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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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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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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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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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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Factors associated with adherence to physiotherapy clinic attendance among caregivers with children with cerebral palsy
(Kamuzu University of Health Sciences, 2021-05-26) Shadreck, Msowoya; Kanduku, Triza; Chinyama, Violet; Promise, Mtimajere
The study will use cross sectional qualitative method employing an interview guide with probes to conduct in-depth interviews as a tool of collecting data. Children with Cerebral Palsy (CP) may have different deficits which require early and continued physiotherapy intervention for effective outcomes. Caregivers of these children are the key determinants to the participation of their children to physiotherapy treatment (PT Rx). There are many factors that can hinder the compliance of caregivers to PT Rx. Therefore, the aim of this study is to explore the factors related to caregivers’ adherence to PT Rx. Specific objectives will include; (1) To explore challenges faced by the caregivers of children with Cerebral Palsy (CP), (2) To discover factors related to adherence to clinic attendance among caregivers with children with CP and (3) To survey factors affecting caregivers’ adherence to home exercise prescription. The study participants will be caregivers of children with cerebral palsy (aged 1 to 18 years) who will be selected from two sites: Queen Elizabeth Central Hospital (QECH) and Feed the Children. The expected results of the study will be orally presented at the physiotherapy department, electronically shared to College of Medicine Research Ethics Committee (COMREC) and presented at a research dissemination conference and published in peer reviewed journals. 26-May-2021
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Children’s air pollution profiles in Africa (CAPPA) v1.0, 20/02/21
(Kamuzu University of Health Sciences, 2021-06-03) Rylance, Jamie
Executive Summary - The type of research study This is a multi-centre observational cohort study about air pollution in African children. The centres included are in Malawi, Tanzania, Uganda, Zimbabwe, Ghana, South Africa, and Nigeria. - The problem to be studied There is extensive literature on the wide-ranging health impacts of exposure to air pollution on populations. Children are vulnerable due to their developing bodies (Gehring et al., 2013, Gauderman, 2007); evidence shows that children’s lungs exposed to higher levels of air pollution have less volume than those in cleaner areas (Mudway et al., 2019). While personal exposure studies are becoming established in Europe, no such large-scale studies have yet been carried out on the African continent. This study aims to close that gap, providing valuable evidence to help improve the health of Africa’s young population. - The objectives [i] Broad The study aims to describe the burden of personal air pollution exposure (particulate matter <10 and <2.5 microns (PM10/2.5), and nitrogen dioxide (NO2)) in urban children with asthma symptoms in sub-Saharan Africa, its geographic, and temporal variability, the role of indoor and outdoor microenvironments and activity profiles, and effect of socioeconomic variables. To assess how personal air pollution exposure affect children with asthma symptoms in urban Sub-Saharan Africa, and the influence of socioeconomic factors on the effects. [ii] Specific 1. To collect personal air pollution exposure data, activity profiles, and lung function measurements from 60 children with asthma symptoms aged between 12 and 14 years, in Blantyre, Malawi. 2. To analyse personal air pollution data for exposure patterns and peak exposures. 2.3., and tTo compare air pollution as well as activity profiles of children in relation to their socioeconomic and geographical backgrounds both within and between countries, and compare with measured data from school-age children in London. 3.4.To explore potentially detrimental effects of air pollution, and feasibility of mitigation strategies in children with asthma symptoms identified by ACACIA. - Methodology From March 2021, we will recruit 60 children who participated in the ACACIA study. The participant will be provided a backpack fitted with air monitoring equipment to carry and keep close to them. Each child’s exposure to NO2 and PM2.5, as well as their GPS-location, temperature and humidity, will be collected at a 1-second intervals for 96 hours, and stored on a microchip within the backpacks’ logging unit. The data analysis procedure will follow that developed for a previous similar study in London – ‘Breathe London Wearables’1. Once monitoring at a site is complete, encrypted data will be uploaded from the backpack sensor units to a secure server where it will be decrypted. The digital CAPPA questionnaire will be filled in by each participant and will provide additional information regarding each participant’s personal exposure. Participants will also measure and record their lung function twice a day using a peak flow meter. - Expected findings and their dissemination This study will increase knowledge on air pollution exposure of young people in Blantyre, Malawi. The study will provide data on exposure to harmful pollutants and the risk to children’s health in this increasingly urbanised region. Links between data on respiratory health of young participants who experience asthma symptoms with air pollution exposure data will be explored and will lead to new insights. A copy of the final report, published papers, and conference abstracts will be submitted to; the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences Research Committee, and the University Research and Publication Committee.
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Adapting and implementing group-based postpartum/well-child care at clinics in Blantyre District, Malawi
(Kamuzu University of Health Sciences, 2021-07-29) Gresh, Ashley
Type of Research Study: A mixed methods study. The Problem: Postpartum care, defined in this study from the time of birth through the first year, sets the stage for long-term health and well-being for both the mother and her child; further it is a critical time to reduce maternal and infant morbidity and mortality. The World Health Organization (WHO) recommends that every mother and baby should have at least four postpartum visits within the first six weeks of giving birth. The first year after childbirth is a period of not only physical recovery but is an important time to identify and manage health and social challenges including psychosocial adaptations and transitions to a parental role, that make women and children vulnerable for poor health outcomes. Globally there is no standardized package of care for the first year postpartum. Further, there are low rates of postpartum care attendance, revealing women’s unmet needs during this critical period in their life course. Sub-Saharan Africa, including Malawi, has some of the highest rates of maternal and infant mortality (MMR 439 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births) globally. High rates of maternal and infant morbidity and mortality and preventable illness and disease necessitate transformation in the delivery of postpartum and wellchild care in this critical time in the maternal/infant life course. There is a need to develop through innovative strategies a postpartum/well-child care model that is sensitive to maternal-infant dyads in low resource contexts where rates of maternal and infant morbidity and mortality are high. Objectives: Main objective: The purpose of this study is to adapt, implement, and evaluate the feasibility and acceptability of an integrated postpartum and well-child care group-based healthcare model, called CenteringParenting, in Blantyre District, Malawi. Specific Objective 1: Explore Malawian women’s expectations for culturally appropriate postpartum and well-child clinic care. Specific Objective 2: Co-design with Malawian women, midwives and community volunteers an adapted prototype of group postpartum/well-child care. Specific Objective 3: Examine the acceptability of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi. Specific Objective 4: Examine the feasibility of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi.Methodology: The proposed mixed methods study will use the five-steps of design thinking approach to adapt CenteringParenting: 1) empathize (interviews); 2) define (data analysis); 3) ideate (incubator sessions); 4) prototype (data analysis); and 5) test. This will be done through a rapid ethnographic assessment through interviews and incubator sessions with women, health surveillance workers, community volunteers and providers to create the group postpartum/well-child care prototype. The prototype will then be tested to determine feasibility and acceptability in the Malawian context through interviews, focus groups and surveys. Expected findings: We expect to co-create a prototype for group-based health care for the first year of postpartum and well-child care that will be acceptable and feasible. The findings will inform the next step in future research to determine the effectiveness of the CenteringParenting program model in Malawi. Dissemination of results: Results will be disseminated to the global research community through international journal publications and presentations at international and national research conferences. We also plan to present results at the COMREC conference, an excellent venue that is attended by policy-makers and researchers in Malawi.
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Assessment of burden and risk factors associated with soil transmitted helminth infections among adolescent girls (10-19 years of age) in Katete District of Zambia: A cross-sectional study
(Kamuzu University of Health Sciences, 2021-08-01) Tapisha, Buumba
Type of study-A cross-sectional study The problem: Over 688 million girls and women of reproductive age (WRA) are at risk of STH infections, with 26% of girls and WRA found in Africa. Infections among girls and WRA remain a concern because of their association with anaemia among unpregnant girls and women, maternal anaemia, foetal morbidity, and mortality. Information on subpopulations (like adolescent girls and women of reproductive age) in the district at risk remains unknown, making it difficult to plan and implement interventions as guided in the new NTD roadmap 2021-2030. Objectives: To assess the burden and risk factors associated with Soil-transmitted helminth infections among adolescent girls in Katete District of Zambia. Specifically, to 1. To estimate the prevalence of STH infections among adolescent girls in Katete district, 2. To determine the intensity of STH infections 3. To determine socioeconomic, behavioral, and environmental health factors associated with Soil transmitted helminth Methodology: A cross-sectional study to be conducted in Katete, a rural district in the eastern province of Zambia. Adolescent girls aged between 10 and 19 years will be enrolled in the study as participants. The Sample size is 206 inclusive of a 20% additional number to account for non-response. A multistage sampling will be used to get the study participants. The district has 10 zones that have a total of 105 schools (inclusive of private schools). Cluster random sampling will be used to sample 4 zones and a stratified random method to select 3 schools from each zone to come up with 12 schools. Systematic sampling methods will be used to select 17 study participants from each school (with two schools contributing 18 participants each) to get 206 participants. Primary data will be collected using a structured questionnaire administered by an interviewer/research assistant (to collect demographic, socio-economic, behavioral, environmental-related data). Stool samples will be collected in leak-proof containers from eligible children and analyzed using Kato-Kaz technique to quantify the infections. All statistical analysis will be performed using STATA software version 14. Proportions for infected will be computed to report prevalence and intensity of infection. Crude egg count will be classified light for eggs less than 5000EPG and heavy above 5000 to compare egg count values between different ages, gender and catchment areas. Descriptive data will be analyzed using appropriate summary statistics. Categorical variables will be reported as absolute frequencies with associated percentages, Chi-square test to ascertain the association between categorical independent variable and risk factors associated with soil-transmitted helminth infections. Multivariate Logistic regression to assess factors associated with soil-transmitted helminth infections with 95% confidence interval and significance level set at 5% Expected findings and dissemination: Expected to show the burden of STH by species and intensity of infections and factors associated with soil-transmitted infections. This information will help inform programming against STHs. The findings of the study will be documented in a report and shared with Katete District Health Office, Katete District Education Office, Provincial Health Office, ZNHRA, and COMREC. An oral presentation will be done to Katete District Health Management Team and KUHeS research dissemination conference. The results will be published in a peer-reviewed journal.
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Exploring factors that influence of uptake and utilisation of maternity health services among adolescent women to inform designing of novel adolescent friendly maternity health services in Malawi: A formative qualitative study
(Kamuzu University of Health Sciences, 2021-08-02) Chirwa, Marumbo
Type of research study: the study will use a longitudinal qualitative design in the phenomenological tradition. Pregnant adolescents will be recruited in their second or third trimester and they will be followed until 6 weeks postpartum. Data will be collected during the antenatal period, one week postpartum and six weeks postpartum. The problem: Maternal health services in Malawi are provided in all government hospitals, starting right from the primary health care facilities, and are rendered at no cost. Despite the availability of these services, some adolescent women inadequately utilizse them, and do not gain maximum benefits of the services, by reporting late to book for ANC, for labour and delivery, and as well as for their postnatal checkups. This situation increases the risk of infant and maternal morbidity and mortality. Hence, this research proposal seeks to address this challenge by understanding the factors that influence and strategies for improving the utilization of maternal health services among the adolescents in resource resource-limited settings, which is one of the contributing factors to maternal and infant morbiditly and mortality. Objective: To assess the factors that influence and strategies for optimizing utilization of maternity services among adolescent women. in Zomba Malawi. Specific objectives; toally we will assess knowledge and experiences of adolescent women of maternal health services;, to explore factors that influence adolescent women’s decision to utilize maternal health services, and to identify barriers and facilitators to utilization of maternity services and strategies for optimizing utilization of maternity services among adolescents. in Zomba. Methods: the The study will use a longitudinala qualitative design in the phenomenological tradition. Pregnant adolescents in their second or third trimesters, will be purposively selected and upon giving consent to participate in the study, they will be recruited. Data will be collected from participants through Vignettes, pictorial diaries, and In-depth interviews at three three-time intervals; during the antenatal period, one week postpartum, and six weeks postpartum, to help the researcher understand adolescents’ experiences while they were receiving care when they were pregnant, during labour and deliver and after they had delivered. In addition to the above above-mentioned methods, literate participants will also be given diaries in which they will write down their experiences during pregnancy. All the tools for data collection will be presented in the local language and will be recorded on a digital recorder then transcribed in English verbatim. Transcripts will then be imported into Nvivo software. Thematic data analysis will be used in this study. Safety The safety of data will be ensured by using a password to get access into the database. Expected findings and their dissemination; It is expected that the study will provide information on determinants of uptake and strategies of improving the utilizsation of maternity health services among adolescent mothers. Results of this study will be presented at both the district and at the national level through review meetings coordinated by MOH and other stakeholders. Also, at the College of Medicine research dissemination conference. Printed hard copies will be made available to the College of Medicine library Library and COMREC. Finally, the prepared paper will be submitted to peer review journals for publication and summarized in policy briefs and posters. Possible constraints: Conduct The conduct of the study may be challenged with the ongoing COVID-19 pandemic. We propose to conduct both telephonic and face-to-face methods of data collection to mitigate the unintended consequences of COVOD-19
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Predictors of Isoniazid preventive Therapy uptake and completion in under-5 contacts of adult tuberculosis patients in Blantyre
(Kamuzu University of Health Sciences, 2021-08-11) Chiumia, Symon
Type of study: An Analytical Cross-sectional study in 7 high tuberculosis (TB) burden health facilities in Blanryre District. ihe Problem. The uptake oflsoniazid Prev,:ntive Therapy (IPT) among under-hve childran in contact with adult tuberculosis patients, has heen suboptimal globally (Z1Y"versus global target of>90%" annually) and Malawi is no excr:ption. According to the United Nations High-Levei Meeting, 4 million under-five children wer,) targeted worldwide by 2022. Malawi was assigned a minimumcumulativetargetof1:5,780under-fivechildrenbytheyear2022" Malawi, with its high HIV/TB bun,en and high child mortality, has had a few studies on factors associated with child IP',] uptake. Thus, there is an urgent need to identil), independent predictors oflsoniazid Preventive Therapy Uptake and Completion to reduce the national child disease burden and mortality rates. Objectives: To determine individual predictors ofisoniazid uptake and completion in under-five children in contact with adult pulmonary TB patients in high TB burden health facilities in Blantyre district. Specific: l. To define the characteristics ofunder-fi.Ie children registered for TB screening and IPT uptake and those who completed therapy. 2. To determine predictors of IPT uptake md completion u*i@ tegi$ti€+egressiee Methodoloe-v: We will do the study in 7 out of 14 randomly sel,:cted high TB burden Blantyre district facilities, iadcpende"tly-sl€et€C, +*ieh-*ee;neepeAfuwhich were independently selected seleeted usin 3 routinely collected medical data ofthe contacts registered in 2019. Using sampling frames of facility TB contact registers, we will extract anonymized data of 484 contacts by systematic random sampling ofcontacts. Contact medical factors ard demographic information will be collected. Our primary outcr nes will be the number of conlacts initiated and conlrleted IPT. Descriptive analysis in S1'ATA 2015, followed ,ry logic analyses will be done(bivariable and then multivariable). Exper@ We h1 cothesize that there will be a significant association between contact factors and their chance, cfgetting TB screening, Isoniazid initiation, and completion. These findings will inform key stakeholders on strategies to improve Isoniazid uptake and the planned shorter regimen Isoniazid and Rifapentine (3HP) rollou! thereby reducing child morbidity and mortaliiy. Results .,vi11 be disseminated through peer-reviewed publications and presentations ar relevant scientifi,; conferences and shared with key stakeholders. A project completion report will be submitted to the College of Medicine Research and Ethics Committee.
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Determinants of mortality in neonates with culture negative sepsis: Implications for antimicrobial stewardship
(Kamuzu University of Health Sciences, 2021-09-15) Ghambi, Lughano
Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. This study aims to assess the factors associated with mortality among neonates with culture-negative sepsis by describing their characteristics and comparing the risk factors associated with death amongst those that died and survived. We will conduct a secondary analysis of a cross-sectional study investigating risk factors of neonatal sepsis which was conducted between May 2018 to May 2019 at Queen Elizabeth Central Hospital (QECH), Chatinkha Nursery. Rationale: Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. Primary Objective:To assess the factors associated with mortality among culture negative sepsis neonates in a unit in Malawi. Secondary Objective: To describe the characteristics of the neonates with culture negative sepsis To compare the risk factors associated with death in neonates with culture negative sepsis neonates amongst those that died and survived Study Type: Cross-sectional study (retrospective analysis) Place of study: Queen Elizabeth Central Hospital, Chatinkha Nursery Study population: All neonates with culture negative sepsis from the primary study Sample size: All neonates with culture negative sepsis from the primary study Possible constraints: No major constraints anticipated but the data collection for the study is complete, and therefore the analysis will have to be based on the existing dataset. Dissemination: Results will disseminated through posters, oral presentation and publications
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Assessment of factors associated with retention of HIV exposed infants in early infant diagnosis program in Lilongwe rural: A crosssectional study
(Kamuzu University of Health Sciences, 2021-11-09) Phensere, Julia
The type of research study: This is a cross-sectional study to determine factors associated with retention of infants in the Early Infant Diagnosis program. The problem: The Malawi Country Operational Plan, strategic summary of March, 2020 indicated that rigorous analyses of patient level data and partner performance has identified the retention of clients as the single greatest threat to a sustainable HIV response in Malawi. Data obtained from some health facilities in Lilongwe District shows low retention rates. In the first quarter of 2021, the HIV department reported that Nkhoma Hospital had attrition rate of 17% at 12 months into the EID program and 35% at 24 months, Mitundu had 12% attrition at 12 months and 21% at 24 months, Nathenje had attrition of 15% at 12 months and 22% at 24 months. This study seeks to assess factors associated with retention in the EID Programme in clinics in Lilongwe rural, Malawi. Objectives: Broad objective To assess factors associated with retention of HIV exposed infants in the early infant diagnosis program (EID)in clinics in Lilongwe rural, Malawi. Specific objectives 1. To determine parents/guardians of HIV exposed infants perceived threats associated with retention of HIV exposed infants in EID 2. To Identify the perceived benefits associated with retention of HIV exposed infants in EID 3. To determine the social-cultural factors associated with retention of HIV exposed infants in EID Methodology This Cross-sectional study employing a Barrier Analysis approach will be conducted at Nkhoma Mission Hospital, Ntenthera Health Centre, Nathenje as well as Mitundu Rural Hospital. The study population will be parents/guardians of HIV exposed infants 0-24 months of age. The sample size will be 90, 45 doers and 45 non-doers. Doers are those that do the behavior, in this study doers will be the infants who are consistently retained in the program while non-doers are those that do not do the behavior, in this study non-doers will be those infants that are loss to follow. Data will be collected using a pre-designed barrier analysis questionnaire template, the template will be utilized to develop questions specific for this study. Data will be kept in lockable cabinets. It will be entered on barrier analysis predesigned data analysis software. Expected findings and their dissemination The study expects to find factors that are associated with retention of infant in the EID program. The factors that promote retention as well as those that derail it will be identified through this study. It is expected that the study will uncover sociocultural factors, perceived threats as well as perceived benefits of retaining infants in the EID program. The factors could be socio-economic, religious, cultural, individual/personal factors, community factors, health facility. Studies have shown motivating factors to continue in the Programme to be a wish to have a healthy baby while barriers to be denial of the actual HIV status, lack of disclosure of HIV status, fear of side effects of the drugs, lack of support, unsynchronized hospital appointments for mother and babies among other issues. The findings of the study will be shared with Nkhoma Mission Hospital, Lilongwe District Health Office as well as Kamuzu College of Health Science’s Library. A manuscript will be developed from the findings which will be submitted to a peer review journal for publication
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Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi
(Kamuzu University of Health Sciences, 2021-11-11) Blaise Pascal, Furaha Nzanzu
Type of study: This will be a cross-sectional observational study of children aged 1 day to 15 years anaesthetised at Mercy James Centre (MJC). Problem: Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. However, glucose checking is not routinely performed perioperatively in our settings. This may lead to missing children with deranged blood sugar and related complications. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. Objective of the study: The aim of this study is to assess perioperative glucose levels of the children undergoing anaesthesia in MJC following current anaesthesia protocols. Methodology: Data will be collected for a minimum of 1 month. The sample will be calculated with an online sampling tool. Paediatric patient aged from 1 day to 15 years admitted for surgery at MJC and whose parents or legal guardians will be willing to give written consent will be included in the study. The exclusion criteria will include neonates less than 24 hours old, children coming for examination under anaesthesia and those whose operation will last less than 30 minutes. For each patient, socio-demographic information; pre, intra and postoperative variables will be recorded using a designed data collection form. Anaesthesia chart will be reviewed for data consistency. Data will be analysed using SPSS 26. ANOVA test will be used to compare means. Chi Square test and p-values at level of significance of 5% will be calculated to establish correlations. Expected findings: We expect to find children with deranged glycemia preoperatively mostly hypoglycaemia. We also expected to find children with deranged glycemia postoperatively both hypoglycaemia and hyperglycaemia. Duration of starvation period, types of fluid perioperatively, duration of the surgery may be the major factors associated with the variation of glycemia during anaesthesia. Dissemination: The findings of this study will be presented in one of the meetings at MJC, to Queen Elizabeth Central Hospital (QECH) research committee and to College of Medicine Research and Ethics Committee (COMREC). A manuscript will be submitted for publication in ananaesthesia pair reviewed journal.
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Impact of early supplementation with lipid-based nutrients on cardiovascular health and later child development in rural Malawian children, Version 2.0
(Kamuzu University of Health Sciences, 2021-12-01) Mangani, Charles
Type of research study: Prospective observational study The Problem: In 2011 an estimated 161 million children less than 5 years of age in low- and middle-income countries experienced stunting (measured as-2 SD from the length-for-age/height-for-age World Health Organization Child Growth Standards median). It is well established that the initial years of life are critical for cognitive, motor and social development and adverse growth environment may lead to compromised development (Sudfeld et al., 2015). New estimates indicate that 43% of under‐ 5‐year‐old children in low‐income and middle‐income countries are at risk of not reaching their developmental potential because of adversities throughout prenatal and early life, which can disrupt brain development. Nutritional supplementation may mitigate these adverse outcomes. Lipid‐based nutrient supplements (LNS) is a novel family of micronutrient–fortified, ready‐to‐use products that may boost length gain and reduce growth failure. However, whilst adding SQ‐LNS to the diets of the mothers and their children may carry beneficial effects on neural function status and functional outcomes, it can potentially have adverse effects on their cardiometabolic health. We have completed a clinical trial (iLiNS‐DYAD‐M) in Malawi, testing the health and growth impacts of small quantity lipid‐based nutrient supplement (SQ‐LNS) provision to pregnant and lactating women and their offspring from 6 to 18 months of age. This cohort of 781 intensively monitored women and children offers a unique possibility to assess the impact of SQ‐LNS intervention on child development and to evaluate its potential negative impacts on cardiometabolic health. Importantly, the supplement’s essential fatty acid (EFA) content was designed to promote neurodevelopmental processes (e.g. myelination) and facilitate cognitive and functional processes that typically manifest only later in childhood. Unlike linear growth, brain myelination is not affected by the child’s infections, which were common in the study sample. Therefore, even though the intervention did not affect children’s linear growth in the first 18 months, there are good reasons to predict beneficial impact on key aspects of early brain development and, by consequence, children’s long‐term cognitive outcome. Broad Objectives: To evaluate whether the nutritional supplementation with SQ-LNS provided during gestation and early childhood had an impact on cardiometabolic health, and neurodevelopment. Specific objectives: Objective 1: To evaluate the effect of SQ-LNS supplementation to mother‐infant pairs on key components of cardiometabolic health: body composition, blood pressure and plasma lipids. Objective 2: To determine if SQ‐LNS supplementation to mother‐infant pairs improves the children’s neural function, cognitive skills, and academic achievement later in childhood. Objective 3: To develop a comprehensive concept map, illustrating how various antenatal and postnatal exposures influence neural function, cognitive skills and educational attainment by 9 years of age. Methodology: This is a follow-up of children whose mothers were recruited in the International Lipid-Based Nutrients Supplement (iLiNS-DYAD) trial, a three-arm randomized controlled trial. Participants of the randomized controlled iLiNS‐DYAD‐M trial, last seen at 2.5 years of age, will be re‐invited to three follow‐up visits when they will be about 9 years old. On visit 1 and 2, we will assess children’s neural function, and cognitive and academic outcomes. On visit 3, we will assess child size with standard anthropometrics, her/his body composition with bioimpedance measurements, respiratory health by spirometry and hemodynamics with oscillometric blood pressure monitoring system. Additionally, we will collect a blood sample to study lipid and glucose metabolism. Expected findings and their dissemination: The project is expected to produce results on possible cardiometabolic effects of supplementation provided during gestation and early childhood which can guide future programs. Additionally, we will produce information on the impact of SQ‐LNS supplementation and other exposures on child development, thus facilitating designing and adoption of interventions that can promote human capacity and child wellbeing. We will add to the evidence base on neurocognitive research methods as well as hemodynamics. Results from the study will be disseminated locally (at Mangochi District Hospital), nationally (College of Medicine, Ministry of Health, College of Medicine Research and Ethics Committee COMREC) and in international meetings and journals.
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Graduates of Bachelors of Science in Paediatrics and Child Health in their workplace; evaluation of a national training program of non-physician clinicians in Malawi
(Kamuzu University of Health Sciences, 2021-12-01) Phiri, Ajib
Type of study: mixed-method, sequential explanatory design study (quantitative followed by qualitative). Problem statement: The BSc PCH training program for clinical officers has been implemented, but the cadre’s performance in the field and role in Malawi’s health system is not known. Objective: To explore the contributions of the BSC PCH COs that they make to the care of children at their workplaces and the health care system in Malawi. Methodology: The study will include all 34 graduates (2012-2020). Tools are survey questionnaires and in-depth interviews of graduates, and key informant interviews of key stakeholders from the hospitals, the Ministry of Health and Population, and the Kamuzu University of Health Sciences. Data collection is planned for Quarter 1, 2022. Expected findings: Views and perceptions from graduates and stakeholders will highlight the strengths and weaknesses of the current programme and inform its future design. Dissemination: A dissemination workshop is planned in Malawi to share the results to discuss policy implications and planning. Results will be presented at the dissemination workshop in Malawi and conferences in Malawi and Germany. A manuscript will be submitted to a peer-reviewed journal.
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Graduates of bachelors of science in pediatrics and child health in their workplace; evaluation of a national training program of non-physician clinicians in Malawi
(Kamuzu University of Health Sciences, 2021-12-10) Phiri, Ajib
Type of study: mixed-method, sequential explanatory design study (quantitative followed by qualitative). Problem statement: The BSc PCH training program for clinical officers has been implemented, but the cadre’s performance in the field and role in Malawi’s health system is not known. Objective: To explore the contributions of the BSC PCH COs that they make to the care of children at their workplaces and the health care system in Malawi. Methodology: The study will include all 34 graduates (2012-2020). Tools are survey questionnaires and in-depth interviews of graduates, and key informant interviews of key stakeholders from the hospitals, the Ministry of Health and Population, and the Kamuzu University of Health Sciences. Data collection is planned for Quarter 1, 2022. Expected findings: Views and perceptions from graduates and stakeholders will highlight the strengths and weaknesses of the current programme and inform its future design. Dissemination: A dissemination workshop is planned in Malawi to share the results to discuss policy implications and planning. Results will be presented at the dissemination workshop in Malawi and conferences in Malawi and Germany. A manuscript will be submitted to a peer-reviewed journal. Background Achieving the Sustainable Development Goal (SDG) 3 is key to the global health agenda. Universal health coverage (UHC), so that all individuals receive the essential quality health services they need without suffering financial hardship, is its main element. However, the achievements of the last years did not reach all. The distribution of health and well-being is very uneven. The future of children in many countries is still under threat. Therefore, a recent WHO-UNICEF-Lancet Commission suggested placing the children at the center of the SDG policies [1]. The commission outlines how to overcome the barriers to achieving SDG targets for child health and well-being. The critical shortage of skilled human resources for health (HRH) is one of the most important limitations in many low-and-middleincome countries (LMICs) in Africa and Asia to achieve UHC [2]. In sub-Saharan Africa (SSA) alone, there is an estimated shortage of one million healthcare workers [3]. The causes are manifold and include limited training opportunities, loss of highly skilled workers to private or high-income country settings as well as inadequate working conditions, low morale, and limited career pathways [3, 4]. Creating a new cadre, the non-physician clinician (NPC), is an approach to address some of these causes and was followed by many SSA countries. According to that model, selected tasks of physicians are shifted to NPCs to make more efficient use of the available workforce [2, 3]. In Malawi, the critical shortage of skilled HRH is also a major drawback for the health system [5]. Physician and nurse/midwife ratios in Malawi are among the lowest in the world, affecting particularly the rural people [6]. Between 2006 and 2012, 80% of recent medical graduates were retained in the public sector; however, less than one-third of them were working in rural areas [7]. Although 80% of the population lives in rural areas, only 26% of the health facilities are located there [8]. No paediatric specialists are available in district hospitals [7]. Limited opportunities to network, to refer, and a feeling of professional isolation may contribute to the situation [3]. NPCs called clinical officers (COs) practice in Malawi’s health system successfully for decades, but without opportunities for professional advancement and specialization [9]. In response, in 2012, the College of Medicine (now KUHeS) and the Ministry of Health (now MoHP) of Malawi introduced a 3-year specialist Bachelor of Science (BSc) training program in Paediatric and Child Health (PCH) for the COs, following successful blueprints from other specialties. The KUHeS planned to train 34 BSc PCH COs by 2020, which were expected to be sufficient to staff each district hospital [7]. This cadre is assumed to remain in the public health system and to successfully perform selected specialist tasks. This may allow people especially those are living in rural areas to access a certain degree of specialized services resulting in improved health outcomes [3]. Broad Objective This study aims to examine the contribution of the trained BSc PCH COs at their workplace (health facilities) to the care of children in Malawi. Specific Objectives are: a. To examine the perception of the BSc PCH COs about their contribution to child health care at their workplace, b. to explore the view of the stakeholders about the contributions of the COs to the child health care at their workplace, and c. to identify enabling and limiting factors BSc PCH COs face when providing services for the children at their health facilities.
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Factors associated with treatment outcomes of severe acute malnutrition among under five children admitted at Queen Elizabeth Central Hospital (QECH) nutrition unit: A retrospective cross- sectional study
(Kamuzu University of Health Sciences, 2021-12-10) Ndhlovu, Mirriam
Type of the study: A retrospective cross-sectional study. Problem to be studied: Malnutrition is a physiological condition that results from energy, protein and other nutrient deficiencies leading to growth impairment or excess intake of nutrients causing obesity. There are immediate, underlying and basic causes of malnutrition. Under-nutrition may be caused by diseases and or inadequate intake of macronutrients/micronutrients. Severe acute malnutrition is defined as weight for height/ length of <-3z score or MUAC<11.5cm or bilateral pitting oedema of +2 to +3 in children aged 6 to 59 months. Children with severe acute malnutrition are more susceptible to diseases which increases their mortality. Much of the research in severe acute malnutrition has focused on treatment options to improve treatment outcomes. However, mortality estimates in severe acute malnutrition have remained high in Malawi despite government’s effort to reduce child mortality. Objectives of the study are: Broad objective • To assess factors associated with treatment outcomes of severe acute malnutrition among children aged 1 month to 59 months admitted for nutrition feeding at Queen Elizabeth Central Hospital (QECH). Specific objectives I. To determine whether the admission category (new / readmission) is associated with treatment outcomes of severe acute malnutrition among children aged 1 to 59 months admitted at QECH nutrition unit. II. To determine whether the presence of a particular medical comorbidity (pneumonia, anaemia, TB, diarrhoea, malaria, sepsis and neural disability such as cerebral palsy) is associated with treatment outcomes of severe acute malnutrition among children aged 1 month to 59 months admitted at QECH nutrition unit. III. To determine whether socio-demographic characteristics (age, sex, and primary care taker) of the children aged 1 month to 59 months admitted at QECH nutrition unit are associated with treatment outcomes of severe acute malnutrition. Methodology: This will be a retrospective cross-sectional study to be conducted at QECH nutrition unit from July 1, 2017 to July 31, 2020. The study population will be all malnourished children aged 1 month to 59 months admitted at QECH nutrition unit. All children with surgical and orthopedic conditions will be excluded from the study. A sample size of 312 will be used for the study to achieve 90% power at 5% significance level. Data will be extracted from inpatient registration book and patient medical records. The study population will be divided into two strata, namely; recovered and not recovered. Proportionate will be calculated for each stratum based on total number of study population. The desired sample size will be multiplied by the proportion of units in each stratum. Finally, systematic random sampling will be used where every kth unit will be selected from each stratum. Expected findings and dissemination: Recovery rates and death rates of SAM children aged 1 month to 59 months will be established. Factors associated with the outcomes will be identified and association described. Results of this study will be shared with Kamuzu University of Health Sciences (KUHeS), COMREC, and QECH. Dissemination of the results will also be done in conferences and peer reviewed publications.