Protocols

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    Lived experiences of patients with esopgageal cancer attending palliative care at clinic at Zomba Central Hospital
    (Kamuzu University of Health Sciences, 2020-06-11) Chikhungwa, Sellina
    Type of Research Lived experiences of patients with oesophageal cancer attending palliative care clinic at Zomba Central Hospital. Problem Oesophageal Cancer (OC) is one of the most serious gastrointestinal cancer in Malawi, owing to its rapid development and fatal prognosis in most cases (Mchembe, Rambu, & Chalya, 2013). In Malawi, Zomba Central Hospital is one of the referral hospitals in the eastern part of Malawi with high burden of oesophageal cancer. (Mathiass & Christliches, 2015). Most of the patients with oesophageal cancer at Zomba Central Hospital are diagnosed late while the cancer has already metastasised and palliation is the only option for these patients. Literature suggests that understanding the experiences of patients living with oesophageal cancer and are on palliative care is very important as it provides strategies for caring these patients. (Yeh Lee & Pilkington, 2014) . The proposed study therefore aims to explore how patients diagnosed with oesophageal cancer experience living with the incurable disease. The results of the study will provide insight and understanding of the patient’s situation, reality and phenomenon in their life world. The knowledge will help to meet the patients need for care and psychosocial support. Specific Objectives • To describe the experience regarding the diagnosis of oesophageal cancer. • To discuss the care, support and treatment offered to patients after the diagnosis of oesophageal cancer. • To identify the challenges faced by patients living with oesophageal cancer. 11-Jun-2020vii Proposal Version 3: May 6, 2020 Methodology The researcher proposes a qualitative descriptive design and it will follow a qualitative naturalistic approach (Polit & Beck, 2014). The research will be conducted at Zomba Central Hospital Palliative Care Clinic. Fifteen patients diagnosed with oesophageal cancer will be selected using purposive sampling technique to participate in the study. Data will be collected through in-depth interview using an interview guide and it will be recorded using an audio tape recorder. The recorded data will be analysed using Braun and Crake 2006 thematic analysis approach. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC) and permission from the director of Zomba Central Hospital (ZCH) to conduct the study at Zomba Central Hospital palliative care clinic. Participants will be informed that participation is voluntary and informed consent will be obtained through signing of consent forms. Privacy and confidentiality will be ensured. Expected findings The findings of this study will help nurses to have a rich understanding of the experience of patients living with incurable oesophageal cancer. It will provide knowledge about the problems and concerns patients encounter in their day to day life. The information will also help the ministry of health to develop improved supportive nursing care of patients living with oesophageal cancer. Dissemination Results of the study findings will be presented to academic staff at Kamuzu College of Nursing. The findings will also be presented to Zomba Central Hospital staff. A copy of the thesis will be sent to College of Medicine Ethical Committee being the ethical board ensuring ethical guidelines. Other copies will be sent to Palliative Care Association of Malawi (PCAM). The 11-Jun-2020viii results will also be published in Nursing and Midwifery Journals. In addition, the results will be presented at conferences both locally as well as international
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    Uptake of cervical cancer screening and associated factors among women in Nkhoma, Lilongwe Rural Malawi
    (Kamuzu University of Health Sciences, 2020-09-16) Kamanga, Ella; Banda, Nicholas; Fombe, Hillary
    The study conducted in the period 2011-2015 by Msyamboza et al, showed an increase of cervical cancer screening uptake from 9.3% to 26.5%. However, the available estimates are from health facility-based data. Community-based coverage data is scarce. In addition, current data on the trend of cervical cancer screening uptake is not known. This quantitative cross-sectional study has been designed to come up with the 2016-2020current estimated uptake of cervical cancer screening services and determine its associated factors that hinder or stimulate the cervical cancer screening uptake. This study will be conducted at Nkhoma Lilongwe, rural Malawi. The community-based 2016-2020 uptake and its associated factors will be estimated by calculating the proportion of women aged 25-49 years who have undergone cervical cancer screening. The targeted population are all women aged 25-49 years old from Nkhoma Mission Hospital catchment area. Villages in the catchment area of Nkhoma Mission Hospital will be randomly selected using simple random method and households will be selected using systematic sampling technique. A sample size of 330 women will be drawn including adjustment of 10% for nonresponse. The data will be collected by administering a semi-structured questionnaire. Microsoft office Excel 2016 will be used for data entry and EPI INFO version 7 for data analysis. Data and information will be backed up in external and Google drives. There is an expectation that from 2016 to 2020, the uptake of cervical cancer screening might have increased following the extensive cervical cancer sensitization campaigns in the country. These findings will be presented using tables and graphs.
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    Synthesis and anticancer evaluation of pyridazine derivatives
    (Kamuzu University of Health Sciences, 2020-11-11) Lengwe, Chilufya
    Type of Study Synthetic and Characterization Problem Statement The WHO reports that cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.1 The global burden of cancer has increased significantly such that, according to WHO, it estimated that the number of new cases in the next 20 years is expected to rise to approximately 70%.2Drug resistance in the treatment of cancer is a frequent clinical challenge for cancer patients.68 Several drug resistance mechanisms have emerged such that some drugs can be prevented from entering the cell; they can be pumped out of the cells; drug activity can also be compromised by mutations or altered expression of the target. Although some therapies have shown remarkable clinical success, emergence of drug resistance has posed problems more especially in advanced stages of cancer.69,70 Therefore, it is paramount that efforts to understand the principle underlining mechanisms of cancer resistance and identifying therapies that can treat cancers no longer susceptible to the current treatments are explored.71Unwanted toxicity profiles of the current therapiesis also another motivating factor for the need to develop alternative chemotherapeutic regimens.72 Furthermore, the cost of cancer drugs, has risen concomitantly with the shift from the use of conventional cytotoxic chemotherapy to newer targeted agents -from about $12,000 before 2000 to more than $120,000 median annual price by 2015.73 Therefore, there is a critical need for structurally novel and cheaper anticancer drugs with new mechanisms of action. Aim of the Study To utilize the pyridazine scaffold as a template for the design and synthesis of novel anticancer agents. Specific Objectives i) To perform synthesis and characterization of target compounds using physical andspectroscopic techniques. ii) To perform in vitro antitumor structure-activity relationship (SAR) studies of various pyridazine analogues. iii) Undertake in vitro profiling with respect to solubility, permeability and metabolic stability: include standard deviations. iv) To evaluate the most promising compounds for in vivo efficacy in relevant disease models and pharmacokinetics Methodology Two classes of pyridanzine compounds will be synthesized. In the first case 6- chloropyridazin-3-amine will be coupled with substituted benzoic acids to form N-(6- chloropyridazin-3-yl)-substituted benzamide which will be then coupled with asubstituted boronic acid to formthe target compounds. The second class involves the dichlorinated pyridazine starting material, 3,6-dichloropyridanze,been coupled with excess boronic acid. Expected Findings IC50 values for all the compounds to be synthesized will be determined. Spectroscopy data i.e. NMR, MS and IR as well as the Physical properties such as melting points of all compounds will be generated. Solubility and permeability data of all promising compounds will be generated. Efficacy data of all promising compounds in animals will be generated Dissemination The report of this research will be submitted to the COM and UNZA as host institutions and also presented to College of Medicine Research and Ethics Committee (COMREC). Further, the results of this research will be disseminated through local conferences, workshops and symposia. If possible, a dissemination workshop will be organized.
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    Evaluation of survival and associated prognostic clinical-pathologic factors among women undergoing surgery for early-stage cervical cancer at Kamuzu Central Hospital in Lilongwe, Malawi
    (Kamuzu University of Health Sciences, 2021-12-16) Chikhwaza, Owen;
    Study Type The proposed study is a retrospective cohort study that seeks to evaluate the survival and its associated prognostic factors among patients who underwent radical hysterectomy and or pelvic lymphadenectomy at Kamuzu Central Hospital for Invasive Cervical Cancer between January 2015 to December 2020. The Problem: Invasive cervical cancer is the 4th most common cancer among women worldwide. Malawi has one of the highest burdens of cervical cancer globally with age standardized incidence rate of 75.9 and mortality of 49.8 per 100,000 populations. It is the commonest cancer among women in Malawi, with over 4,000 new cases and 2,900 deaths annually. Early invasive disease is treated by radical hysterectomy with/or without pelvic lymphadenectomy and/or chemoradiation. Malawi has a limited number of gynecologists to competently perform the required surgery for early-stage Invasive Cervical Cancer in two of its four tertiary hospitals, resulting in long waiting lists for surgery, to the detriment of some women who progress to inoperable stages before their scheduled surgery. Although Kamuzu Kamuzu central Hospital has been performing operations for treatment of early invasive cervical cancer since 2015, the survival of those patients has not been evaluated. Furthermore, whereas some studies have linked clinical and pathologic factors including age, disease stage, neoadjuvant chemotherapy, tumor-positive surgical margins to survival outcomes, there is limited data on the same in sub-Saharan Africa, including Malawi. Thus, an evidence-informed selection of patients for surgery is urgently needed to maximize benefits among women in need of surgery for Invasive cervical cancer. This study will provide preliminary data to inform patient selection and counselling for surgery for early-stage ICC. The study will also provide a foundation for further research in this area. Objectives We aim to assess overall survival and determine its associated clinicopathological factors among women who underwent radical hysterectomy +/- pelvic lymphadenectomy for early-stage cervical cancer at Kamuzu Central Hospital in Lilongwe, Malawi. from January 2015 to December 2020. Specifically, we shall determine overall and disease free survival as well as socialdemographic, clinical and histopathological factors associated with survival. Methodology We shall review medical records and histopathology reports from the pathology lab database. In addition to this, we plan to follow up patients using the contacts provided on both health records and histopathology reports to determine their vital status and disease status from health passport records, recorded during annual follow up visits. The data will be collected using standardized Data Collection Form e and analyzed using Stata 15.0. We will use Kaplan–Meier survival analyses to determine survival outcomes and Cox proportional hazards regression to determine clinicopathologic factors associated with survival outcome. Expected findings The expected findings include the five-year overall survival, disease free survival expressed as a percentage of total number operated, and social, clinical and histopathological factors that are associated with the survival. Dissemination The findings of this study shall be shared with the Department of Obstetrics and Gynecology at Kamuzu Central Hospital, Malawi Ministry of Health and Population, through the Department of Reproductive Health and COMREC. Further to this, we intend to present our findings at the Association of Obstetrics and Gynecologist of Malawi Annual Scientific Conference, KUHeS Research Dissemination Conference and other international conferences targeting Obstetricians and Gynaecologists. We further intend to submit the manuscript of this study for publication to both local and international journals
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    Factors related to time from symptom onset to breast cancer diagnosis among patients presenting to Kamuzu Central Hospital
    (Kamuzu University of Health Sciences, 2022-02-09) Chimzimu, Fred
    structured interviewer- administered questioner. Among women, breast cancer is the most common cancer worldwide and incidence and mortality rates continue to rise. Annually 2.1 million new cases and over 600,000 deaths were reported worldwide in 2018. The breast cancer cases in Africa are on the rise and in Malawi 1486 new cases and 821 deaths were estimated in 2020. Breast cancer in Africa affects women in the most active phase of their social and economic life leading to death in the premenopausal age. Additionally, most women are diagnosed with late stage breast cancer in Sub-Saharan Africa [SSA] leading to poor survival. Studies have shown that modifiable social and health system factors contribute to poor survival among breast cancer patients in Africa. In Malawi, patients with breast symptoms typically present to primary health care facilities and are referred to secondary or tertiary health care facilities for diagnostic evaluation. Minimizing time to diagnosis is dependent on: 1] timely patient recognition of symptoms 2] presentation of women to primary health facilities after symptom recognition and 3] appropriate assessment and referral at primary health care level to secondary or tertiary health care facilities. This study aims at establishing patient and health care system factors influencing the time the patient recognizes breast cancer symptoms to the time she presents to a health worker [patient interval] and the time from patient’s initial health care presentation to diagnosis of breast cancer [diagnostic interval] among breast cancer patients at KCH. The specific objectives are: To identify patient factors that affect the patient interval among breast cancer patients at KCH, to recognize patient and health system factors that affect the diagnostic interval among breast cancer patients at KCH and to analyze the patient and diagnostic interval among breast cancer patients at KCH. This study will be conducted at Kamuzu central Hospital, a tertiary hospital in Lilongwe. The study population will be newly histopathologically diagnosed breast cancer patients and those who have been enrolled to breast cancer cohort [ LCCC 1611]. They should be 18 years of age and above and should able to provide consent. Our sample size is 80 and data collection will be done in six months from December 2021 to May 2022. One time off, face to face interview using a questionnaire will be used to collect data on knowledge of breast cancer and symptom appraisal, first health centre visit and breast cancer diagnosis. We also abstract data from the parent study [LCCC 1611] on patient demographics, social economic status, histopathological diagnosis and stage breast cancer at time of diagnosis. The collected data will be entered in Microsoft database which will be password protected. Then the data will be analysed using STATA version 14.1. Basic descriptive statistics will be conducted on collected patient information. Long patient interval will be defined as ≥6 months from symptom recognition to presentation to primary health facility and long diagnostic interval and long diagnostic interval will be defined as > 3 months from first presentation to primary health facility to histopathological diagnosis. Chi-square and Fishers exact will test to identify factors associated with stage of presentation and stage of diagnosis [early versus late]. Multivariate logistic regression will be used to identify factors associated with late presentation and late diagnosis. We anticipate that there will be long patient and diagnostic interval and we will be able to identify associated factors. The findings of this research will be presented to KCH management and at Ministry of Health. A copy of the final report will be submitted to; The College of Medicine Research and Ethics Committee, College of Medicine Library, The Health Sciences Research and Ethic committee, The university Research and Publication Committee and University of North Carolina Project Library. Dissemination will be through attendance of local and international conferences.
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    Development of a paediatric oncology short learning program for nurses in Malawi
    (2022-03-16) Majamanda, Maureen
    Executive summary The type of research study This is a sequential multi method study which will use purposive sampling technique. The problem Care of children with cancer is highly specialised and requires well educated, trained and dedicated nurses to provide high quality care (‘Andersson et al. 2012). In Malawi, the curriculum for nurses has limited content for oncology nursing, as such nurses receive little or no paediatric oncology-specific education during pre-service education (Hockenberry et al., 2020). Unlike in high income countries (HIC) and other low and middle income countries (LMIC), where nurses are given an orientation education programme when newly hired or allocated to paediatric oncology settings, in Malawi, no such education and training is available. Most preparation occurs as part of institutional orientation and nurses learn on the job through experience, intuition, doctors’ instructions and everyone teaches them as they see fit (Tynjälä, 2008). This has also been seen to promote transfer of negative characteristics at the work place as nurses may be learning from mistakes (Hussein et al. 2017; Tynjälä, 2008). In addition, nurses are rotated to other units within the hospital annually or every two years, a practice which further compromises sustainability and quality of care (Gundo et. al. 2019; So et al., 2016). Consequently, nurses provide substandard care to children with cancer, thus contributing to poor patient outcomes (Day et al., 2015). In Malawi, many children who are newly diagnosed with cancer report to hospital with advanced disease. This makes it difficult to treat cancer that is curable when treatment is instituted early and make cancer treatment to be expensive. These issues and many more provide a complex and unique situation for Malawi. As such there is need for well-prepared nurses with appropriate knowledge, skills and attitudes to properly provide individualised and holistic care to children with cancer and their families. Education and training of nurses in paediatric oncology specialty has been identified as an important step in improving care of children with cancer in LMIC (Challinor et al., 2014). In Malawi, there is no paediatric oncology education and skills training program for nurses working in paediatric oncology settings. As such the learning needs of nurses in paediatric oncology care remain unexplored. Main Objective To develop a paediatric oncology short learning program for nurses in Malawi. Specific Objectives 1. To explore the paediatric oncology learning needs of nurses in Malawi according to nurses, other health care professionals and parents/guardians. 2. To validate a paediatric oncology short learning programme for nurses in Malawi. 3. To evaluate a paediatric oncology short learning programme for nurses in Malawi. Methodology The data collection methods in this study will include scoping review, focus group discussions, pre and post-test questionnaire, semi structured interviews and participants to the short learning program will respond to a learning program evaluation form with open ended questions. Expected Findings and Dissemination Findings of this study will inform the development of a paediatric oncology short learning programme for nurses in Malawi. The developed short learning programme will empower nurses with appropriate knowledge, skills and attitudes to provide evidenced based nursing care that will lead to improved health outcomes of children with cancer in Malawi. Findings from this study will be published in peer reviewed journals and will be presented at local and international conferences. A PhD thesis will be submitted to the University of the Witwatersrand, Kamuzu University of Health Sciences libraries and College of Medicine Research Ethics Committee.
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    Point-of-care HPV testing for the evaluation of cervical cancer risk in Thyolo, Malawi,
    (Kamuzu University of Health Sciences, 2022-03-16) Twabi, Hussein
    The type of research study We will conduct a prospective cohort study for a diagnostic evaluation at Thyolo District Hospital outpatient gynaecological unit. The problem to be studied Cervical cancer is the leading cause of cancer-related death in low- and middle-income countries. Malawi has the world’s highest incidence and mortality rates due to cervical cancer. This is despite cervical cancer being one of the most preventable and treatable malignant conditions worldwide. Human papilloma virus (HPV) testing has been found to be more effective in screening for cervical cancer than conventional and liquid-based cytology. The emergence of point-of-care (POC) HPV tests have made it possible to implement HPV testing in low-resource settings, and this may be the best strategy for cervical cancer screening in such settings. The Research objectives Broad objective Determine a baseline screen strategy utilising point-of-care HPV testing in patients presenting for routine cervical cancer screening. Specific objectives • To determine the sensitivity, specificity, positive and negative predictive value of POC HPV testing for prevalent and incident high-risk HPV serotypes in participants presenting for cervical cancer screening. • To determine the predictive value of POC HPV testing for cervical abnormalities identified on VIA screening. • To describe the spatial distribution of HPV-positive and VIA-positive individuals in the community. Methodology We will conduct a survey of the cervical cancer screening registers at Thyolo District Hospital. We will then conduct a prospective cohort study of diagnostic accuracy. Participants will be 300 female adults presenting for routine cervical cancer screening at Thyolo District Hospital. Following consent, they will undergo sterile speculum examination wherein cervical cytobrush samples for Cepheid Xpert® HPV point-of-care test and Cervical cytobrush sample for real-time (RT) reverse transcriptase polymerase chain reaction (PCR) will be taken. Visual Inspection with acetic acid (VIA) will then be conducted. Clinic staff will be provided with the results of the VIA and RT-PCR to inform patient management. Participants will return at 3 weeks and 6 weeks for reassessment, with no further assessments planned. The primary outcome will be prevalence of HR-HPV serotypes identified by the tests.Expected findings and their dissemination. We hypothesize that there is a high burden of HR-HPV serotypes in women attending cervical cancer screening. Additionally, we expect the POC HPV test to have high sensitivity and specificity in identifying HR-HPV positive individuals. The results of this study will be submitted to College of Medicine Research and Ethics Committee (COMREC) and to journals for peer-reviewed publication, as well as the Thyolo District Hospital and the Queen Elizabeth Central Hospital to inform clinical approaches to cervical cancer screening. The results of the study will also be shared with policy makers at the Ministry of Health in Malawi and the World Health Organization (WHO).
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    Assessing immunosuppressive status in HIV clients with cervical cancer at Queen Elizabeth Central Hospital, Gynaecology Unit
    (Kamuzu University of Health Sciences, 2022-04-11) Maluwa, Thokozani; Dinala, Yusuf
    Type of study Retrospective folder review study. Problem Women living with HIV have increased risk of developing cervical cancer which is associated with an increase in mortality rate. Malawi being one of the countries with high HIV prevalence rate, this study wants to determine the immunosuppressive status of HIV positive women with cervical cancer. Broad objective • To assess immunosuppressive status in HIV clients with cervical cancer Specific Objectives • To determine the effect that cervical cancer has on HIV viral load status and CD4 count. • To explore association of viral load status in HIV patients with cervical cancer with age, cancer stage, socio-economic status and level of education. • To assess how ART adherence, affect HIV viral load status in HIV patients with cervical cancer. methodology This will be a retrospective folder review study. A total of 87 HIV clients with cervical cancer files will be obtained from QECH, gynecology department. A simple random sampling method will be used to sample the files. Variables such as age socio-economic status, level of education, stage of cancer, ART intake will be collected through a questionnaire. CD4 count and Viral load data between 2016-2021 will be collected from the files of the selected clients. Expected findings The viral load of HIV patients with cervical cancer will increase while CD4 will decrease. This is because HIV and AIDS patients have reduced immunity and the cancer lowers the immunity further hence the virus replicates rapidly. PowerPoint presentation will be done at Kamuzu College of Health Sciences (KUHeS) and at any designated Research Conferences. A final copy will be sent to the research supervisor(s), QECH, COMREC, Head of department and the Library. Manuscripts will also be prepared and be submitted at journal for publications. 11-Apr-2022 Assessing immunosuppressive status in HIV clients with cervical cancer at Gynecology unit, QECH, Blantyre; Malawi V2.0 21 March 2022
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    Assessing the acceptability of paclitaxel as treatment for Kaposi Sarcoma in patients and clinic providers in Mangochi
    (Kamuzu University of Health Sciences, 2022-07-11) Kachedwa, Francis
    Type of Study: This is a qualitative study that seeks to assess the acceptability of Paclitaxel as treatment for Kaposi Sarcoma in patients and clinic providers in Mangochi. Background of the problem: Kaposi Sarcoma patients in Malawi have long been treated with Vincristine either as a monotherapy or in combination with bleomycin. Given many reports of toxicity in vincristine patients at higher dosages albeit with little or no concomitant benefits of dosage increases, the government of Malawi revised the first line treatment for Kaposi Sarcoma. In this regard, the Malawi Ministry of Health (MOH), has embarked on rolling out Paclitaxel for Kaposi Sarcoma treatment to district hospitals, Mangochi inclusive, with only a few districts remaining. As this is a new intervention, there is a considerable knowledge gap as regards to patients’ and providers’ perceptions on Paclitaxel among other aspects. Such varying perceptions may have a significant bearing on the acceptability of Paclitaxel in the target population. Studies are therefore required especially in this preliminary stage of the intervention in order to unravel areas that require urgent addressing of quality issues among others. Therefore, in this regard, this study seeks to explore the acceptability of paclitaxel at the district hospital level of care. Objectives of the study: Broadly, the aim of the study is to assess the acceptability of paclitaxel as treatment for Kaposi Sarcoma (KS) among patients and providers in Mangochi district. The study seeks to specifically highlight perceptions of patients and providers on Paclitaxel usage and explore some pertinent barriers and enablers to acceptability of paclitaxel at a district hospital level of health care. Methodology: This is a qualitative study design that shall employ a phenomenological approach. The study will take place at Mangochi District Hospital in Mangochi District. The study population shall include of 32 participants comprising of 16 patients and 16 clinic providers selected through Non-probabilistic purposive sampling. Data will be collected through in-depth interviews using interview guides for both patients and providers. A focus group discussion will be conducted among providers for issues of maintaining patients privacy and confidentiality. The protocol shall be submitted for COMREC approval and approved written consents shall be administered or read to the participants to seek their consent. No names of participants shall be used in this study and the digital files and transcripts shall be stored under lock and key/ passwords with access limited to the research team. Data will be analysed manually using content analysis as guided by the Theoretical framework of acceptability. Dissemination of Expected findings: The study is expected to unravel any possible acceptability issues associated with Paclitaxel as treatment for Kaposi Sarcoma. The findings of this study will be shared to COMREC, COM library, Mangochi DHO, and at an annual dissemination conference organized by KUHeS, among other such conferences. A publishable manuscript will be submitted to relevant local and international journals. 11-Jul-2022 vii Study Protocol Version 1.3 15 th June 2022 Possible constraints Some study participants may refuse to be enrolled or withdraw for fear of delays to receive their treatment. The study conduct shall ensure that participants receive their treatment unhindered prior to commencement the in-depth interviews. There may be fears of interviews taking too long, effecting the participants time of getting home or conducting other planned activities hence leading to refusal of enrollment. The investigator shall make sure to use time management techniques to ensure that the interviews and discussions are completed by or before the allotted time as described in the informed consent.
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    Perceived determinants of health-related quality of life among cancer patients at KCH and QECH in Malawi, version 1.0
    (Kamuzu University of Health Sciences, 2022-08-05) Banda, Jonathan Chiwanda
    Type of study: Qualitative study Problem to be studied: Perceived determinants which could influence quality of life among patients living with cancer at Kamuzu and Queen Elizabeth Central Hospitals. In Malawi, there is lack of studies evaluating health-related quality of life themes among cancer patients which limit the possibility of ascertaining type of physical, psychological and social problems experienced by them and how to approach them. Aim: To explore main determinants influencing health-related quality of life among cancer patients at Kamuzu and Queen Elizabeth Central Hospitals in Malawi. Objectives: 1. To explore individual level factors affecting health-related quality of life among cancer patients at Kamuzu and Queen Elizabeth Central Hospitals in Malawi. 2. To explore system level factors affecting health-related quality of life among cancer patients and hospital staff at Kamuzu and Queen Elizabeth Central Hospitals in Malawi. Methods: A phenomenological qualitative study to measure the in-depth lived experiences for patients, guardians and health workers at the oncology clinics by exploring their perception of health-related quality of life themes and insights. The study will be conducted between May and June 2022 at oncology units from Kamuzu and Queen Elizabeth Central Hospitals in Malawi. Purposive sampling of the twenty-six participants in both study sites will be used. This sample size will surpass the minimum requirement of at least 12 participants to achieve saturation for qualitative studies Participants will be recruited in four categories based on the type of information being investigated. Ethics consideration: The permission to conduct the study will be sought from Kamuzu Central Hospital (KCH) and Queen Elizabeth Central Hospital (QECH). Ethics approval will be sought from the Kamuzu University of Health Sciences Research Ethics Committee. Data collection will follow informed written consent to be obtained from participants before enrolment. Participants names will be kept anonymous by disguising all identifying names of participants during analysis. Expected findings: 1) Perceived individual level determinants of health-related quality of life among cancer patients. 2) Perceived systemic level determinants of health-related quality of life among cancer patients. Dissemination of results: The findings of this study will be disseminated to the public through COMREC, scientific conferences and via international peer-reviewed journals publication. The results will also form part of the thesis for the principal investigator.
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    Assessing Women’s Perception towards Cervical Cancer Screening at Mponela Rural Hospital, Dowa
    (2023-01-11) Kawale Chiphangwi, Florence
    STUDY DESIGN: This will be descriptive qualitative research study, assessing women’s perception towards cervical cancer screening at Mponela rural hospital. INTRODUCTION/BACKGROUND: Cervical cancer is listed among the top gynaecologic cancers worldwide. It is ranked fourteenth among all cancers and fourth-ranked cancer among women worldwide. It is estimated that 85% of all cervical cancer deaths occur in developing countries. Malawi has the highest cervical cancer mortality rate in the world with 51.5 death per 100. 000 deaths per year. This is seven times the global rate, and double the rate in Eastern Africa. A call for cervical cancer elimination has been made and Malawi has adopted cervical cancer elimination strategies, which among them is cervical cancer screening. PROBLEM STATEMENT: Despite the available cervical cancer screening strategies that have been put in place in Malawi, and specifically Mponela Rural Hospital, cervical cancer screening rate still remains low. Currently only 4% of women in Mponela have accessed cervical cancer screening, against the 80% national target for cervical cancer screening. No studies have been done to establish the communities’ perceptions of cervical cancer and cervical cancer screening at Mponela Rural Hospital. Therefore the aim of this study is to assess the women’s perceptions towards cervical cancer screening STUDY OBJECTIVES: This study aims at assessing the women’s perceptions towards cervical cancer screening at Mponela Rural Hospital. SPECIFIC OBECTIVES 1. To assess women’s knowledge on cervical cancer 2. To explore women’s belief towards cervical cancer screening 3. To assess the barriers and facilitators to cervical cancer screening 4. To identify strategies that can promote cervical cancer screening METHODOLOGY: A descriptive qualitative research design using in-depth interviews to 30 women aged between 25 and 64 years of age who have never undergone cervical cancer screening at Mponela Rural Hospital. Eligible women waiting for other services, and have never had cervical cancer screening will be selected purposefully. In-depth interview will be done using a semi structured thematic interview guide to deeply explore women’s perceptions on cervical cancer screening. The instrument will be tested at Mtengowanthenga Mission Hospital, and trustworthiness of the instrument will be determined. EXPECTED FINDINGS: It is expected that women’s perceptions on cervical cancer screening at Mponela Rural Hospital will be identified. This will help in establishing policies and strategies that can help in increasing the uptake of cervical cancer screening. ETHICAL CONSIDERATION: Prior to starting the study, approval of the study will be sought from College of Medicine Research and Ethics Committee and permission will be obtained from Dowa District Health Office research committee. Explanation about the search study will be explained to the eligible women, and informed consent will be sought. DATA ANALYSIS: Thematic data analysis will be used to describe and interpret the data, as well as to select code and construct themes. DISSEMINATION OF THE RESULTS: The results will be disseminated to College of Medicine Research and Ethics Committee, Kamuzu University for Health Sciences, Dowa District Health research committee as well as publishing in a nursing journal