Implementation Science

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Explore the occurrence and predictors of depression and anxiety amongst adults (60 years and above) utilizing secondary data collected by the Malawi Longitudinal Study on Family and Health in the three selected districts of Malawi i.e. Rumphi, Mchinji and Balaka
(Kamuzu University of Health Sciencies, 4-08-21) Khosa, Justice
This is a cross-sectional quantitative study design aimed at exploring the occurrence and predictors of depression and anxiety amongst older adults 60 years and above in Malawi (Rumphi, Mchinji and Balaka districts) utilizing secondary data collected by the Malawi Longitudinal Study on families and Health. Problem Statement Life expectancy trajectory in Malawi shows a steady increase which indicates that the country might have an aging population at some point in the years to come. Few studies have explored some of the factors that affect quality of life in different special groups including the elderly. Study Objectives The main aim of this study is to determine the occurrence and predictors of depression and anxiety amongst people aged 60 years and above (the elderly) inMalawi. Specifically; (i) To investigate the prevalence of depression and anxiety amongst people aged 60 and above (the elderly) in Malawi. (ii) To identify the social predictors of depression and anxiety amongst people aged 60 and above in Malawi. (iii) To establish the physiological (physical conditions) predictors of depression and anxiety in people aged 60 and above in Malawi. Methodology The study will utilize data already collected by the MLSFH in the three districts ofMalawi namely Rumphi, Mchinji and Balaka representing all the three regions ofMalawi. This study will include all adults aged 60 years and above in the MLSFH mature adult dataset of 2018. Data will be abstracted fromthe parent study to suit the current need. Consent will be sought fromthe MLSFH team to utilize their data and a waiver from COMREC. Data will be analyzed using Stata (version 14.0) to establish the prevalence and physiological and social predictors of depression and anxiety. Expected results and Dissemination: It is anticipated that this study will help to isolate the magnitude of depression and anxiety and factors that predict the two conditions inMalawi. Results of this studywill be presented to MLSFH team, COMREC and published in peer reviewed medical journal for reference. The study results will also help to isolate some specific factors that affect the quality of life of such special groups, and then design proper programs and interventions aimed at promoting and improving quality of life for such groups.
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Assessing viral load testing adherence and coverage and the related client outcomes in the 90:90:90 era: A case study of Ntchisi District Hospital
(Kamuzu University of Health Sciences, 2020-06-05) Kholomana, Thokozani
This will be a retrospective quantitative cohort study. The problem to be studied: Viral load (VL) testing is one of the essential measure of HIV client progress in regards to ART where suppression shows treatment success. So this study intends to find out the level of VL coverage and adherence to protocol and describe the relationship between those clinical factors and the development of Tuberculosis (TB), infantile deaths and miscarriages. Main objectives: To assess the viral load testing adherence and coverage and the related client outcomes Specific objectives 1. To assess the level of clinical adherence and coverage in regards to viral load time frames 2. To measure the prevalence of Tuberculosis in HIV care enrolled clients and the related VL adherence and coverage before diagnosis 3. To estimate the rate of miscarriages in HIV clients and the related VL adherence and coverage prior to incident 4. To determine the prevalence of infantile deaths and the related VL adherence and coverage prior to the incident Methodology Study design: The study will employ a retrospective quantitative cohort design. Study place: This will be conducted in Ntchisi district. Respondents will be recruited from Ntchisi district hospital ART clinic. Study population: HIV reactive clients attending Ntchisi district hospital ART clinic will be eligible for this study. Study Period: The study will run from April 2019 to July 2020. This is a 16-month period which conceptualization of the proposal to thesis submission will be done. Data collection procedures: This study will utilize a checklist to extract data following the subjects consent. The checklist will look at such variables as age, sex, marital status of HIV positive patients, TB status, infantile deaths status, miscarriages, the number of VL tests and the times when their viral load testing was done. Mainly the clients master cards, and the prevention of mother to child transmission (PMTCT) registers utilized will be used to extract such data. Data management and analysis: All data will be kept in Microsoft excel with a passcode for safety. So, these data will be exported to Stata wherein cleaning and analysis will occur. Moreover, respondents’ identities will not be identifiable since they will be represented by codes. Data analysis will involve both descriptive and inferential statistics. Constraints: The researcher supposes there might be missing VL results in other study participants. In regards to this, the researcher plans to rectify this by following up with the central laboratory. Implications of the study: Results from this study are expected to contribute knowledge to the body of research in HIV medicine. For that cause, this information will be important when developing interventions for HIV clients’ care, providers protocol, including mentorship and supervision schedules. Expected findings and their dissemination: This study will find the period prevalence of Tuberculosis, miscarriages, and infantile deaths in people living with HIV (PLHIV). Moreover, this will show coverage and adherence frequencies in regards to VL testing in PLHIV and the relationship and association between the dependent and independent variables. Moreover, the results be contained in the author’s Master of Global Health thesis that will be submitted to COMREC and college library.
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Knowledge, attitudes and perceptions among public university students in Blantyre District regarding provision of voluntary abortion services.
(Kamuzu University of Health Sciences, 2020-06-10) Takudzwa, Audrey Mabuwa; Chikore, Michelle; Kumwenda, Susan
Type of research study This will be a cross-sectional study design that will focus on university students at College of Medicine and Polytechnic. The problem Maternal mortality around the world has been a burden for years and it is even more of a problem in low income countries such as Malawi. The maternal mortality rate is 574 deaths per 100 000 live births in Malawi 2014. Approximately 22 800 deaths globally from complications of abortions. An induced abortion takes place when a pregnancy is terminated by the deliberate removal of the foetus from the uterus by the use of external methods as a result of an unwanted pregnancy. In Malawi, abortion is only legal if the mother’s life is at risk. This leads to women and girls seeking unsafe abortion services. The median age at first intercourse is 16.8 years old and median age at first birth among women aged 20-49 in Malawi is 19.1 years old, hence why we believe university students would be a good age group to sample. Objectives General objective To assess the perception of college students regarding the voluntary termination of pregnancy. Specific objectives To assess their level of knowledge on their sexual and reproductive health and rights. To compare the attitudes between medical and non-medical students on abortion. To evaluate the difference in the perceptions between the junior and senior years. Methodology The objectives will be addressed through an anonymous questionnaire which will be filled in. The research will be carried out over a period of six weeks. Non-numerical data will be grouped by soliciting five-point Likert-scaled responses along a continuum from “strongly agree” to “strongly disagree” then percentages and proportions can be derived from there. We will conduct the study after approval from the College of Medicine Research Ethics Committee. The participants will sign informed consent forms before they can participate. They will be given information about the study, participate voluntarily and be able to withdraw if they wish. Expected findings We expect to establish the perceptions of college students regarding the provision of voluntary abortion services, be able to compare the perceptions between the students at Polytechnic and the College of Medicine and identify a difference, if any, between the attitudes of the lower years and upper years. Dissemination Study findings will be disseminated to the COM academic staff and all members of the University of Malawi who will attend the fourth year Research Dissemination day during the Knowledge, attitudes and perceptions among public university students in Blantyre district regarding provision of voluntary abortion services. 2020/2021 academic year. The study findings will also be submitted to a peer reviewed journal and a final copy will be shared with the College of Medicine Library and COMREC.
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Awareness and practice of patients’ rights and responsibilities amongst patients at Chiradzulu District Hospital, Southern Malawi.
(Kamuzu University of Health Sciences, 2020-06-25) Mataka, Raphael; Chamatambe, Peter; Demera, Emmanuel
This study is designed to assess the awareness and practice of patients’ rights and responsibilities amongst patients. It will be a quantitative cross-sectional study which will be done at Chiradzulu District Hospital, Southern Malawi. 237 patients will be selected using convenient random sampling. Social demographic factors will be collected from the study participants using questionnaires that will be administered by the researchers. This study will help the Ministry of Health, policy advocates, and other stakeholders to assess the effectiveness of awareness of program activities and put in place strategies to reinforce awareness and practice of patients’ rights and responsibilities.
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Health seeking behaviour among medical doctors at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2020-06-29) Simkoza, Mtendere; Kaluwa, Kalingeko; Mzama, Mercy
Health seeking behaviour [HSB] affects the quality of healthcare people can access. Human beings have different places where they seek their health care and doctors have different approaches, and various factors that contribute on a particular approach. Various issues behind self-prescription, self-treatment and informal consultations have been described pertaining to doctors’ HSB. This study aims to explore the perceptions and practices on HSB of doctors at A TERTIARY HOSPITAL IN MALAWI, using a qualitative approach. The study period is 6 weeks, data will be collected using In-depth interviews, and the target population is the medial doctors. The data collected will be analysed using various software. It is anticipated that the study will give us some insight pertaining to what factors affect MDs choices when getting the medical help they need. The study findings will be compiled and presented at the Research Dissemination Seminar organized by the COM in MBBS 4, and possibly be submitted for publication in the Malawi Medical Journal.
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The perceptions of health providers towards palliative care
(Kamuzu University of Health Sciences, 2020-09-16) Zibophe, Kennedy; Ndalama, Samuel; Mtawali, Bina; Nambuzi, Rachael
TYPE OF STUDY This will be a descriptive qualitative study which will explore the reasons and factors causing trained nurses and clinicians in palliative care reluctance in providing the services in district hospitals. THE PROBLEM Due to increase in Palliative care conditions in Malawi, the Ministry of Health introduced short trainings to nurses and clinicians to start providing palliative care services since year 2014 after recognizing the need in the hospitals and communities. Despite many health care providers being trained on one week initiators course, services have not been adequately provided in many districts so as at Thyolo DHO. We think this is happening due to perceptions they have towards palliative care. THE OBJECTIVES Our broad objective to explore the perceptions of trained and practicing nurses and clinical Officers towards palliative care at Thyolo District Hospital. Specifically, we will try to identify the factors that are hindering trained palliative care providers not providing the palliative care services, explore perceptions of trained palliative care nurses and clinicians regarding palliative care service, Identify the perceptions of nurses and clinicians not trained in palliative care regarding PC service as well as exploring the perceptions of trained nurses and clinicians in palliative care but not practicing towards palliative care services. METHODOLOGY This will be done by conducting in-depth interviews with the key informants and conducting focus group discussion (FGD) for those participants willing to be interviewed. Data will be collected using audio recorders and purposive sampling methods will be employed to identify participants. Approximately 12 participants, that is 5 clinicians and 7 nurses will be interviewed during the data collection process from general wards and palliative care clinic. The data will be analyzed manually using thematic content analysis. Data will be analyzed concurrently with data collection. EXPECTED FINDINGS AND THEIR DISSEMINATION Our expected findings will provide an insight on perceptions of health care providers that are hindering provision and implementation of PC services. Their suggestions (possible solutions) on how to improve PC service delivery at TDH will help promote efficiency and address the existing inequalities in PC hence improve the quality of life of palliative care patients. The findings of our study will be presented to TDH staff, faculty members, College of Medicine Library and submitted to COMREC.
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Lived experiences of widows living in Mzuzu
(Kamuzu University of Health Sciences, 2020-09-16) Chipolombwe, Vivien
Title of study: Lived experiences of widows living in Mzuzu Type of study: Qualitative Research Problem statement: The increasing number of women who have lost their husbands globally has elicited emotive public concerns. It has become a matter of priority for national and international organizations. There is evidence that there are 250 million widows worldwide. In Malawi, widows are considered to be one of the vulnerable groups. This could be due to the bad experiences that they go through such as: property and land grabbing and culturally rituals of sexual cleansing. In Malawi, these women’s distinctive needs have not been met by society, organizations and health systems. There is dearth of evidence in Malawi regarding the experiences that widows go through. Therefore, this study seeks to explore this under researched area with the aim of developing strategies that would address this issue. Broad objective : To explore the lived experiences of widows in Mzuzu Specific objectives  Describe perceptions of widows concerning their widowhood  Explain the psycho-social experiences of widows  Identify the support system of widows  Identify challenges that widows face in their lives Methodology: This study will adopt a qualitative approach in order to get into detail about the psychosocial issues experienced by widows in Mzuzu. The study will follow a narrative design as a distinct form of qualitative research which will be conducted in Mzuzu City in the areas of Chibanja, Zolozolo and Chasefu. Participants in this study will be widows who did not remarry after the death of their spouses. Data will be elicited from 15 participants using a semi structured interview guide. Ethical consideration: The approval to conduct this study will be obtained from the College of Medicine Research Ethics Committee (COMREC). Permission will also be sought from gate keepers of the community while observing rights of participants. A standardized procedure for data analysis will be developed by coding the narrative materials into a meaningful whole. Data analysis will be done manually using the six phases of thematic analysis and qualitative content analysis (QCA).
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An audit of the clinical cases and outcomes on patients admitted to the intensive care unit (ICU) at Kamuzu Central Hospital (KCH), Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Munthali, Leonard; Napolo, Upile; Bwanali, Akim
Since its introduction, in the 1950's critical care medicine has significantly improved the quality of care and outcomes of the critically ill [1] However, the same cannot be said of the developing countries; lack of financial resources, equipment and well trained staff has limited its impact especially in Sub Saharan Africa. [2,3]. This deems as a problem as the demand for critical care medicine increases due to the rise in population coupled with the rise in incidence of critical illnesses. Multiple studies have shown inefficiencies in ICUs within the developing countries with alarming mortality rates. However, only few studies have been done in Malawi. Methods A quantitative retrospective cohort study at Kamuzu Central Hospital, ICU. That will be Looking at the clinical cases and treatment outcomes of patients admitted to the ICU spanning from 1stJanuary to 31st December 2019. Participants will be selected by consecutive sampling method. Preliminary analysis of records, revealed that the ICU admits an average of 22 patients per month, thus we expect to a study about 264 participants. The study is expected to take place for no more than 6 weeks. All data will be entered into Microsoft excel and analysis will be done using Epi info. Expected findings It is expected that findings will help to understand patterns of admission and factors associated with mortality in the ICU. This will guide interventions aimed that reducing the mortality Problem statement. In low resource settings, such as ours, the allocation of ICU facilities is determined by perceived patient outcome. It is up to the physician to decide if the patient is too sick or not sick enough to be admitted to the ICU. This often results in the admission of patients with a poor prognosis while other patients with a better chance of survival are unable to access the care they need and deserve. Previous studies have shown that the mortality rate of patients that are admitted to the ICU is high. In 201 2, a study was conducted at the KCH ICU, it showed a general mortality rate of 60.9 % with sepsis being the commonest cause of death. Finally, there has been limited published research on the resources and performance of the ICU. In fact, since the construction of the current ICU at the hospital, little to no research has been done. Therefore, we are unaware the ICU's efficiency.
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Assessing the capacity of district hospitals in mobilizing and allocating resources after health care decentralization
(Kamuzu University of Health Sciences, 2020-09-16) Udedi, Evelyn
qualitative cross sectional study aimed at assessing whether district hospitals have the capacity to mobilize and allocate resources in light of decentralization, in Kasungu and Nkhotakota District Hospital(s). Key informant interviews will be conducted using a flexible interview guide. b. The problem It is common knowledge that the delivery of efficient health services requires adequate and consistent availability of the right resources, be it human, financial, equipment or material resources. This is the more reason Malawi is a signatory to the Abuja declaration where it pledged to allocate 15% of the national budget towards the health sector. Over the years the Ministry of Health, has put in place various strategies to aid in resource mobilization for the health sector as a means to the Abuja declaration and one of such strategies is decentralization of the health care system. However, despite the positive gains that have been attributed to decentralization and health delivery systems, there still remains a gap in addressing the limits of decentralization vis a vie authority accorded district health management teams in health financing. In realizing this gap, this paper will look at how decentralization has capacitated District hospitals in mobilizing and allocating resources. This will assist the Ministry of Health through the Local Governments to address gaps in resources usually associated with less than adequate service delivery in district health facilities. c. The Objectives The specific objectives of the study are: i.To explore the capacity of the hospitals in revenue generation and availability of essential medicines and supplies. ii. To explore perceptions on hospitals human resources management regarding recruitment and retention measures. iii. To explore perceptions of health personnel on their autonomy in light of decentralization at district hospital. 16-Sep-2020. The study will employ a qualitative approach which will enable us to have in-depth understanding of the capacities of district health management teams in mobilizing and allocating resources within their districts. To have rich data on the perceptions of managers, key informant interviews will be conducted. Purposive sampling will be used to recruit 16 participants ranging from district health office managers, planning, administrative and finance managers from the district assembly as well as 3-4 policy makers at Ministry of Local government, Min of Health and Min of Finance/Treasury. e. Expected Findings and Dissemination It is anticipated that the study will generate findings that are well enriched with adequate data that provides a deep understanding of the subject and contribute meaningfully to the body of knowledge in health financing. We expect to determine whether capacitating district health managers with authority would result in more opportunities arising, improvements in resources such as essential medicine, equipment and supplies, noticeable changes in revenue generation, and human resource attrition trends due to decentralization. Final research data will be made available to other interested investigators, and stakeholders. It is the intention of the investigator to submit findings to peer-reviewed journals, present at national and international forums, and hold dissemination meetings amongst important stakeholders including the Ministry of Health, through the District Health Office and the Ministry Local Government through the District Councils.
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MAP-care: Multimorbid Ageing Primary Palliative care in Ghana, Malawi and Zimbabwe
(Kamuzu University of Health Sciences, 2020-10-20) Harding, Richard
Type of study This is a mixed methods study that will recruit older patients (defined as those aged 50 years and above) with serious multimorbidity including their formal and informal caregivers within a community setting. Problem People around the world are ageing, including those from Low and Middle Income Countries (LMIC). This presents a new challenge i.e. how can we provide care that is focused on the person rather than the multiple illnesses that they are likely to live with? Long term illnesses are becoming more common as people age, and living with these multiple illnesses can present many symptoms; physical, psychosocial and spiritual concerns. Survival can be unpredictable, and cure cannot be achieved for many conditions associated with ageing. Palliative care improves the quality of life of patients and their families and can also be cheaper than care usually received from formal settings. In Africa, palliative care has not focused on the common diseases of older people. This study seeks to understandf how to expand the benefits of palliative care into primary care for older people with multiple serious illnesses. Objectives The overall aim of the study is to establish the needs of older people with multimorbidity in a primary care setting and to evaluate a model of person-centred care for older people with multimorbid serious illness, delivered within primary care in Sub-Saharan Africa that is feasible and acceptable to patient and families. The specific objectives are as follows: 1) to determine primary care staff, patient and family views of costs, barriers, facilitators and necessary support to achieve primary person-centred palliative care for older patients with multimorbid serious illness, 2) to refine a cost tool to measure levels of catastrophic expenditure in the context of progressive multimorbidity, suitable for use in LMIC and 3) to assess stakeholders’ views on acceptability of the novel model of care and ways to refine to the local context to enhance use Methodology This study will use Medical Research Council (MRC) guidelines for development and testing of complex interventions. The MRC complex intervention process guidance will identify the “interdisciplinary mix” (professional and lay) of stakeholders in the health system to engage in the development of the logic model to define and implement the novel care model, and to test fidelity. Qualitative interviews will be conducted to assess the needs and perspectives of patients and caregivers at baseline and study completion. Quantitative assessment of outcomes will be completed for a group of older patients and their caregivers who receive the pilot care model. qualitative in-depth interviews with staff and patient/family dyads’ views (n≤15) will be conducted before and after the piloting of a model of care suitable for older people with multimorbity in primary care setting. A costing tool designed in Malawi for use in households affected by cancerwill be revisedusing the qualitative data with n=7-10 patient/family dyad cognitive interviews. Expected findings and dissemination Qualitative findings will be presented through reports which will be submitted to COMREC and for peer review publication. An updated costing tool will be presented to the African Palliative Care Associatwion for consideration. Further output from this study will be manuscripts published in peer reviewed scientific journals and for conference presentations locally and internationally.
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Comparative analysis of antimicrobial resistance profil E.coli isolated from intensively reared and free range chickens in selected districts of Zambia
(Kamuzu University of Health Sciences, 2020-11-11) Chawinga, Kenneth
Type of study: A cross-sectional study Aim of the study: To investigate and compare the antimicrobial resistance profile of E. coli isolated from intensively reared and free range chickens Specific objectives: 1. To isolate ESBL producing E. coliisolates from commercial broiler and free-range retail chickens 1.To determine the carriage of ESBL-Producing commensal E. coliin healthy intensively and free range chikens 2. To determine antimicrobial sensitivity of the isolates to commonly used antimicrobials 1. To determine presence of antimicrobial resistant genes in the isolated strains.2.To determine the phenotypic and genotypic characterization of antimicrobial resistance in isolated strains. 3.2. 3. To asses the diversity of antimicrobial usage at farm/household level. Problem statement: Extended-spectrum beta-lactamases were found first in Klebsiella pneumonia and then predominantly in E. coli, making the later an important group of bacteria in dissemination of antibiotic resistant genes, mainly from the AMR Profile of E.Coli in Chickens COMREC Application Version 2.0_02/11/2020 COMREC Application diverse compounds and widely used therapeautic class of antibacterials due to their excellent safety profile and broad antimicrobial spectrum. This, unfortunately, has also given rise to a continuous increased resistance,globally in health care settings as well as in the community, due to their permanent ability to cause antimicrobial resistant genes to become more common in the population (Ur Rahman et al. 2018). Extended-spectrum beta-lactamase (ESBL) producers are Gram-negative bacteria that produce enzymes that impart resistance to most beta-lactam antibiotics such as penicillins, cephalosporins, and the monobactam aztreonam (Chishimba et al. 2016). This cross sectional study ,of comparative analysis of antimicrobial resistance profile of E. colithat will be isolated fromapparent healthyintensively reared and free range chickens in Kabwe and Kapiri Mposhi Districts located in Central Province in Zambia, shall endeavor to bring out evidence of; 1. Presence of ESBL producing E. Coli in the gastrointestinal tract of free range and intensively kept chickens1.To determine the carriage of ESBL-Producing commensal E. coliin healthy broilers and freerange 2. Antimicrobial sensitivity of the isolates to commonly used antimicrobials and 3. Presence of antimicrobial resistant genes in the isolated strains 2.To determine the phenotypic and genotypic characterization of antimicrobial resistance in isolated strains. 3. To asses the diversity of antimicrobial usage at farm/household level.
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Socio-economic factors associated with hypertension in adults aged 45 and below in Malawi- a cross sectional study
(Kamuzu University of Health Sciences, 2020-11-11) Laher, Beverly
Type of study: Quantitative cross-sectional Study Problem: Despite the high rates of mortality and morbidity due to NCDs, attention to this group of diseases is arguably insufficient both at global, regional and country level. Hypertension is the leading cause of cardiovascular disease and its prevalence continue to escalate in the least developed parts. Hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke. The highest prevalence of hypertension is documented in the African region at an estimated 46% in 2013. Studies initially identified hypertension to be a disease of the affluent. However emerging evidence suggests that the condition also affects those from underserved and socially disadvantaged communities like Malawi, where 65% of the population is reported to be poor and resides in rural areas. Most studies establishing this association used income and expenditure as economic indicators. These indicators may not depict the economic status of rural Malawians as most are not formally employed nor do they document household expenditure. In addition, globally reported hypertension risk factors such as obesity and physical inactivity in Malawi are uncommon. It is reported that most hypertensives in Malawian are lean, young and highly physically active. Establishing context specific factors associated with hypertension, may improve its management and assist in the attainment of the WHO target to reduce hypertension by 25%. This study therefore aims to determine the socioeconomic factors associated with hypertension in rural Malawi using the wealth index as an economic indicator. This study also aims at determining the mechanism through which low socioeconomic status leads to hypertension. Methodology: This will be a population-based study using secondary data from the Malawi Longitudinal Study of Families and Health (MLSFH), a long-standing publicly-available longitudinal cohort study that documents more than two decades of demographic, socioeconomic and health conditions in three districts in Malawi.In particular, this analysis will focus on cross-sectional survey data for 2019; focusing on Education levels, stress and household wealth as potential socioeconomic correlates for hypertension. This study aims to determine the association of household wealth, stress and hypertension. Ethical issues including seeking permission to access, use and protect the data will be followed. Expected findings and dissemination: The investigator will determine the socioeconomic factors associated with hypertension in a low socioeconomic setting, in rural Malawi. The findings will be presented to COMREC and the research dissemination organized by the college, the department for viva and publishing findings in a recognized health peer-reviewed journal once accepted
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Feasibility study of a community-based intervention to reduce air pollution exposure.
(Kamuzu university of Health Sciences, 2020-11-11) Sepeede, DR Salah
Study Type A before-after study to test the feasibility of a community-wide cooking intervention Problem to be studied Air pollution is a leading environmental health risk globally, particularly in low- and middle-income countries, contributing to pathology in the major organ systems and poor pregnancy outcomes (Schraufnagel et al., 2019a, 2019b; World Health Organization, 2018). Whilst evidence exists for health improvement from air pollution reduction interventions, the interventional research in low income settings has to date largely relied on the introduction of single devices (improved cookstoves) in attempts to tackle the problem, and these have not reached their theoretical potential, in terms of achieving particulate exposure reductions seen in laboratory conditions, due at least in part to insufficient uptake (also incorporating exclusive use), and continued use (Hanna, Duflo, & Greenstone, 2016). The overall PAMODZI study (“P.02/19/2600 - Participatory Approaches in Mpemba for Developing Clean Air interventions (PAMODZI) version 2.0”) has sought to understand the cultural and social context in which smoke exists, describe the patterns of smoke exposure within a village in rural Malawi, and top co-develop a context-appropriate, feasible cleaner air intervention together with the community on the village. Following the initial ethnographic and participatory phase, we now seek to implement this intervention, in an engaged and receptive way, within the same village. Such an evaluation with community at the centre throughout, will optimise the chances of success in achieving its goals and reap meaningful conclusions in terms of how we do Global Health research. Overall aim 1 To assess feasibility of a community-based intervention in Makanjira village to reduce smoke exposure and to determine the effects of the intervention on particulate exposures in this setting Objectives 1 To assess how the study population (in the village) engage with the research intervention, in terms of uptake and continuing use of the intervention (qualitative and quantitative outcomes) 2 To assess whether the proposed approach for air quality monitoring is informative and acceptable (see protocol section vi] Data collection) 3 To quantify any changes in ambient and personal PM2.5 and carbon monoxide (CO) exposures from baseline to selected follow-up timepoints (as described in methodology section) Methodology The study will involve two phases: 1 ‘Before’ (baseline phase) - Baseline ambient particulate monitoring using stationary PM2.5 and CO monitors at three public points within the village; additional baseline monitoring of individual exposures as required given previously collected data (2x24 hour periods per participant); community preparation for intervention introduction. 2 ‘After’ (post-intervention phase) – Initial month of in-depth observation (realist process evalution) postintervention introduction; similar qualitative evaluation approximately 3 selected timepoints post-evaluation. Ambient air quality monitoring (3 points) at one month post-intervention and at the final follow-up timepoint; personal air quality monitoring (2x24 hour periods per participant) at the same two timepoints. Intervention will incorporate two elements: 1 Local wood burning cookstove for each household 2 Request to cook outdoors or on a well-ventilated khonde where possible Data Management and analysis Qualitative and quantitative data will be collected and analysed separately as appropriate. Qualitative data will be entered into NVIVO for management and analysis, which will be thematic, done iteratively throughout and beyond the period of fieldwork, in discussion with the research assistant and fieldworker. Quantitative data will be input into excel and the programme ‘R’ will assist in statistical analysis. Comparisons will be made between baseline CO and PM2.5 levels at baseline and post-intervention. Decisions on appropriate analyses and specific statistical tests will be informed by discussions with staff from the statistical support unit at MLW. Expected findings and dissemination An in-depth account of uptake and continued use of the cooking intervention and complex implementation factors. In addition, a qualitative indication of any changes to personal and ambient particulate exposures in the village throughout the time of the trial. These will be disseminated through a number of pathways, both locally within the community itself, regionally and nationally in Malawi, including to COMREC, and through wider scientific networks through publication and presentation. This will be supported by the MLW Science Communications team.
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Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Harnish, Christopher
This study seeks to describe and assess the architectural design factors of delivery suites that influence the maternal birth experience and peripartum health outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. The factors of quality of care and patient outcomes which will be assessed are: maternal privacy; peripartum maternal mental health; paternal and guardian involvement and spatial efficiency at Queen Elizabeth Central Hospital. This information will inform evidence-based maternity ward architectural guidelines to improve quality of health care, patient outcomes and patient satisfaction. Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. These findings may lead to improvements in architectural designs of maternity wards in health facilities in Malawi; health worker flow and efficiency; patient outcomes; and satisfaction for themselves and their families.
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Reaching the stigmatised: A 3-year retrospective analysis of the static and mobile mental health clinics of Nkhoma Mission Hospital in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2021-01-05) Johnston, Anna
Type of research study This is a retrospective analysis of data collected over a 3 year period. The problem to be studied This research will describe the demographic characteristics of patients attending both the static and mobile clinics of Nkhoma Mission Hospital, Lilongwe, Malawi. There will then be an analysis of the distances of the mobile clinics from the static clinic at Nkhoma Mission Hospital, Lilongwe. This will be demonstrated using mapping technology to create a visual representation of the distances. Analysis will then be carried out on the differences in the demographic characteristics of those attending both the static and mobile clinics. Broad Objective: To describe the individuals accessing Nkhoma Mission Hospital’s Mental Health Services and understand the implications of the geographical locations of the static clinic in Nkhoma Mission Hospital and the 12 associated mobile clinics from February, 2017 and September 2020. Specific Objectives: - To describe and understand the demographics of individuals attending the static and mobile mental health clinics of Nkhoma Mission Hospital, Lilongwe, Malawi. - To establish the distance between Nkhoma Mission Hospital and the 12 outreach clinics and calculate the time taken to travel to each of these clinics. - To use OSM mapping technology to demonstrate the geographical location of the mobile clinics in relation to the static clinic at Nkhoma Mission Hospital. - To determine whether the demographics affect the utilisation of either a mobile clinic or static clinic. - To analyse if, and how, the follow up of patients differs based on the geographical locations of the static and mobile clinics. Methodology This research is a quantitative study which involves the analysis of data which has already been collected. The data was collected as part of routine clinical data collection. The data will be anonymised for the purposes of this study analysis. Expected findings There is likely to be a variation in demographic characteristics of patients attending the different clinics. The static clinic will probably see a wider range of demographics, as there were 415 patients attending the one static clinic at Nkhoma, compared with a combined total of 495patients spread across the 12 mobile clinics. The use of mapping will provide a helpful visual representation which may be used in future by programme organisers when assessing delivery of services to populations living further from the main clinic at Nkhoma Hospital. It is expected that there will be significant differences in the follow up of patients based on whether they attended the static clinic at Nkhoma Hospital or mobile clinics in the surrounding areas. Dissemination of results The findings of the study will be shared with University of Dundee, Scotland and Nkhoma Mission Hospital, Malawi. The data analysis will be used in the researcher’s final dissertation, which will be submitted to the University of Dundee. This will form part of the researcher’s assessment for a Bachelor of Medical Sciences Degree in International Health. Results may be disseminated in peer review journals and presented at medical meetings.
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Assessing implementation of infection prevention and control practices among maternity ward healthcare workers at QECH
(Kamuzu University of Health Sciences, 2021-01-13) Chitimbi, Zacheus; Magombo, Michael; Kamkwanya, Mike
Type of study: This is a cross section qualitative study design. Research Problem: Healthcare associated infections are one of the major contributing factors to the high mortality rates in maternity wards despite different efforts in hospital infection prevention and control measures. Proper implementation and adherence to the standard measures of infection prevention and control by healthcare workers is an effective means to minimize the risk of transmission of these HAIs in hospitals. Objective: The main objective is to assess how the infection prevention and control practices are being implemented amongst maternity ward healthcare workers at QECH. Methodology: The study participants are clinicians, nurses, hospital cleaners and hospital management. A sample size of 20 participants, selected using purposive sampling method. Data to be collected using in depth interviews facilitated by an interview guide and observation of healthcare workers and their work environment with an audit checklist. Expected results and dissemination: We expect to find out the knowledge of healthcare workers on IPC measures, their perception, attitudes and adherence towards IPC measures and identify barriers to compliance with the IPC measures. The results will be presented at College of Medicine research dissemination presentations and a report is going to be sent to the College of Medicine library. We would also like to publish the study in the Malawi medical journal.
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Evaluating the outcomes of glaucoma surgeries at a tertiary eye hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Mhango, Priscilla
Glaucoma is the second commonest cause of blindness and the most common cause of irreversible blindness worldwide. In developing countries, where the treatment options are limited, management of glaucoma is challenging. In Malawi, due to various difficulties, including the lack of availability and affordability of a wide range of medical and laser therapies, surgery is usually advised and planned for within a year of diagnosis for most patients. The success rate of surgery depends on several factors, such as the type of surgery performed and the potential complications during the intra and post-operative period. This success rate is typically measured according to the reduction in intraocular pressure (IOP) as well as the post-operative visual acuity. Type of Study This will be a retrospective case series study. Problem There is a paucity of data showing the success rate of adult glaucoma surgery in the Malawian setting. This study aims to establish a baseline success rate of glaucoma surgeries at a tertiary eye hospital in Blantyre. Objectives Broad To describe the clinical profile and outcomes of adult glaucoma surgeries at LSFEH Blantyre, Malawi in order to generate therapeutic data to inform improved disease management. Specific 1. To establish the severity of glaucoma in patients undergoing glaucoma surgeries at LSFEH Blantyre, Malawi 2. To describe determine pre-operative factors associated with post-operative IOP in adult glaucoma surgeries at LSFEH Blantyre, Malawi. 3. To establish the post-operative factors associated with post-operative IOP outcome in adult glaucoma surgeries at LSFEH Blantyre, Malawi. 4. To determine the proportion of successful glaucoma surgeries by comparing the post-operative to the preoperative IOP. Study location This study will be carried out at Lions Sight First Eye Hospital, a referral and teaching eye institution at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methodology Case files of patients who underwent glaucoma surgeries, specifically trabeculectomy, combined trabeculectomy and cataract surgery and Ahmed valve surgery between March 2019 and February 2020 will be examined. The following information will be collected from the hospital records: age, gender and demographic details. Details on pre-operative assessment such as visual acuity, intraocular pressure, optic disc appearance and previous surgery will be recorded. Additionally, details on surgical findings, post-operative visual acuity, IOP and complications will also be recorded. The required information will be filled into the data collection form (see appendix 1) and entered into an excel spreadsheet. The data will then be exported to STATA version 16 for analysis. The primary outcome measure is post-operative IOP reduction. The mean percentage reduction in IOP will be shown as column charts and mean IOP reduction will be compared using Wilcoxon’s sign ranked test. Additionally, the IOP will be categorised into successful and not successful. Descriptive statistics will be used on and clinical presentation parameters. Categorical data such as gender and age group will be summarised as frequency distribution tables. Data showing the proportion of cases with intraoperative and post-operative complications displayed in pie chart form and the various complications will be presented in bar graphs. A multivariate binary logistic regression model will be used to identify the factors affecting the outcome. Hypothesis We hypothesise that greater than 60% of the patients will have successful glaucoma surgeries. This is based on observational studies from other African countries. Results dissemination Results from the study will be presented at the College of Medicine research dissemination conference with the intention of publishing in peer-reviewed journals. Additionally, a written report of the final research project will be submitted to the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and LSFEH Clinical Director.
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Assessing therapeutic turnaround time of creatinine, urea and FBC from emergency departments at Queens central hospital
(Kamuzu University of Health Science, 2021-01-16) Gondwe, Yilinase
Type of research An observational descriptive study will be conducted on creatinine, urea and full blood count testing requests from the adult emergency department delivered at the Clinical Chemistry and hematology section of the Queens Elizabeth Central hospital (QECH) laboratory department The problem to be studied Therapeutic turnaround time is the period from test ordering to the time the results for the test are given. Clinicians rely on shortness of turnaround time (TAT) to achieve early diagnosis, treatment of the patients and early patient discharge from emergency departments or hospital in-patient services and the hospital as a whole. A clear knowledge of Laboratory Turnaround Time (LTAT) will enable critical assessment of laboratory services and improve therapeutic turnaround time (TTAT), thus improve care provision and shorten the length of stay in the emergency department. Objectives This study will define the therapeutic turnaround time for creatinine, blood urea nitrogen (BUN) and full blood count (FBC) tests from the adult emergency department at Queen Elizabeth Central Hospital (QECH). Specifically, this study will quantify the demand for creatinine, urea and full blood count tests from the adult emergency department; and further identify factors affecting the turnaround time for these tests in the emergency department and at in a clinical laboratory. Methodology Blood samples will be received at the Clinical Chemistry Department for creatinine and urea and at hematology department for full blood count within the QECH laboratory department. A number of tests will be observed in a time period of a month and a sample size of 196 will be observed. Average time taken to complete each phase of the test will be measured and overall turnaround time for each test will be calculated. Clinical data. Emergency department and laboratory issues identified as affecting the turnaround time will be categorized and reported in proportions to define the demand and describe the factors affecting the TTAT. EPI Info 7.0 will be used for data analysis. 163.5 Expected findings and dissemination The expectation is that the TTAT identified in this study will be more than 60 minutes which is the acceptable TTAT as described by Robert Hawkins. The study findings will be presented to the Medical laboratory science (MLS) department, QECH emergency and laboratory departments. The final study report will be submitted to College of Medicine Research and Ethics Committee (COMREC) and college of medicine library. These results will be disseminated through attendance of local conferences/seminars and publication in peer-reviewed journal.
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Access to early bubble Continuous positive airway pressure in Neonatal Intensive Care Unit at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-02-05) Kamanga, Emmanuel; Sichinga, Tuntufye; Mbwana, Zainab
Objective: The main aim of this study is to evaluate accessibility of bubble Continuous Positive Airway Pressure by preterm infants in Neonatal Intensive Care Unit at a large referral hospital of central region. Methods: Study design: The study is going to be a quantitative cross-section study. We will use secondary data recorded in daily running of the neonatal unit from January through December 2019. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit admits about 400 preterm infants requiring Continuous Positive Airway Pressure therapy annually. Research Problem: Prematurity accounts for over a half of neonatal mortality in Malawi and mainly due to RDS respiratory distress syndrome. Low-cost bubble bCPAP is being implemented in hospitals to treat respiratory distress syndromeRDS.. There is limited data on the accessibility of the therapy and the rolled out low-cost bubble Continuous Positive Airway Pressure bCPAP Pumani devices. This study will evaluate the accessibility of early Continuous Positive Airway Pressure CPAP intervention on the preterm infants. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit NICU admits about 400 preterm infants requiring Continuous Positive Airway Pressure CPAP therapy annually. Expected outcomes: The study will provides up-to-date information on the need and utilization of low-cost Continuous Positive Airway Pressure CPAP devices rolled out in NICU Neonatal Intensive Care Unit at Kamuzu Central Hospital.
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Perception and practices of prescribers on the prescription of surgical antibiotic prophylaxis and resistance at Kamuzu central, Bwaila and Area 25 hospitals in Lilongwe
(2021-02-08) Myaba, Tiwonge
Research study: The study will be a cross-section, quantitative, descriptive design. Problem statement: Antimicrobial Resistance is a global public health threat to humans. The World Health Organization also indicates that antimicrobial resistance has reached alarming levels in many parts of the world including low- and middle-income countries such as Malawi. This is attributed to inappropriate use of antimicrobials at different levels in the health system. It is also certain that health workers such as prescribers have highly contributed through irrational prescription practices and surgical antimicrobial prophylaxes. Antimicrobial prophylaxis refers to a short course of antimicrobial therapy administered prior to surgery to reduce microbial counts to a level that will not overwhelm host immune response. Hospital acquired infections is a major contributor to increased mortality and health care costs due to development of resistant microorganism. There are reports of increased number of acquired surgical infections which some lead to amputation of leg, hysterectomies of young women in the surgical wards of these public hospitals. It is not clear whether it is due to irrational pre and post-operative prescription of the antibiotics which may lead to resistance of organisms to antibiotics. It is also not known whether health professionals follow the guidelines of prophylactic antibiotics hence the study will look into the practices and perception of prescribers on the use of surgical antibiotic prophylaxis and resultant resistance in different wards at Kamuzu Central Hospital (KCH), Bwaila and Area 25 hospitals in Lilongwe, Malawi. Aim of study: The aim of this study is to assess the perception and practices among prescribers on the use of surgical antibiotics prophylaxis in public hospitals of Bwaila, Area25, and Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. Objectives a) Assess knowledge of prescribers on the use of surgical antibiotic prophylaxis and resistance, b) To evaluate perception on the use of antibiotic prophylaxis and resistance among prescribers, c) To assess adherence to guidelines of surgical antibiotic prophylaxis among prescribers. Methodology A cross-sectional, quantitative, descriptive study design will be used. This study will be conducted in three public hospitals. It will target all prescribers who work in the mentioned hospitals. Study period will start in October 2019 to October 2020. This study is expected to have 169 individuals to participate. Ethical approval from College of Medicine Research Ethical Committee (COMREC) and permission from the Director – Kamuzu Central and District Health Office (DHO) will be sought. Study participants will give consent before participation. Questionnaire will be used to collect data. Data will be analyzed using SPSS. Results will be presented in form of tables, histograms and pie chart Expected findings and dissemination It is anticipated that factors contributing to high rate of surgical infections and knowledge level on the use of surgical antibiotic prophylaxis and resistance will be known. Furthermore, poor adherence to prophylaxis antibiotic guidelines and irrational prescription of antibiotics by prescribers will be established. The results will be presented in form of dissertation to College of Medicine, University of Malawi and copies will be submitted to College of Medicine Research and Ethical Committee, College of Medicine Library and College of Medicine Pathology Department.