Maternal & Child Health

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Assessing factors that affects uptake of family planning among adolescents at Mulanje district hospital
(Kamuzu University of Health Sciences, 2021-08-11) Banda, Limbani, Martin, Caroline Nyirenda, Tchete
Young women in Malawi have high unmet needs for modern contraceptives. Child marriages and early pregnancies continue to be high. Youth-friendly contraceptive services use were defined as “a variety of possible approaches attempted by clinics to increase a young person’s access to services (e.g., clinic hours to suit schedules of young people) and improve quality of care (e.g., providers with specialized training in young young women and men health).However, access to health and social services for young young women and men in rural areas continue to be sparse. Our study focuses on young young women and men individual, community and institutional factors that inform young people’s family planning/contraceptive needs, use and experiences. Most young young women and men are affected by sexually transmitted infections and unwanted pregnancies because they do not effectively access and use of contraceptive methods. This study will assess the factors that affect service uptake and utilization for young young women and men aged 15-24 years at Mulanje District Hospital. The study will look at individual, social and cultural factors, access to youth friendly health services (YFHS) that encourage or discourage uptake of family planning for young young women and men living in Mulanje. The study is a mixed methods design. The qualitative part will use focus group discussion and in-depth interviews to understand multiple factors that influence uptake of contraceptives. The quantitative component will review hospital records in registers and a questionnaire will be used to understand and young young women and men’s uptake of contraception, proportion of young young women and men accessing abortion and YFH services. Analysis of qualitative data will use thematic approach. Descriptive statistics using tables and graphs will be used to analyze quantitative data. The study population will include young young women and men aged 15 -24 years. The study will use random sampling to select young young women and men presenting themselves at the YFHS clinic. We propose to use self-care approaches as the conceptual framework to understand and address individual, places of access and environmental factors related to family planning or contraceptive use. The study period will take seven months to complete according to the school of health sciences and management schedule. Ethical clearance will be requested from the College of Medicine Research Ethics Committee and the Mulanje District Hospital Management committee. Participants will be requested to consent before getting involved in this study. Participant’s names and identity will be replaced by codes to maintain privacy and confidentiality. The strength of the study is that it will use mixed methods to review of hospital records in registers and in-depth interviews to understand and young young women and men’s uptake of family planning/contraceptive use. The potential limitations to the study are not getting the targeted number of participants due to Covid 19 restrictions, young young women and men refusing to talk about their experiences when accessing health and social services at the hospitals including financial constraints. The results will be presented to the Department of Health Systems Management and Policy as an examination. The hard copies will be shared through the library at College of Medicine and presentation will be shared through conferences under the College of Medicine.
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Behavioral design for antenatal and postnatal care in Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Mbilizi, Yamikani
Type of study: Behavioral formative research ii. Problem: According to USAID’s 2019 statistics, Malawi has one of the highest maternal mortality rates in Africa and globally, with 439 maternal deaths per 100,000 live births. Recently, the government adopted the new WHO guidelines that recommend 8 antenatal contacts during pregnancy. The 2015- 2016 Demographic and Health Survey (DHS) found that 95% of women accessed ANC. Yet, only 51% of women completed (the previously recommended) 4 visits. Only 24% of women seek ANC during the first trimester. At a global level, UNICEF’s 2019 data reports that at least 85% of women access antenatal care with up to 65% receiving 4 antenatal visits. In comparison, only 46% of Malawian mothers meet the previously recommended 4 ANC sessions. In Malawi, women often attend ANC late. JHPIEGO will conduct implementation research (IR) for antenatal and postnatal service delivery models and tools in Malawi (and Ethiopia and Mali). This IR will generate evidence on how best to strengthen antenatal and postnatal platforms—not only to deliver equitable, high quality services, but also robust and resilient enough to test interventions and transition to scale. JHPIEGO’s study design will employ human-centered design to explicitly reflect actual conditions and incorporate considerations necessary to understand and inform scale up and sustainability. The project will use human-centered and behavioral design (HCD) to develop context-specific program implementation strategies, approaches, and models of antenatal and postnatal care for pregnant and postpartum women in Malawi. In the first phase (empathy) of the HCD approach that will be used end users are engaged to better understand the barriers and drivers to antenatal and postnatal care, and to solicit their suggestions for interventions that better meet the needs of the population. For this activity, interviews and group discussions will be conducted with women, aged 18-49 who live in Blantyre (Malawi) to understand their realities and how they facilitate or hinder access to and use of antenatal and postnatal care services. In addition, interviews will be conducted with related individuals and community groups identified by the women, to understand their perspectives and the way in which they influence women’s decisions. All of these participants shall advise and subsequently validate ideas generated through the inquiry period. The ideas generated through this workshop will then be narrowed down and prioritized for further testing after approval from local authorities. The intent of this study is to work with women, related individuals, and community groups using the HCD methodology to gather information in order to design, develop and implement an intervention. The results are not designed to be generalizable. They would be applicable to women in Malawi only. Ideas will be generated during the design workshop but after prioritization and selection of the ideas, separate studies that will be designed from these activities will examine the feasibility and acceptability for the intervention(s) designed as a result of HCD. These protocols will be developed and submitted in the future since they will be human subjects research.
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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 affecting quality of antenatal care services at health centres in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Juan, Cosmas; Phiri, Mphatso; Maunde, Mwayi
Introduction Health care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. Maternal and newborn health, are priorities for the Government of Malawi, as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011- 2016 Health Sector Strategic Plan (HSSP). AIM The research is a cross sectional study that looks at the quality of ANC as a factor which is reducing the recommended number of times women are supposed to visit the ANC to have a fair consensus about as to why women are not attending the recommended 4 ANC visit. METHODOLOGY The study is a qualitative cross-sectional study to be conducted at health centres around Blantyre. This will involve women attending the ANC and also health workers at the health centre. The study will be conducted in 6 weeks mainly collecting data on the type of ANC services received and women’s perceptions on utilization of the ANC, data analysis and interpretation and dissemination. The inclusion criteria will be; women with gestation age 32 weeks and above, aged 18-40, attending the ANC being chosen at random. A written consent will be attained for each woman who participates in the data collection. Conclusion The expected results will show the setbacks in ANCs that are attributing to lower ANC attendance and so create a room of improvement in which can be tackled in the future resource appointment. Justification According WHO IDSR Guidelines in 2013/14 and as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011-2016 Health Sector Strategic Plan (HSSP), Maternal and newborn health are priorities for the Government of Malawi (1). In Malawi, the proportion of women that received the recommended four or more ANC visits generally declined from 1992 (62%) to 2010 (46%) before rising modestly in 2015-16 to 51% (3). 95% of women who gave birth in the 5 years preceding 2016, received antenatal care from a skilled provider at least once for their last birth and 51% of women had 4 or more ANC visits (1). Our research aims at finding out why there is a high proportion of women who are not adhering to the recommended 4 ANC visits. The study is to be conducted in Health centres around Blantyre.
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The influence of client demand on care practices during ANC, labour and postnatal care
(Kamuzu University of Health Sciences, 2020-09-16) Mauluka, Chancy
Type of Study: Quasi-experimental study (implementation science research). Background: Quality of care is affected by a wide spectrum of bottlenecks that range from human resource deficiency, inadequate drugs/equipment, and suboptimal clinical practice. On the demand side, clients are not aware of their right to demand care practices and they do not have knowledge about the care that has to be provided to them during ANC, labour and postnatal care. In addition, mothers lack selfesteem, self-efficacy and skills to demand care from service providers. In the absence of such, service providers continue to skip clinical guidelines even in cases where necessary supplies are available. This study aims to explore the extent to which care practices can change if clients are empowered to demand services in the continuum of care from ANC to postnatal. Objectives: The specific objectives of this study are to: i) identify care practices that can be demanded by the mother in the continuum of care from ANC to PNC, ii) develop an intervention package (tools) to improve mothers’ knowledge of care practices and promote demand the practices from service providers, iii) assess improvement in terms of mothers’ knowledge of care practices offered during ANC, labour and PNC after being exposed of the tools, iv) assess improvement in terms of mothers’ demand for care practices during ANC, labour and PNC after being exposed to the tools, and v) measure effectiveness of the intervention in terms of actual provision of the care practices by health workers during ANC, labour and PNC. Methodology: The research will combine qualitative and quantitative methods for data collection. The study will be conducted in Kasungu district where intervention and control sites will be selected. The target population for the study includes a) pregnant mothers b) mothers with children not more than three months c) service providers at health centre level d) health specialists (RHD, NGOs) and e) psychologists. A two-staged approach will be used in sampling, whereby health centres will be systematically selected based on their service readiness and finally selected randomly to arrive at the final research sites. Willing mothers will be randomly selected to achieve sample size. The research undertakes to study a minimum of 326 women in antenatal, post-partum and postnatal care to establish with confidence if client demand for services can increase adherence to recommended practices by at least 15%. Quantitative data will be collected using structured questionnaires for the mother while a checklist for vignettes will be used to observe adherence to standards during contacts. Qualitative data will be collected using FGD guides and guides for vignettes which will be used in simulations to explore demandable services at the point of care. Qualitative data will be analysed using Atlas software to code emerging themes while quantitative data will be analysed using Stata to generate percentiles and correlation between outcomes of interest and independent variables. Expected findings and their dissemination: This work hypothesises that when individuals are empowered with knowledge and skills to demand, they can influence care practices in the continuum of care from ANC to postnatal care. Findings of the study will be disseminated through national and international conferences, as well as publications.
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Quality of basic maternal and neonate care signal function and clients perceived care in health facilities in Malawi:
(Kamuzu University of Health Sciences, 2021-08-11) Manda, Eddie
Study type: This is a secondary data analysis of national health facility surveys using Malawi 2013-2014 Service Provision Assessment Survey data for 960 health facilities in Malawi. Background: Global campaign for facility delivery has been an idea supported by many countries. However, an increase in volume of health-care facility deliveries might not reduce maternal or newborn mortality if quality of care is insufficient. There is little systematic evidence for the quality at health facilities caring for women and newborn babies in low-income countries like Malawi. This study is going to analyze the quality of basic maternal and neonatal care functions and its association with patients perceived quality of care received during antenatal care services in health-care facilities in Malawi. Objective: The main objective of this study is to determine quality of basic maternal and neonatal care, during routine delivery, emergency obstetric care, emergency neonatal care and client perceived quality of care during antenatal care services using the SPA data collected in 2013-2014 in 960 health facilities in Malawi. Setting: This is a secondary data analysis that will include data from 632 health facilities across Malawi that Malawi SPA survey of 2013-2014 captured its data on maternal delivery and newborn care and antenatal care services. Method: This is a secondary data analysis study which is going to use data from the Malawi Service Provision Assessment (SPA) survey of 2013-2014 done regularly by Demographic Health Survey to collect data on resource availability. The DHS and SPA are cross-sectional, nationally-representative surveys. Detailed reports on each national DHS and SPA, describing details of sampling, fieldwork, and characteristics of respondents can be obtained from the DHS website (measuredhs.com). In this study, we are going to explore whether facilities have the necessary signal functions for providing emergency and basic maternal and newborn care, and antenatal care (ANC) using descriptive and multivariate regression. We are also going to explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we are going to explore patient’s satisfaction and its association with quality of services received. Expected findings and their dissemination: The quality of basic maternal and neonatal care signal function in both government and private owned health facilities (primary, secondary and tertiary) in Malawi will be determined. In this analysis, the association between women’s reports of their care and observed indicators of care during labor and delivery will also be determined. The results of the study will be presented to the College of Medicine Research Committee through submitted dissertation and will also be submitted to the Malawi Medical Journal for possible publication. The results will also be presented to the Ministry of Health through National Research Council. The results will also be releases as a thesis and will be stored and displayed at the college of medicine library.
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Survival of low birth weight babies admitted at Chiradzulu District Hospital (public) and St. Joseph Mission Hospital (private) in Malawi
(Kamuzu University of Health Sciences, 2020-05-13) Zgambo, Austin Chibisa
The type of research study This will be a hospital based retrospective cohort study collecting quantitative data from Nursery ward registers on Low birth weight babies. Low birth weight is defined as a birth weight of less than 2,500 g regardless of gestational age. This practical cut-off for international comparison is based on epidemiological observations that babies weighing less than 2,500 g are approximately 20 times more likely to die than those born with a weight of over 2, 500 g. Globally, it is estimated that 12 to 17% of all births are Low birth weights. However, the great majority (91%) of Low birth weight babies occur in low and middle-income countries. Malawi, being part of low-income countries, has nearly 12% of babies born with Low birth weight. Both the public and private sectors are responsible for the provision of healthcare services in the country. The problem Losing a baby is a devastating experience and every parent experiences grief in his/her own way. The World Health Assembly endorsed targets to reduce Low birth weight prevalence by 30% by 2025. Despite the availability of interventions to improve survival of Low birth weight babies, it still remains a challenge in low resource settings. People have a perception that quality of care is better in private hospitals than public hospitals partly due to differences in resource base. Consequently, better patient outcomes are expected in private than in public healthcare facilities. However, research analysis revealed that private sector health facilities had poorer patient outcomes compared to public sector health facilities. But this general analysis may not apply to all specific areas of health outcomes, for example, survival of low birth weight babies in these private and public health care facilities. Furthermore, few studies on neonatal survival have been conducted in Malawi but none of them has compared survival rates of low birth weight babies in public and private hospitals. Therefore, this study is intended to fill knowledge gap concerning survival rates of Low birth weight babies from admission to hospital discharge and the comparison of it between a public and private hospital. The Objectives The aim of the study is to compare the survival rates of Low birth weight babies admitted at Chiradzulu public hospital and St. Joseph’s private mission hospital; and to determine factors associated with mortality in these hospitals. Methodology It will be done in Chiradzulu district, specifically at Chiradzulu district hospital and St. Joseph’s Mission hospital’s nursery wards. The study will assess records of Low birth weight babies admitted in nursery wards at two hospitals between 1 January 2018 and 31 December 2019. Systematic random sampling will be used to achieve a calculated sample size. A pretested data extraction tool will be used for data abstraction. There could be a possibility of missing records but use of recent period (2018 – 2019) coupled with use of both case files and ward admission registers will ease the problem of missing data. Data will be entered in a Microsoft Excel application and later exported to STATA version 14 for analysis. Results will be presented in tables and graphs’ format. Ethical clearance will be obtained from the University of Malawi’s College of Medicine Research and Ethics Committee (COMREC). A written permission letter will be obtained from Chiradzulu District Council through the Director of Health and Social Services. Expected findings and their dissemination We are anticipating knowing the survival rates of Low birth weight babies between a public and private hospital; and common contributing factors to mortality among these babies. Knowledge of neonatal survival rates and mortality factors will help hospital managers to implement and/or scaleup appropriate interventions in nursery wards. The results will be shared with COMREC; Chiradzulu and St. Joseph’s hospitals; Malawi Ministry of Health, through the Reproductive Health Unit and published in Malawi Medical Journal for publicity at local as well as global level.
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Understanding the epidemiology of iNTS disease in Africa in preparation for future iNTS
(Kamuzu University of Health Sciences, 2020-10-08) Gordon, Melita
Type of study Clinical research study involving collecting samples from human participants. Prospective serological studies will be carried out across 4 sub-Saharan African sites (Malawi, Kenya, Burkina Faso, Ghana), for which Malawi will be the leading site. A core protocol has been written for all 4 sites in a separate document. This protocol focuses on the Malawi site. Methods to measure age-stratified acquisition of antibody and bactericidal activity to NTS. Data will be collected on the key risk factors for invasive disease: malaria, anaemia and malnutrition and stool samples to measure enteric NTS exposure. Children 0 to 5 years selected from mapped and censused randomly selected households Chikwawa, Malawi; an area with substantial malaria burden - a key risk factor for iNTS. Paired immunology and stool samples for NTS taken 3 months apart for 2000 children; distributed over each age stratum of 1 year, from the age of 0 to 5 years (4000 samples in total). A small number of confirmed invasive NTS cases identified at Queen Elizabeth Hospital (QECH), Blantyre, Malawi, will also have samples for investigated for antibody and bactericidal activity at presentation and 1 month follow-up. Other sites (Kenya, Burkina Faso, Ghana): Prospective serological community study with unpaired/ single samples taken from children aged 0-5 years. No data collected on risk factors. Expected findings and dissemination We will describe the pattern of immunological susceptibility to NTS and enteric exposure in relation to risk factors and geographical settings to facilitate early iNTS vaccine licensure. The final study report will be submitted to the College of Medicine Research Ethics Committee (COMREC) University of Malawi, University of Liverpool IRB and the funders (Wellcome Trust and VacciNTS project). The results will be presented locally, nationally and internationally including other partner sites in the seroepidemiology work package of the VacciNTS consortium contributing to key knowledge for vaccine development and deployment. This will have relevance for policy decisions regarding iNTS control in Malawi and other sub-Saharan African countries. Results will be submitted for publication in a peer reviewed academic journal.

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