Implementation Science

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Access to early bubble Continuous positive airway pressure in Neonatal Intensive Care Unit at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-02-05) Kamanga, Emmanuel; Sichinga, Tuntufye; Mbwana, Zainab
Objective: The main aim of this study is to evaluate accessibility of bubble Continuous Positive Airway Pressure by preterm infants in Neonatal Intensive Care Unit at a large referral hospital of central region. Methods: Study design: The study is going to be a quantitative cross-section study. We will use secondary data recorded in daily running of the neonatal unit from January through December 2019. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit admits about 400 preterm infants requiring Continuous Positive Airway Pressure therapy annually. Research Problem: Prematurity accounts for over a half of neonatal mortality in Malawi and mainly due to RDS respiratory distress syndrome. Low-cost bubble bCPAP is being implemented in hospitals to treat respiratory distress syndromeRDS.. There is limited data on the accessibility of the therapy and the rolled out low-cost bubble Continuous Positive Airway Pressure bCPAP Pumani devices. This study will evaluate the accessibility of early Continuous Positive Airway Pressure CPAP intervention on the preterm infants. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit NICU admits about 400 preterm infants requiring Continuous Positive Airway Pressure CPAP therapy annually. Expected outcomes: The study will provides up-to-date information on the need and utilization of low-cost Continuous Positive Airway Pressure CPAP devices rolled out in NICU Neonatal Intensive Care Unit at Kamuzu Central Hospital.
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Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Harnish, Christopher
This study seeks to describe and assess the architectural design factors of delivery suites that influence the maternal birth experience and peripartum health outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. The factors of quality of care and patient outcomes which will be assessed are: maternal privacy; peripartum maternal mental health; paternal and guardian involvement and spatial efficiency at Queen Elizabeth Central Hospital. This information will inform evidence-based maternity ward architectural guidelines to improve quality of health care, patient outcomes and patient satisfaction. Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. These findings may lead to improvements in architectural designs of maternity wards in health facilities in Malawi; health worker flow and efficiency; patient outcomes; and satisfaction for themselves and their families.
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Assessing implementation of infection prevention and control practices among maternity ward healthcare workers at QECH
(Kamuzu University of Health Sciences, 2021-01-13) Chitimbi, Zacheus; Magombo, Michael; Kamkwanya, Mike
Type of study: This is a cross section qualitative study design. Research Problem: Healthcare associated infections are one of the major contributing factors to the high mortality rates in maternity wards despite different efforts in hospital infection prevention and control measures. Proper implementation and adherence to the standard measures of infection prevention and control by healthcare workers is an effective means to minimize the risk of transmission of these HAIs in hospitals. Objective: The main objective is to assess how the infection prevention and control practices are being implemented amongst maternity ward healthcare workers at QECH. Methodology: The study participants are clinicians, nurses, hospital cleaners and hospital management. A sample size of 20 participants, selected using purposive sampling method. Data to be collected using in depth interviews facilitated by an interview guide and observation of healthcare workers and their work environment with an audit checklist. Expected results and dissemination: We expect to find out the knowledge of healthcare workers on IPC measures, their perception, attitudes and adherence towards IPC measures and identify barriers to compliance with the IPC measures. The results will be presented at College of Medicine research dissemination presentations and a report is going to be sent to the College of Medicine library. We would also like to publish the study in the Malawi medical journal.
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Assessing the readiness of a tertiary health facility (Queen Elizabeth Hospital) to antimicrobial stewardship programme
(Kamuzu University of Health Sciences, 2021-03-21) Reuben, Zeress; Mkwate, Weston
In this cross-sectional study, we will find out how different health care professionals contribute to antimicrobial resistance specifically antibiotics at Queen Elizabeth Central Hospital, Blantyre Malawi and access if antimicrobial stewardship program would be a tool to address this problem at the facility. Antibiotics have been chosen due to increased rate of drug resistance while the rate of new medication discovery to substitute those that the bacteria have developed tolerance or resistance is very low. Antibiotic resistance occurs naturally but misuse of antibiotics in humans and animals exacerbates it. Therefore, special training, knowledge acquisition and awareness campaign among health care professional and the public concerning antimicrobial resistance will help to reduce further increase in drug resistance as they will have true and useful information. The main objective of this study is to implement antimicrobial stewardship program at Queen Elizabeth Central Hospital. The study will further attempt to assess enablers of Antimicrobial Stewardship Program (AMSP); assess barriers of AMSP; determining feasibility of antimicrobial stewardship program and assessing the expected benefits of AMSP. A four-week cross sectional study will be conducted at Queen Elizabeth Central Hospital under Pharmacy department, Laboratory department, |Medical wards (3B and 5A wards) and the data will include all information gathered from pharmacy personnel, nurses, laboratory scientists and medical doctors which are of a priority to this research. The questionnaires will be used to collect data from different health care professionals concerning antibiotic use and antimicrobial resistance and the collected data will be analysed using a software SPSS. The expected finding is that antimicrobial resistance is on rise due to lack of clear and proper information about antimicrobial stewardship program and its implementation among health care professionals at Queens central hospital would help to minimise this problem. The collected results will be submitted to COMREC and published to try to narrow the gap that exists among health care professionals (as most of the time they work independently) in order to deal with antimicrobial resistance.
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Evaluating the outcomes of glaucoma surgeries at a tertiary eye hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-01-13) Mhango, Priscilla
Glaucoma is the second commonest cause of blindness and the most common cause of irreversible blindness worldwide. In developing countries, where the treatment options are limited, management of glaucoma is challenging. In Malawi, due to various difficulties, including the lack of availability and affordability of a wide range of medical and laser therapies, surgery is usually advised and planned for within a year of diagnosis for most patients. The success rate of surgery depends on several factors, such as the type of surgery performed and the potential complications during the intra and post-operative period. This success rate is typically measured according to the reduction in intraocular pressure (IOP) as well as the post-operative visual acuity. Type of Study This will be a retrospective case series study. Problem There is a paucity of data showing the success rate of adult glaucoma surgery in the Malawian setting. This study aims to establish a baseline success rate of glaucoma surgeries at a tertiary eye hospital in Blantyre. Objectives Broad To describe the clinical profile and outcomes of adult glaucoma surgeries at LSFEH Blantyre, Malawi in order to generate therapeutic data to inform improved disease management. Specific 1. To establish the severity of glaucoma in patients undergoing glaucoma surgeries at LSFEH Blantyre, Malawi 2. To describe determine pre-operative factors associated with post-operative IOP in adult glaucoma surgeries at LSFEH Blantyre, Malawi. 3. To establish the post-operative factors associated with post-operative IOP outcome in adult glaucoma surgeries at LSFEH Blantyre, Malawi. 4. To determine the proportion of successful glaucoma surgeries by comparing the post-operative to the preoperative IOP. Study location This study will be carried out at Lions Sight First Eye Hospital, a referral and teaching eye institution at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methodology Case files of patients who underwent glaucoma surgeries, specifically trabeculectomy, combined trabeculectomy and cataract surgery and Ahmed valve surgery between March 2019 and February 2020 will be examined. The following information will be collected from the hospital records: age, gender and demographic details. Details on pre-operative assessment such as visual acuity, intraocular pressure, optic disc appearance and previous surgery will be recorded. Additionally, details on surgical findings, post-operative visual acuity, IOP and complications will also be recorded. The required information will be filled into the data collection form (see appendix 1) and entered into an excel spreadsheet. The data will then be exported to STATA version 16 for analysis. The primary outcome measure is post-operative IOP reduction. The mean percentage reduction in IOP will be shown as column charts and mean IOP reduction will be compared using Wilcoxon’s sign ranked test. Additionally, the IOP will be categorised into successful and not successful. Descriptive statistics will be used on and clinical presentation parameters. Categorical data such as gender and age group will be summarised as frequency distribution tables. Data showing the proportion of cases with intraoperative and post-operative complications displayed in pie chart form and the various complications will be presented in bar graphs. A multivariate binary logistic regression model will be used to identify the factors affecting the outcome. Hypothesis We hypothesise that greater than 60% of the patients will have successful glaucoma surgeries. This is based on observational studies from other African countries. Results dissemination Results from the study will be presented at the College of Medicine research dissemination conference with the intention of publishing in peer-reviewed journals. Additionally, a written report of the final research project will be submitted to the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and LSFEH Clinical Director.
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Exploring facilitators and barriers to blood collection and repeat donations in high and low performing districts/programs in Malawi
(Kamuzu University of Health Sciences, 2021-03-17) Chipeta, Effie
Type of Study The Malawi Blood Transfusion Services (MBTS) was established in 2003 to provide centralized and safer blood supplies. Since its inception, the quantity of blood units collected through MBTS and hospital blood banks had increased to 87,166 units in 2017 and all districts in Malawi contributed to collection efforts. However, despite this increase, Malawi remains with a 27% deficit in required blood supplies. So far there has been limited research to understand the facilitators and barriers to blood collection and factors associated with repeat donations in Malawi. Research into understanding the facilitators and barriers to first time donation and regular donation in Malawi are critical to the design and successful retention of programs that promote life-long donation. Objectives This study seeks to examine and factors associated with blood collection and repeat donations among low and high performing districts in Malawi. Specifically, the study seeks: a) To explore the barriers and facilitators to blood donation and repeat donations among blood donors in Malawi b) To explore strategies to enhance blood collection among voluntary non remunerated blood donors in schools c) To explore strategies for building a sustainable pool of blood donors post secondary school in Malawi. Study design and data collection methods The proposed research will use a cross-sectional, qualitative, descriptive design to examine a range of factors that influence blood donation and donor retention. The study will utilise qualitative data collection methods such as in depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) to collect data from donors, non-donors, community leaders, policy makers, and program staff. Data management and analysis All KIIs, FGDs, and IDIs will be audio recorded, transcribed verbatim and translated into English by trained research assistants. Recordings and anonymized transcripts will be kept in passwordsecured computers. Data will be analysed using using qualitative thematic analysis using Atlas.ti software. Ethical considerations Covid-19 preventive measures/anonymity/confidentiality/permission/information sheet and consent will be applied and followed. Possible constraints We anticipate challenges in the recruitment of school based VNRBDs. Schools have been closed and it’s still not certain when schools will reopen. This might also affect the study timelines and logistical challenges if data collection spills over to the first quarter of 2021 which in Malawi is the rainy season. In addition, due to the Covid-19 restrictions and the need to observe the precautionary measures, it may be challenging to conduct ideal group discussions as well as face to face interviews. Results Dissemination Results will be presented according to the study objectives. These will be presented in research reports that outline methods used, key findings, and recommendations. Further dissemination of results will also occur through publication(s) in peer-reviewed journal(s) as well as presentations at seminars/conferences, stakeholder meetings and websites. A report will be provided to COMREC. The implications of this study The study will provide insights on how barriers and facilitators of blood donations and retention of blood donors which will help formulate strategies to improve blood supplies in Malawi.
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Implications of fieldworkers’ institutional support systems for research integrity practices in Africa
(Kamuzu University of Health Sciences, 2021-03-04) Kazungu Kombe, Francis
Fieldworkers play a critical role in health research practices in most international health research centres in Africa. Fieldworkers are usually employed to provide support in seeking informed consent, collecting qualitative and quantitative data, biological samples and maintaining good relationships with communities involved in research (Kombe, 2015; Mosavel, Ahmed, Daniels, & Simon, 2011). Furthermore, the integrity of research and the ethical and scientific outputs generated by most international health research sites in Africa rely heavily on fieldworkers, whose practices and ability to adhere to international and local ethical and scientific standards and guidelines determine the quality of data collected (Kombe, 2015). Recent literature has highlighted concerns related to the quality of data collected by fieldworkers, attributable to a lack of or limited support given to fieldworkers by their principal investigators (PIs) or study coordinators (Kingori & Gerrets, 2016a). While some empirical studies have been conducted to explore and describe the day-to-day ethical challenges faced by health research fieldworkers (Kamuya et al., 2013a; Kingori, 2013; Rossman & Rallis, 2010), very little has been done to understand fieldworkers' institutional support systems and how they influence the overall integrity of research. Understanding the influence of fieldworkers’ institutional support systems on research integrity may provide important insights in developing best practice guidelines for supporting fieldworkers in Blantyre District in MalawiAfrica. Type of study This is a qualitative mixed-methods study that intends to use a case-study approach together with qualitative approaches, including in-depth interview, non-participant observations and consultative discussion to develop an in-depth understanding of the implications of fieldworkers' institutional support systems for research integrity. Problem statement The literature underlines the importance of fieldworkers in international health research. The roles fieldworkers play, and the diverse challenges and dilemmas they face have been well documented. However, much less has been done to better understand the implications of fieldworkers’ institutional support systems and how these influence the overall integrity of research. General objectives This study aims to examine the implications of fieldworkers’ institutional support systems for research integrity practices in Blantyre District in MalawiAfrica Study objectives Specific objectives  To describe and analyse the existing literature, including concepts and theories related to fieldworkers’ institutional support systems and policies  To identify and describe existing fieldworkers’ institutional support systems at the participating research institutionsTo critically evaluate how existing fieldworkers’ institutional support systems and policies shape fieldworkers ethical and research integrity practices  To develop a best practice model and make recommendations to the participating institutions on fieldworkers’ institutional support systems Methodology This study intends to use a qualitative mixed-methods approach to develop a broad and indepth understanding of the implications of fieldworkers' institutional support systems for research integrity. The proposed approach will involve five main methodological approaches, including literature and document review, key informant interviews, Individual In-Depth Interviews (IDIs), Non-Participant Observations (NPO), and consultative discussions with key stakeholders. Expected findings Data will be analysed thematically. Findings from this study will include the status of the existing policies and guidelines related to fieldworkers (if any) from the participating institutions, the views of senior management, middle-level field managers and fieldworkers, including centre directors, principal investigators, field managers, supervisors and fieldworkers, on how existing policies and guidelines influence the fieldworkers scientific contribute to understanding how existing health research systems and policies, and research management practices may shape fieldworkers' everyday scientific and ethical practices and the integrity of the research. Such understanding may provide important insights in developing best practice guidelines for supporting fieldworkers in Africa. Dissemination of findings Preliminary analysis of the data will be done continuously and used to inform key themes for further exploration, especiallyduring the last phase (phase three) of the study. During the consultative discussions (phase three) the preliminary findings will be presented to those who will participate in the consultative discussions for further synthesis. At the end of the study, the study results will be presented summary form, to the management of each participating institution. In addition, each participating institution, and the college of medicine research ethics committee (COMREC) will be given a copy of the study findings. Results of this study will also be published in the PhD thesis which will be submitted to the University of KwaZulu Natal, South Africa, the Malawi Liverpool-Wellcome (MLW) research programme in Malawi and in peer review journals and scientific conferences.
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Nutrition education, knowledge, attitudes, and practices among physicians in hospitals in Malawi: A baseline cross-sectional study
(Kamuzu University of Health Sciences, 2021-03-17) Ausmann, Lynne
Problem statement It is estimated that poor diet, which has been shown to be responsible for many NCD’s, is liable for 11 million deaths globally. In many sub-Saharan African countries, including Malawi, the incidence of NCD’s is growing, and undernutrition, diabetes, overweight and obesity are now diet-related diseases of public health concern. Medical doctors who are trusted providers of healthcare, need to be knowledgeable and competent in nutrition-care as it applies to health promotion, prevention and treatment of these chronic diseases. However, there is limited information on medical nutrition education and knowledge among practicing medical doctors as it relates to self-efficacy in nutrition care in Malawi. 2.1 Broad objective To assess graduate doctors’ medical nutrition education, knowledge, attitudes and practices regarding nutrition care in Malawi. 2.2 Specific Objectives a. To evaluate the nutrition-related knowledge, attitudes and self-efficacy of graduate doctors b. To determine the associations among Knowledge, Attitudes and Self-Efficacy c. To compare nutrition-related knowledge, attitudes and self-efficacy with level of clinical training. d. To provide baseline values to the key performance indicators outlined in the Performance Measurement Framework. e. To provide relevant and practical recommendations for improving nutrition training at sub-national (district) and national level based on the gaps identified in the policies and their implementation under the thematic area of Human Resources for Health. Methodology The medical nutrition education KAP survey is a cross-sectional study conducted among 78 health care workers in Malawi public health service, from August 2020 to October 2020. Hospitals will be purposively selected based on availability of medical doctors in those facilities. Results and dissemination The medical nutrition education KAP survey is the first study of its kind in Malawi that will contribute new information on the deficits in nutrition education in medical education in Malawi and other related settings. The findings will facilitate future research and implementation of targeted interventions to improve on any gaps in knowledge and practice identified. Primarily, the findings from this audit will be disseminated back to all involved departments in l clinical services. Realizing that the results are to be of primary interest to all departments, a presentation will be made to all clinical departments highlighting the key findings. Results will also be disseminated through local (COM annual research dissemination conference), regional and international scientific meetings/conferences/seminars/workshops and by publication in peer-reviewed journals. A copy of the final report and any ensuing publications will be submitted to the COMREC, the College of Medicine Library, the Health Science Research Committee and the University Research and Publication Committee
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A pilot intervention to support improved hand hygiene at QECH TIPS Chatinkha
(Kamuzu University of Health Sciences, 2021-02-10) Mangochi, Helen
Type of research study: Qualitative research study using In-depth interviews, focus group discussions and participant observation A formative study using a Trial of Improved Practice approach through qualitative research methods (i.e. participant observation, in-depth interviews and focus group discussions) Problem statement Our recent assessment of hand hygiene practices in the Chatinkha neonatal unit identified intermittent availability lack of water, soap, and hand sanitizers as a key barrier for medical staff, patients and guardians to perform these practices effectively. Understanding the barriers and opportunities to the use of hand sanitizers to facilitate proper hand hygiene in this high risk setting will enable an effective roll-out plan to be established across QECH and other health care settings in Malawi. Broad Objective: To determine pilot the level of acceptance, barriers, and opportunities for the long-term use of hand sanitizer for infection prevention and control in Chatinkha neonatal unit at QECH Specific Objectives: 1. To assess the current barriers and attitudes of health care workers, patients and guardians towards hand hygiene practice; 2. Develop a program for the implementation of hand sanitizer use for hand hygiene appropriate for health care workers, patients and guardians 2.3. To determine the level of acceptance, barriers and opportunities for long term use of hand sanitizer among health care workers, patients and guardians 3. Trial the pilot intervention in the Chatinkha neonatal unit. Methodology: The study will use the Trials of Improved Practice approach. TIPs is a formative research technique used to pre-test the actual practices that a future programme may aim to promote. The procedure consists a series of visits in which the interviewer and the participant analyse current practices, discuss what could be improved, and together reach an agreement on one or a few solutions to try. These are then trialed on a small scale as an iterative process with feedback loops from participants to inform future plans. Importantly TIPs focusses on behaviour, what people do, rather than knowledge, or what people know or believe. Trials are the best way to gauge the acceptability of new practices and learn how to promote and support them. Within the TIPS model, we will use qualitative research methodologies, including participant observation, semi-structured qualitative interview and focus group discussions with front-line staff (including ancillary, allied health professional staff and medical and nursing staff), and with caregivers Ethnographic fieldwork involving interviews, focus group discussions and participant observation. However Expected findings: Barriers and opportunities to effective hand hygiene will be identified and it is anticipated that use of hand sanitizers will be accepted by both health care workers and guardians, . as a means of minimizing the risk of infection transmission. It is anticipated that use of hand sanitizers will be accepted by both health care workers and guardians. Further to that, barriers to its use will be identified and further opportunities will be created to provide an alternative solution to hand washing, with the aim of minimizing the risk of infection transmission. Dissemination: Feedback workshops will be held with relevant stake holders including unit staff and guardians. We will then hold wider dissemination of study findings, to Queen Elizabeth Hospital (QECH) management. Results will also be presented at Malawi College of Medicine Research Ethics Committee and disseminated to the Ministry of Health, Malawi. We will consider presenting findings at national and international conferences and aim to publish findings in academic journals.
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The prevalence of Post-traumatic stress disorder, depression and anxiety in adult burns patients at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2021-02-08) Nyirenda Mbewe, Joyce
Type of study: Post-traumatic stress is a one of the disorders of reaction to trauma and stressful events. It has a complex course, mainly being a chronic condition with significant contribution to years lost due to disability. An observational study, cross-sectional type, will be carried out to investigate the prevalence of posttraumatic stress disorder (PTSD) in an adults with burn injuries as well as prevalence rates of depression and anxiety in this population. It will also examine the associated factors mainly demographics and clinical history. Problem: Common mental disorders are one of the leading contributors to global burden of disease. And about 75% of those with mental disorders do not receive adequate care. It is therefore a public health concern. Literature suggests that those with burns suffer from post-traumatic stress disorder, anxiety and depression. Objectives: The objectives include to investigate the prevalence of post-traumatic stress disorder, depression and anxiety in this patient population. It will also investigate the associated factors of PTSD i.e. demographics, burn history and personal psychiatric history. Methodology: The study will be conducted at Queen Elizabeth Central Hospital (QECH) and data will be collected between January and April 2021. The study population will be adult and adolescent burns patients aged 16- 65 presenting to the burns unit in this period of time. QECH has a burns unit which includes both admissions and outpatient services. The estimated sample size to be used is 100. All patients presenting to the burns unit during this period will be recruited. Post-traumatic stress disorder will be identified using the post-traumatic stress disorder check list (PCL-5), depression using the patient health questionnaire 9 (PHQ-9) and anxiety with the generalised anxiety disorder 7 (GAD-7). A pre-coded questionnaire will be used to collect relevant clinical information from the patient, file and or health passport book. DATA will be analysed using STATA and rates of PTSD, depression and anxiety will be calculated with a 95% confidence interval, factors associated with PTSD will be calculated using bivariate and multivariate analysis. Expected findings It is estimated that post-traumatic stress disorder, its symptoms, depression and anxiety will be highly prevalent in the study population. Dissemination: The results will be disseminated in form of reports to the COM library, COMREC, Health Services Research Committee, University Research and Publications Committee and Queen Elizabeth Central Hospital, QECH, the burns unit and presented at the annual College of Medicine Research Dissemination Conference. Results: will also be published in a peer reviewed journal.
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Reaching the stigmatised: A 3-year retrospective analysis of the static and mobile mental health clinics of Nkhoma Mission Hospital in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2021-01-05) Johnston, Anna
Type of research study This is a retrospective analysis of data collected over a 3 year period. The problem to be studied This research will describe the demographic characteristics of patients attending both the static and mobile clinics of Nkhoma Mission Hospital, Lilongwe, Malawi. There will then be an analysis of the distances of the mobile clinics from the static clinic at Nkhoma Mission Hospital, Lilongwe. This will be demonstrated using mapping technology to create a visual representation of the distances. Analysis will then be carried out on the differences in the demographic characteristics of those attending both the static and mobile clinics. Broad Objective: To describe the individuals accessing Nkhoma Mission Hospital’s Mental Health Services and understand the implications of the geographical locations of the static clinic in Nkhoma Mission Hospital and the 12 associated mobile clinics from February, 2017 and September 2020. Specific Objectives: - To describe and understand the demographics of individuals attending the static and mobile mental health clinics of Nkhoma Mission Hospital, Lilongwe, Malawi. - To establish the distance between Nkhoma Mission Hospital and the 12 outreach clinics and calculate the time taken to travel to each of these clinics. - To use OSM mapping technology to demonstrate the geographical location of the mobile clinics in relation to the static clinic at Nkhoma Mission Hospital. - To determine whether the demographics affect the utilisation of either a mobile clinic or static clinic. - To analyse if, and how, the follow up of patients differs based on the geographical locations of the static and mobile clinics. Methodology This research is a quantitative study which involves the analysis of data which has already been collected. The data was collected as part of routine clinical data collection. The data will be anonymised for the purposes of this study analysis. Expected findings There is likely to be a variation in demographic characteristics of patients attending the different clinics. The static clinic will probably see a wider range of demographics, as there were 415 patients attending the one static clinic at Nkhoma, compared with a combined total of 495patients spread across the 12 mobile clinics. The use of mapping will provide a helpful visual representation which may be used in future by programme organisers when assessing delivery of services to populations living further from the main clinic at Nkhoma Hospital. It is expected that there will be significant differences in the follow up of patients based on whether they attended the static clinic at Nkhoma Hospital or mobile clinics in the surrounding areas. Dissemination of results The findings of the study will be shared with University of Dundee, Scotland and Nkhoma Mission Hospital, Malawi. The data analysis will be used in the researcher’s final dissertation, which will be submitted to the University of Dundee. This will form part of the researcher’s assessment for a Bachelor of Medical Sciences Degree in International Health. Results may be disseminated in peer review journals and presented at medical meetings.
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The social and ethical implications of data-prompted ancillary care in southern Africa, Malawi
(Kamuzu University of Health Sciences, 2021-03-04) Kapumba, Blessings
type of research study: This is a qualitative research study. The problem: Data-driven Ancillary Care is increasingly emphasised as an ethical approach in medical research. It, however, raises complex ethical concerns when research is conducted in resource-constrained settings (RCS) where participants may have additional health care needs outside the scope of the research, not usually provided by the local health care system. Limited information is available on observational research findings and understanding on practices of ancillary care provision during research, particularly in RCS. The objectives: To explore research stakeholders’ views and perspectives on the social and ethical issues surrounding the provision of ancillary care during research in Malawi. To explore research stakeholders’ views and perspectives on the provision of ancillary care, if any are encountered by researchers in Malawi, and how they respond to them. Specific 1. To describe experiences and perspectives of research stakeholders on the practices of the provision of ancillary care during research. 1. To document experiences and perspectives of research stakeholders on the process and practice of provision of ancillary care 2. To describe how researchers decide whether or not to respond to the ancillary care needs of their research participants. To determine the process researchers follow to decide whether or not to provide ancillary care to their research participants 2. To explore views among research stakeholders on the values and practices beyond perceived ancillary care obligations of researchers which may need to be balanced in decisions about study demands and ethical requirements. To determine the values and practices beyond perceived ancillary care obligations of medical researchers which may need to be balanced in decisions about study demands and ethical requirements. 3. To develop a framework and standard guidelines for ancillary care practices that address complexing social and ethical questions in RCS. Methodology: We will conduct qualitative in-depth interviews with key research stakeholders in Malawi, including researchers, Ministry of Health officials, research ethics committees (REC) members, and research participants; and grant officers from international research funding institutions including Wellcome Trust, European & Developing Countries Clinical Trials Partnership (EDCTP) and Bill and Melinda Gates foundation, to understand their views and perspectives on the provision of ancillary care. Potential constraints We do not envisage major problems in conducting this study as it involves qualitative research with a relatively small sample. There are potential challenges around ensuring consent is fully voluntary, as MLW staff and some study participants enrolled in other studies may see participation in interviews as compulsory. We will mitigate this by emphasising that participation is their own free choice, and that nonparticipation will have no implications for their work, access to services or relationship with MLW. Expected findings and their dissemination. We will produce findings on practices of ancillary care provision during medical research in Malawi, ethical issues arising, and approaches to ethical provision of ancillary care to study participants in RCS. Findings will be shared with participant groups and the wider public through discussion with the ministry health officials and Malawi research ethics committees including College of Medicine Research Ethics Committee (COMREC) and written up in journal articles and disseminated at national and international conferences, including the College of Medicine Research Dissemination conference.
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Understanding the measurement of aggregate performance of primary health care systems in Malawi
(Kamuzu University of Health Sciences, 2021-03-29) Makwero, Martha
Type of research study: Qualitative exploratory study The problem: The importance of data for appraising PHC performance and use for evidence based decision making cannot be over emphasized. The use of data requires that we fully appreciate the process through which policy or program decisions makers aggregate, synthesize and use the available data. However, in principle, primary health care (PHC) appraisal and decision making based on data is limited. The objectives: The study aims to assess the ways in which the PHC policy makers collect and use data for performance management at the District and National level. The specific objectives of the study are as follows: 1. To describe the processes and tools through which PHC policy makers use to collect, analyse and utilize data for PHC performance. 2. To understand facilitators and barriers in the use of data for assessing PHC system performance management at district and national levels. 3. To explore people’s awareness and understanding of data management process 4. To develop recommendations for data management process in Malawi Methodology: The study will employ the key informant interviews to answer the specific objectives of this study. Data will be collected at three levels: health centres, district hospitals and each zone in Malawi. Service providers and decision makers will be purposively selected for the key informant interviews. One district from each zone will be selected for data collection through simple random sampling. At each selected district, three health centres will be conveniently sampled for data collection. Expected findings: The study is expected to unearth the salient processes and tools involved in data collection, synthesis and use for appraisal and decision making in PHC. The study is further anticipated to uncover contextual barriers and facilitators in the data use cycle. The information has potential to inform strategies laid in the national health information policy on improvement of data use Dissemination: Results will be disseminated through presentation of study findings to various institutions such as the district health offices, Ministry of Health, COM library, COMREC and other interested organizations.

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