But this general analysis may not apply to all specific areas of health outcomes, for example, survival of low birth weight babies in these private and public health care facilities. Furthermore, few studies on neonatal survival have been conducted in Malawi but none of them has compared survival rates of low birth weight babies in public and private hospitals. Therefore, this study is intended to fill knowledge gap concerning survival rates of Low birth weight babies from admission to hospital discharge and the comparison of it between a public and private hospital. The Objectives The aim of the study is to compare the survival rates of Low birth weight babies admitted at Chiradzulu public hospital and St. Joseph’s private mission hospital; and to determine factors associated with mortality in these hospitals. Methodology It will be done in Chiradzulu district, specifically at Chiradzulu district hospital and St. Joseph’s Mission hospital’s nursery wards. The study will assess records of Low birth weight babies admitted in nursery wards at two hospitals between 1 January 2018 and 31 December 2019. Systematic random sampling will be used to achieve a calculated sample size. A pretested data extraction tool will be used for data abstraction. There could be a possibility of missing records but use of recent period (2018 – 2019) coupled with use of both case files and ward admission registers will ease the problem of missing data. Data will be entered in a Microsoft Excel application and later exported to STATA version 14 for analysis. Results will be presented in tables and graphs’ format. Ethical clearance will be obtained from the University of Malawi’s College of Medicine Research and Ethics Committee (COMREC). A written permission letter will be obtained from Chiradzulu District Council through the Director of Health and Social Services. Expected findings and their dissemination We are anticipating knowing the survival rates of Low birth weight babies between a public and private hospital; and common contributing factors to mortality among these babies. Knowledge of neonatal survival rates and mortality factors will help hospital managers to implement and/or scaleup appropriate interventions in nursery wards. The results will be shared with COMREC; Chiradzulu and St. Joseph’s hospitals; Malawi Ministry of Health, through the Reproductive Health Unit and published in Malawi Medical Journal for publicity at local as well as global level.
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Effect of delay to surgical intervention on outcomes in paediatric patients with Hirschsprung’s disease at Mercy James Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2020-06) Amos, Nelson; Mhembere, Shingirai; Sichinga, Mwabi
This is a mixed method study with the quantitative part employing a retrospective cohort study design. The main objective of the study is to examine the effect of delay from surgical admission to surgical intervention focusing on the period between colostomy creation and definitive surgical management on outcomes and complications for patients with Hirschsprung’s disease at Mercy James, Queen Elizabeth Central Hospital. For the quantitative section of study, secondary data collected from the records will be used. For the qualitative section, primary data which will be collected by the researchers will be used. Data is to be collected from the paediatric and surgery departments at Queen Elizabeth Central Hospital. For the quantitative section, simple random sampling will be used to select the participants while no sampling technique will be employed for the qualitative section. The results of this study will be used to synthesize possible solutions and may set the foundation for initiating feasible interventions for the affected patients. The research findings will be disseminated orally at the dissemination seminar which will be held at The College of Medicine. The results of the study will be sent to the College of Medicine Research and Ethics Committee (COMREC), the University Research and Publication Committee, the Health Sciences Research Committee, the College of Medicine Library and the course coordinator.
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Lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital, Malawi Version 3
(Kamuzu University of Health Sciences, 2020-06-02) Machongo, Redson
Lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital, Zomba-Malawi. Problem Statement Antibiotic resistance is a global public health issue which is increasing and has implications for morbidity, mortality and health care cost both in hospitals and in the community. Inappropriate use of antibiotics is among the major causes of the global emergency of antibiotic resistance among children. The problem of inappropriate use of antibiotics among children is of special concern because they are still developing immunological systems, hence they are susceptible to many infectious diseases. As such they receive a considerable disproportional amount of antibiotics which exposes them to antibiotics resistance. In response to this problem, this study proposes to investigate the lived experiences of care givers of children under the age of five years on the use of antibiotics at Zomba central hospital in order to improve awareness of population more especially the care givers of under five children about appropriate use of antibiotic, through this study. Aim of the study To explore the lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital, Zomba-Malawi. Specific objectives 1. To understand perceptions of caregivers of children under the age of five years on antibiotic usage at Zomba central Hospital. 2. To explore practices of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital. 3. To determine factors that influence caregivers of children under the age of five years to use antibiotics at Zomba Central Hospital. This is a descriptive cross-section qualitative study with a phenomenological approach to explore the lived experience of caregivers of children under the age of five years on antibiotic usage at Zomba central hospital. The study will use interview guides (Appendix 3) to conduct in-depth interviews among caregivers and health care-workers. We will interview a total of 23 participants so as to capture as much information as possible. These will include 16 care givers of children under the age of five years and 7 health care workers as key informants. Purposive sampling will be used to select the participants from the children’s ward. Interviews will be conducted in English and Chichewa and recorded using a digital recorder. Data will be analysed thematically. Expected findings and their dissemination It is expected that the study will provide information on the lived experiences of caregivers of children under the age of five years on antibiotic usage. Results of this study will be presented at both the institutional and at national level through review meetings, research seminars, conferences coordinated by, COM, MOH, ZCH and other stakeholders. Printed hard copies will be made available to College of Medicine library and COMREC. Finally, we will prepare and submit papers to peer review journals for publication.
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Developing a rapid understanding of the impact of Covid-19 on maternity services and pregnant women’s health in rural and urban Malawi
(Kamuzu University of Health Sciences, 2020-06-05) Crampin, Amelia
Type of study: This is a qualitative study exploring the early impact of Covid-19 preparatory work on the maternity services and the experiences of women currently pregnant and women in postpartum periods. Problem statement: There is a lack of knowledge of the effects of novel coronavirus (SARS-COV-2) in pregnancy. Emerging case-reports and case-series have raised uncertainties about risk of pregnancy complications such as higher rates of miscarriage, preterm birth, pre-eclampsia, caesarean delivery and perinatal death. The lack of available evidence has led to advice to treat pregnant women as a vulnerable group. The potential consequences of Covid-19 disruption of maternity services and women’s health in pregnancy in Malawi are devastating. In many countries Covid-19 has led to rapid reshaping of health care services for pregnancy (e.g. reducing all but essential antenatal screening, reducing number of antenatal checks) and for pregnant women (e.g. self-isolating in the third trimester). Much of this will almost certainly be impossible to implement in Malawi. We aim to conduct a rapid evaluation of the situation in order to directly inform and drive best practice. Objectives General objective: To understand the early impact of Covid-19 on maternity services in both rural and urban Malawi. Specific objectives: 1. To acquire views from health care providers looking after pregnant women on the changes that have been made in health service delivery and their working environment during the COVID-19 pandemic. 2. To gain views from women who are currently or recently pregnant about changes that have been made in their antenatal care, birth plans and health seeking behaviours during the COVID-19 pandemic. 3. To find out whether pregnant women and service users have been reached with COVID-19 information, and whether they are able to comply with government advice 4. To understand whether health needs of pregnant women are being met during the COVID-19 pandemic. Methods The study will take place in sites where the DIPLOMATIC partnership (established to evaluate interventions to prevent stillbirth and complications of premature birth) is planning intervention trials. This includes the Malawi Epidemiology and Intervention Research Unit (MEIRU) has well-established infrastructure – Chilumba in Karonga District and Area 25 in Lilongwe and Chileka, Zingwangwa, Limbe and Bangwe in Blantyre District. We will train data collectors to administer telephone questionnaires from their homes, with precautions in place to ensure confidentiality and data security. Potential participants will be identified through our DIPLOMATIC network of participating maternity service providers. We will recruit a sample size of 16 facility staff and 24 women split between the study sites. Expected findings: The data collected will allow us to answer key questions including:  What is the availability of personal protective equipment and how has the Covid-19 pandemic impacted on routine antenatal and delivery care?  What are women’s concerns about being pregnant during the Covid-19 pandemic and are these concerns influencing their choices about their healthcare during pregnancy? Dissemination: The study will be written up and submitted to appropriate peer-reviewed journals. The study results will be presented to relevant conferences. Study results and publications will be shared with COMREC. Interim results will be made available to the Government of Malawi, Ministry of Health to inform the public health response to the COVID-19 pandemic.
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Assessment of the effect of malnutrition on adverse pregnancy outcomes on adolescent pregnant women in Mchinji District: A cross sectional study Version 2.0
(Kamuzu University of Health Sciences, 2020-06-10) Zinyemba Chingoli, Manes
Malawi’s teenage pregnancy rate is at 29%[1] and Mchinji district ranks third in the country with teenage pregnancy rate of 37.5% only superseded by Machinga ( 41.1%) and Nsanje (38.8%) [1]. Adolescent pregnancies comprise 25% of all births and 20% of maternal deaths[2]. On the other hand, 7.2% of women of child bearing age (15-49) in Malawi are thin for their height (Body Mass Index (BMI) <18.5), and the situation is worse for adolescent girls aged between 15-19years amongst whom 13% are thin for their height[1]. Problem Studies have shown that in Malawi adolescent pregnancies comprise 25% of all births and contributes 20% of maternal deaths[2]. The country has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100,000 live births[2]. Furthermore, Adolescent pregnancy is associated with higher risks of adverse pregnancy outcomes including neonatal complications such as prematurity, low or very low birth weight, and perinatal mortality[6]. It is also associated with major maternal complications such as hypertensive pregnancy disorders, abortion, urinary infections, and premature rupture of the fetal membranes[6]. Some other studies have further shown that failure to achieve normal delivery is directly related to the height of the mother which is influenced by nutritional status in childhood and adolescence[10]. This could imply that in Malawi, where stunting in under five children is estimated at 37% [1], a substantial percentage of women do not reach their potential height hence difficult to achieve normal delivery. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low‐ and middle‐income countries[7]. Objectives Broad Objectives To determine the effect of malnutrition (wasting- MUAC (Mid Upper Arm Circumference) <22 cm) on pregnancy outcome in adolescent women in Mchinji. Specific Objectives Specifically, the study will address the following objectives:  To describe the prevalence of wasting in adolescent pregnant women receiving antenatal services at Mchinji district hospital from December 2018 to December 2019.  To describe the prevalence of adverse pregnancy outcomes among adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019.  To compare the proportion of adverse pregnancy outcomes (Miscarriage, preterm birth, stillbirth and low birth weight) among wasted and well-nourished adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019. This will be a cross sectional study based on routinely collected facility data that is recorded in the antenatal, supplementary feeding and maternity registers. Type of Study and Methodology A cross sectional study design will be used. The routinely collected facility data for antenatal, supplementary feeding and maternity services will be collected then analysed. Data will be collected from service registers focusing on data from December 2018 to December 2019. Data will be collected using a case report forms (CRF). Data will be analysed using Stata version 14.0. Categorical response variables will be presented using proportions and will be analysed using Chi- square. For objective three, Chisquare test will be done to check whether there is association between nutrition status and proportions of adverse pregnancy outcome. Logistic regression will be run to adjust for confounders affecting the relationship between nutrition status and proportion of adverse pregnancy outcome. Expected results It is expected that there will be significant differences in proportion of adverse pregnancy outcome between malnourished and well-nourished adolescent mothers. Dissemination The results from this study will be shared with COMREC, Mchinji district hospital and College of Medicine through the Research Dissemination Meeting.
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Exploring determinants of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka District: An interpretive phenomenological analysis study
(Kamuzu University of Health Sciences, 2020-06-15) Njolomole, Blessings
Exclusive breastfeeding is the most widely known and effective intervention for preventing earlychildhood illnesses and deaths. Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades .In Malawi despite having some improvements in early initiation of exclusive breast feeding (EIBF), in the last decade there has been a decline in EBF and EIBF rates. This study aims at exploring drivers and barriers of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district. The specific objectives include to;1) assess the level of knowledge of mothers with children aged 0-6 weeks on the importance of exclusive breastfeeding;2) explore the perception of mothers with children aged 0-6 weeks towards exclusive breast feeding;3) assess drivers of exclusive breast feeding among mothers with children aged 0-6 weeks and 4) explore influences on exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district The study will employ a qualitative interpretive phenomenological analysis (IPA) approach. Participants will be recruited using purposive sampling technique to select breast feeding women with children 0-6 weeks while snowballing technique will be used for recruiting significant others. Three focus group discussions (FGD) of 6-8 women with children 0-6 weeks old and nine in-depth interviews with these women will be conducted while eleven in-depth interviews will be conducted with significant others (Spouses, grandparents and siblings of the women with children 0-6 weeks) and key informants involving 2 maternity nurses and 2 clinicians. Data will be analyzed using content thematic analysis.
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Factors affecting quality of antenatal care services at health centres in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Juan, Cosmas; Phiri, Mphatso; Maunde, Mwayi
Introduction Health care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. Maternal and newborn health, are priorities for the Government of Malawi, as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011- 2016 Health Sector Strategic Plan (HSSP). AIM The research is a cross sectional study that looks at the quality of ANC as a factor which is reducing the recommended number of times women are supposed to visit the ANC to have a fair consensus about as to why women are not attending the recommended 4 ANC visit. METHODOLOGY The study is a qualitative cross-sectional study to be conducted at health centres around Blantyre. This will involve women attending the ANC and also health workers at the health centre. The study will be conducted in 6 weeks mainly collecting data on the type of ANC services received and women’s perceptions on utilization of the ANC, data analysis and interpretation and dissemination. The inclusion criteria will be; women with gestation age 32 weeks and above, aged 18-40, attending the ANC being chosen at random. A written consent will be attained for each woman who participates in the data collection. Conclusion The expected results will show the setbacks in ANCs that are attributing to lower ANC attendance and so create a room of improvement in which can be tackled in the future resource appointment. Justification According WHO IDSR Guidelines in 2013/14 and as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011-2016 Health Sector Strategic Plan (HSSP), Maternal and newborn health are priorities for the Government of Malawi (1). In Malawi, the proportion of women that received the recommended four or more ANC visits generally declined from 1992 (62%) to 2010 (46%) before rising modestly in 2015-16 to 51% (3). 95% of women who gave birth in the 5 years preceding 2016, received antenatal care from a skilled provider at least once for their last birth and 51% of women had 4 or more ANC visits (1). Our research aims at finding out why there is a high proportion of women who are not adhering to the recommended 4 ANC visits. The study is to be conducted in Health centres around Blantyre.
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The influence of client demand on care practices during ANC, labour and postnatal care
(Kamuzu University of Health Sciences, 2020-09-16) Mauluka, Chancy
Type of Study: Quasi-experimental study (implementation science research). Background: Quality of care is affected by a wide spectrum of bottlenecks that range from human resource deficiency, inadequate drugs/equipment, and suboptimal clinical practice. On the demand side, clients are not aware of their right to demand care practices and they do not have knowledge about the care that has to be provided to them during ANC, labour and postnatal care. In addition, mothers lack selfesteem, self-efficacy and skills to demand care from service providers. In the absence of such, service providers continue to skip clinical guidelines even in cases where necessary supplies are available. This study aims to explore the extent to which care practices can change if clients are empowered to demand services in the continuum of care from ANC to postnatal. Objectives: The specific objectives of this study are to: i) identify care practices that can be demanded by the mother in the continuum of care from ANC to PNC, ii) develop an intervention package (tools) to improve mothers’ knowledge of care practices and promote demand the practices from service providers, iii) assess improvement in terms of mothers’ knowledge of care practices offered during ANC, labour and PNC after being exposed of the tools, iv) assess improvement in terms of mothers’ demand for care practices during ANC, labour and PNC after being exposed to the tools, and v) measure effectiveness of the intervention in terms of actual provision of the care practices by health workers during ANC, labour and PNC. Methodology: The research will combine qualitative and quantitative methods for data collection. The study will be conducted in Kasungu district where intervention and control sites will be selected. The target population for the study includes a) pregnant mothers b) mothers with children not more than three months c) service providers at health centre level d) health specialists (RHD, NGOs) and e) psychologists. A two-staged approach will be used in sampling, whereby health centres will be systematically selected based on their service readiness and finally selected randomly to arrive at the final research sites. Willing mothers will be randomly selected to achieve sample size. The research undertakes to study a minimum of 326 women in antenatal, post-partum and postnatal care to establish with confidence if client demand for services can increase adherence to recommended practices by at least 15%. Quantitative data will be collected using structured questionnaires for the mother while a checklist for vignettes will be used to observe adherence to standards during contacts. Qualitative data will be collected using FGD guides and guides for vignettes which will be used in simulations to explore demandable services at the point of care. Qualitative data will be analysed using Atlas software to code emerging themes while quantitative data will be analysed using Stata to generate percentiles and correlation between outcomes of interest and independent variables. Expected findings and their dissemination: This work hypothesises that when individuals are empowered with knowledge and skills to demand, they can influence care practices in the continuum of care from ANC to postnatal care. Findings of the study will be disseminated through national and international conferences, as well as publications.
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Behavioral design for antenatal and postnatal care in Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Mbilizi, Yamikani
Type of study: Behavioral formative research ii. Problem: According to USAID’s 2019 statistics, Malawi has one of the highest maternal mortality rates in Africa and globally, with 439 maternal deaths per 100,000 live births. Recently, the government adopted the new WHO guidelines that recommend 8 antenatal contacts during pregnancy. The 2015- 2016 Demographic and Health Survey (DHS) found that 95% of women accessed ANC. Yet, only 51% of women completed (the previously recommended) 4 visits. Only 24% of women seek ANC during the first trimester. At a global level, UNICEF’s 2019 data reports that at least 85% of women access antenatal care with up to 65% receiving 4 antenatal visits. In comparison, only 46% of Malawian mothers meet the previously recommended 4 ANC sessions. In Malawi, women often attend ANC late. JHPIEGO will conduct implementation research (IR) for antenatal and postnatal service delivery models and tools in Malawi (and Ethiopia and Mali). This IR will generate evidence on how best to strengthen antenatal and postnatal platforms—not only to deliver equitable, high quality services, but also robust and resilient enough to test interventions and transition to scale. JHPIEGO’s study design will employ human-centered design to explicitly reflect actual conditions and incorporate considerations necessary to understand and inform scale up and sustainability. The project will use human-centered and behavioral design (HCD) to develop context-specific program implementation strategies, approaches, and models of antenatal and postnatal care for pregnant and postpartum women in Malawi. In the first phase (empathy) of the HCD approach that will be used end users are engaged to better understand the barriers and drivers to antenatal and postnatal care, and to solicit their suggestions for interventions that better meet the needs of the population. For this activity, interviews and group discussions will be conducted with women, aged 18-49 who live in Blantyre (Malawi) to understand their realities and how they facilitate or hinder access to and use of antenatal and postnatal care services. In addition, interviews will be conducted with related individuals and community groups identified by the women, to understand their perspectives and the way in which they influence women’s decisions. All of these participants shall advise and subsequently validate ideas generated through the inquiry period. The ideas generated through this workshop will then be narrowed down and prioritized for further testing after approval from local authorities. The intent of this study is to work with women, related individuals, and community groups using the HCD methodology to gather information in order to design, develop and implement an intervention. The results are not designed to be generalizable. They would be applicable to women in Malawi only. Ideas will be generated during the design workshop but after prioritization and selection of the ideas, separate studies that will be designed from these activities will examine the feasibility and acceptability for the intervention(s) designed as a result of HCD. These protocols will be developed and submitted in the future since they will be human subjects research.
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An education package to improve health worker communication with women and families after still birth or neonatal death
(Kamuzu University of Health Sciences, 2020-10-08) Chimwaza, Angella Faith
Study type This study will be an action research that will follow the cycles of problem identification, planning change and action to implement the change. The approach will be complemented with use of the Behaviour Change Wheel which is a structured approach to designing behaviour change educational interventions. The problem Stillbirth or neonatal death is acknowledged as among the most traumatic and distressing life experiences with profound and long-lasting impacts for parents. Good communication is identified as being essential. This includes appropriate empathic and compassionate verbal and non-verbal communication and respect for privacy. However, negative experiences feature prominently in the global literature surrounding parents’ views and perceptions surrounding care after stillbirth and neonatal death. Our recent qualitative work across rural and urban facilities in East Africa has confirmed parents in these settings received inadequate information surrounding their care. In the proposed study, we will use our exploratory data to produce, test and refine a stillbirth communication package. We will also assess the acceptability of the package and determine the feasibility of a full-scale trial to assess effectiveness and the possibility of a scale up of the intervention. Broad objective: The broad objective of the study is to investigate the effectiveness of an educational package on health worker communication with women and families after stillbirth or early neonatal death (neonatal deaths that occur before the mother is discharged from the hospital after delivery) in Malawi, Uganda, Zambia and Zimbabwe. The specific objectives of the study are to: • assess knowledge, skills, attitude and confidence of healthcare workers in communication of stillbirth; • develop an education intervention to use in health worker communication of still birth; • assess the impact of an education package on health worker communication of on still birth and early neonatal death; • determine the acceptability of the package with healthcare workers, managers and undergraduate midwifery students; • establish the feasibility of implementing the intervention as a full trial protocol. Methodology : Study design: This study will use mixed methods; a quasi-experimental design, and qualitative methods. The study will take place in four countries: Malawi, Uganda, Zambia and Zimbabwe. In Malawi the study will take place at Queen Elizabeth Hospital. The sample will comprise 120 (30 per 4 countries) healthcare workers; 60 Student midwives (from Malawi and Uganda) and up to 15 clinical trainers (depending on saturation of data) and service managers per country. The Intervention will be a one-day educational workshop focused on ‘Good communication after a stillbirth or neonatal death co-produced with input from stakeholders and Community Engagement and Involvement (CEI) in-country. A pre and post-test questionnaire will be used to collect quantitative data. Qualitative data will be guided by an interview guide. Data analysis of quantitative data will be done using SPSS. Qualitative data will be transcribed verbatim and analysed using framework analysis. This approach allows for analysis of a prior and emergent concepts and themes. Expected findings: We expect that participants will improve on how they communicate to a woman/mother and significant others about a stillbirth or neonatal death. Dissemination: Study findings will be disseminated at COMREC and other research dissemination conferences, to CEI groups, stakeholders and health care workers and nursing /midwifery colleges through facility events. The findings will also be published in appropriate journals
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Understanding the epidemiology of iNTS disease in Africa in preparation for future iNTS
(Kamuzu University of Health Sciences, 2020-10-08) Gordon, Melita
Type of study Clinical research study involving collecting samples from human participants. Prospective serological studies will be carried out across 4 sub-Saharan African sites (Malawi, Kenya, Burkina Faso, Ghana), for which Malawi will be the leading site. A core protocol has been written for all 4 sites in a separate document. This protocol focuses on the Malawi site. Methods to measure age-stratified acquisition of antibody and bactericidal activity to NTS. Data will be collected on the key risk factors for invasive disease: malaria, anaemia and malnutrition and stool samples to measure enteric NTS exposure. Children 0 to 5 years selected from mapped and censused randomly selected households Chikwawa, Malawi; an area with substantial malaria burden - a key risk factor for iNTS. Paired immunology and stool samples for NTS taken 3 months apart for 2000 children; distributed over each age stratum of 1 year, from the age of 0 to 5 years (4000 samples in total). A small number of confirmed invasive NTS cases identified at Queen Elizabeth Hospital (QECH), Blantyre, Malawi, will also have samples for investigated for antibody and bactericidal activity at presentation and 1 month follow-up. Other sites (Kenya, Burkina Faso, Ghana): Prospective serological community study with unpaired/ single samples taken from children aged 0-5 years. No data collected on risk factors. Expected findings and dissemination We will describe the pattern of immunological susceptibility to NTS and enteric exposure in relation to risk factors and geographical settings to facilitate early iNTS vaccine licensure. The final study report will be submitted to the College of Medicine Research Ethics Committee (COMREC) University of Malawi, University of Liverpool IRB and the funders (Wellcome Trust and VacciNTS project). The results will be presented locally, nationally and internationally including other partner sites in the seroepidemiology work package of the VacciNTS consortium contributing to key knowledge for vaccine development and deployment. This will have relevance for policy decisions regarding iNTS control in Malawi and other sub-Saharan African countries. Results will be submitted for publication in a peer reviewed academic journal.
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Experiences of mothers with critically ill preterm neonates at Mzuzu central hospital, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Elia, Precious Lyton
Study title: Experiences of mothers with critically ill preterm neonates at Mzuzu Central Hospital. Type of study: This is a qualitative descriptive study. Introduction Annually, about 15 million preterm neonates are born worldwide. The majority (85%) of global preterm births occur in Asia and Africa. In Malawi, 18.1% of all babies are born preterm and complications of preterm birth contributes to 33% of neonatal mortality rate (27/1000 live births). And about 75% of preterm neonates end up being hospitalized in neonatal intensive care unit (NICU). Problem Preterm births are a leading cause of admissions in neonatal care unit at Mzuzu Central Hospital. Mothers of preterm neonates play a critical role in the care of the preterm baby. However, information on the mothers’ experiences of having critically ill preterm neonates is scanty. Therefore, this study seeks to explore the experiences of mothers with critically ill preterm neonates in neonatal care unit. Objectives: Main objective of the study is to explore the experiences of mothers with critically ill preterm neonates at Mzuzu Central Hospital. This study will specifically investigate experiences of having critically ill preterm neonate, sources of support as well as challenges that the mothers of critically ill neonates meet as the child is admitted in neonatal care unit. Methodology The study will use descriptive qualitative research design to explore the experiences of the mothers with critically ill preterm neonates at Mzuzu Central Hospital. Fifteen (15) mothers with critically ill preterm neonates admitted in NCU are expected to be purposively recruited in the study. However, principle of data saturation will be applied during data collection to determine the sample size. Data will be collected through face to face in-depth interviews with individual participants. The interviews will be guided by semi structured interview guide with open ended and probe questions. Thematic analysis will be used to analyze the qualitative data and the results will be presented in themes and direct quotations from participants. Tables will also be used to present demographic data of mothers. Expected findings and dissemination of results It is estimated that the current study will find that mothers will have mixed reactions of stress and joy when caring for their preterm baby. Furthermore, limited access to the baby, lack of adequate support, lack of accommodation for mothers within the unit are possible challenges that mothers meet when caring for critically ill preterm neonate. The study results will be disseminated through a research report. Copies of results will be submitted to College of Medicine Research and Ethics Committee (COMREC), University of Malawi Research and Publication Office, KCN library and Mzuzu Central Hospital. The results will be presented in local and international conferences and seminars. In addition, the study results will be published in peer reviewed journals.
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Prevalence of early and late neonatal sepsis at chatinkha nursery – Queen Elizabeth Central Hospital, Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Nyanga, Wilson; Nyongani, Mertha
Important measures and progresses have been made and put in place over the past three decades to combat and reduce global under 5 mortality from 91 deaths per 1000 live births in 1990 to 43 deaths per 1000 live births in 2015. However, mortality in neonates (under 28 days of age) remains disproportionately high, representing about two thirds of under 5 deaths. Of these deaths a huge percentage occur in Sub Saharan Africa thus inclusive Malawi. The prevalence of early and late neonatal sepsis at Chatinkha Nursery at Queen Elizabeth Central Hospital is the problem that this study will deal with. The broad objective is to investigate the prevalence of early and late neonatal sepsis at Chatinkha Nursery: Queen Elizabeth Central Hospital in Blantyre. This will be a cross sectional quantitative study on the prevalence of early and late neonatal sepsis. This study will analyze secondary data of all files of neonates who had met the criteria of sepsis from January to March 2019 or data from the Health Management Information System (HMIS) this will include: patient files, Nurses report book and the Death registration book. Therefore, this research will be centered on the following specific objectives: to ascertain the prevalence in HIV exposed and non-HIV exposed at Chatinkha Nursery, to compare the prevalence of neonatal sepsis in neonates who were born before arrival (BBA) at the hospital and those who were born at the hospital, to determine the prevalence of neonatal sepsis in neonates born via caesarian section and those born via spontaneous vaginal delivery and to estimate other predisposing factors to sepsis. It is expected that at the end of this research, prevalence of early and late neonatal sepsis will be evaluated in line with our specific objectives. The results of this study will aide clinical personnel with decisions regarding the management of early and late onset neonatal sepsis with the aim being to reduce morbidity and mortality. This research will be presented at College of Medicine research dissemination presentations for the undergraduates, a final copy will be given to COMREC and COM library. BACKGROUND AND INTRODUCTION The third Sustainable Development Goal (SDG) for child health aims to end preventable deaths of newborns and children less than 5 years of age by 2030. It cannot be met without substantial reduction of infection-specific neonatal mortality in the developing world. [1] Neonatal infections are a major cause of death worldwide. It is estimated that approximately 4 million deaths occur annually in developing countries in the neonatal period, attributable mostly to infections, birth asphyxia and consequences of premature birth and low birth weight.[2] Sub Saharan Africa bears a disproportionate burden of neonatal mortality, contributing an estimated 49.6% of under-5 deaths with mortality rates highest in sub Saharan Africa. Neonatal sepsis is a condition defined as bacteremia within the first month of life accompanied by signs of systemic infection. RATIONALE OF THE STUDY The prevalence of early and late neonatal sepsis despite being generally high in Sub Saharan Africa, differs within the same region at different times and depends on conditions predisposing to infection. However, we have limited data for Malawi about the topic, so Chatinkha being one of the major neonatal care unit in Malawi this calls for a study that will determine the prevalence of early and late neonatal sepsis, having known the prevalence, the burden of neonatal sepsis will be reduced. STUDY OBJECTIVES GENERAL OBJECTIVE To investigate the prevalence of early and late neonatal sepsis at Chatinkha nursery at Queen Elizabeth Central Hospital. SPECIFIC OBJECTIVES  To ascertain the prevalence of early and late neonatal sepsis in HIV exposed and non HIV exposed neonates  To compare the prevalence of neonatal sepsis in neonates born before arrival(BBA) at the hospital and those who were born at the hospital  To determine the prevalence of neonatal sepsis in neonates born via Caesarian section and those born via spontaneous vaginal delivery  To estimate other predisposing factors for sepsis.
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Determinants of long acting reversible contraceptives (LARC) use among 10 to 24 year old youths in Lilongwe
(Kamuzu University of Health Sciences, 2020-11-17) Maruwo, George
Type of research study This is a cross sectional study using secondary data analysis from a youth FP/RH outreach clinics program Problem Statement Despite limited resources, Malawi continues to register substantial progress on key family planning indicators. Demographic Health Survey reports an unmet need for Family Planning of 18.7% with 10.8% unmet need for spacing and 7.9% unmet need for limiting. However, unmet need is highest (22%) among women aged 15-19. Nonetheless, Teenage pregnancy remains a significant public health issue in Malawi. Tailoring LARC services for the youth may assist in attainment of health for all.(1) Objectives The study aims to identify the determinants of Long Acting and Reversible contraceptive uses among youth in Lilongwe. Methodology This is a cross-sectional study using secondary data of clients aged 10-24 years accessing SARC and LARC services from the 64 youth outreach sites within Lilongwe. Factors to be examined will include level of education, marital status, age, number of living children, occupation, and area of residence. Expected findings and their dissemination The study expects to identify key trends of contraceptive use among youth in Lilongwe. Furthermore, the findings from the study will uncover key determinants of LARC and SARC use that might assist Lilongwe district health office, and Banja La Mtsogolo in formulation of new strategies in reaching youth with services. In addition, the report of this study will be submitted to College of Medicine in fulfillment of the completion of Master of Public Health and College of Medicine Research Ethics Committee (COMREC). Furthermore, the results 17-Nov-2020Page 6 of 31 will be shared with the Ministry of Health and Population, in particular, The Reproductive Health Directorate to inform policy in FP/RH programming on youth interventions.