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- ItemRestrictedAssociated factors among health care workers at Queen Elizabeth Central Hospital, Malawi(Kamuzu University of Health Sciences, 2021-11-09) Chikhoza, Angella JosephThe type of research study This is a quantitative, descriptive cross sectional study. The Problem The COVID-19 pandemic has caused high mortality rates worldwide; and this forced scientists to develop COVID-19 vaccine within one year. HCWs are at high risk of contracting the COVID-19 due to nature of their work. Furthermore, HCWs were among the priority groups to receive COVID-19 vaccine. Before COVID-19 vaccination program was rolled out, some studies were conducted to assess the acceptability of COVID-19 vaccine among HCWs in other countries, such as United States of America (USA) and United Kingdom (UK). Research showed that majority of HCWs were hesitant to receive the vaccine; their concerns centered on short and long term side effects. Furthermore, since COVID-19 vaccination program was rolled out, there has been misinformation among the general population on COVID-19 vaccine and its side effects. Study Objectives The main objective To determine factors associated with uptake of COVID-19 vaccine among HCWs at QECH in Blantyre, Malawi. The specific objectives are To determine the proportion of HCWs that received COVID-19 vaccine at QECH in Blantyre, Malawi. To identify social-economic factors associated with uptake of COVID-19 vaccine among HCWs at QECH. Methodology The study participants will be clinical HCWs which includes; nurses, clinicians, doctors and physiotherapy personell; Non clinical HCWs includes; pharmacy, laboratory personell, radiologists and hospital attendants. They will be recruited from the following departments at QECH; COVID-19 isolation units, Ear, Nose and Throat (ENT), High Dependency Respiratory Unit (HDRU),male and female medical (3B and 4A), male and female surgical (5A and 5B), Accidents and Emergency (A and E), Adult Emergency and Trauma Centre (AETC), orthopedic, gynaecological, Chatinkha nursery, peadiatric Moyo, Peadiatric Special Care Ward (PSCW), postnatal, laboratory, pharmacy, radiology and physiotherapy. Expected results and dissemination Lack of adequate knowledge on COVID-19 vaccine among HCWs may result to suboptimal uptake of COVID-19 vaccine. If true, the study results will inform in strategy/ policy making to optimize the uptake of COVID-19 vaccine and of future pandemics. The study results will be presented using tables, graphs and charts. The study findings will be disseminated to study participants, QECH, Ministry of Health (MOH) and College of Medicine Research Ethics Committee (COMREC) among others. The researcher will also attend local conferences to disseminate the study results.
- ItemRestrictedCharacterising health care workers’ risk of exposure to SARS-COV-2 compared to non-health care workers in Blantyre, Malawi.(Kamuzu University of Health Sciences, 2020-06-05) Kateta, Steve RobertBackground: Cases of COVID-19 continue to rise exponentially globally and also in Malawi. Frontline health care workers (HCWs) remain at increased risk of contracting SARS-CoV-2, a virus that causes COVID-19. Sickness and death of HCWs to COVID- 19 will have devastating effects on Malawi’s already fragile health system. This study aims at characterising risk of exposure to SARS-CoV-2 among HCWs compared to non-HCWs. Main Objective To characterize the exposure and risk of HCWs to COVID-19 in Blantyre compared to non-HCWs Specific objectives i) To describe the demographic characteristics of HCW in the frontline of COVID-19 response ii) To establish the incidence (proportion of HCWs with) of COVID-19 among HCW compared to the non-HCWs iii) To ascertain the workplace/ occupational factors associated with/or contributing to health care workers contracting SARS-CoV-2 Study design: Prospective descriptive cohort study Study place: Blantyre District, Malawi Study population: Frontline HCWs and matched non-HCWs in Blantyre Study duration: May to August 2020 Data management and analysis: An electronic, predesigned questionnaire will be used to collect data. Data curation and storage will be GCP compliant. STATA software will be used to analyse the results. Proportions of HCWs and non-HCWs infected with SARS-CoV-2 will be calculated and Chi-square test used to test the difference. Multivariable logistic regression will be performed to explore occupational factors that increase the risk of being infected. Expected results: We expect to understand the risk health care workers have of contracting SARS-CoV-2 and ascertain the workplace factors that increase this risk. This information will assist policy makers in optimising infection prevention control measures in workplaces, contributing to protecting HCWs in Malawi. Dissemination of results: Results of this study will be presented to Blantyre DHO, QECH, College of Medicine and Ministry of Health. Furthermore, results will be disseminated through local, regional and international scientific meetings/conferences/seminars/workshops and by publications in peer-reviewed journals. In addition to a thesis being submitted in fulfilment of a Master of Medicine degree, a copy of the final report and any enduing publications will be submitted to COMREC and the College of Medicine Library.
- ItemRestrictedContinuity of Essential Health Services (CES) Study(Kamuzu University of Health Sciences, 2021-06-04) Stones, WilliamType of Study This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. BACKGROUND RATIONALE Malawi registered its first Covid-19 cases in March 2020. A Presidential Taskforce on Covid -19 was immediately set up and Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. OBJECTIVES The overall study objective is: • To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services. 2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. METHODS The methodology will include focus group discussions (FGDs) and key informant interviews (KIIs), followed by in-depth interviews (IDIs) to capture respondents of vulnerable groups. The data will be collected from Mchinji and Blantyre Districts (indicative locations to be confirmed following consultation) and the study population will include adult pregnant/breastfeeding women, parents/caretakers of children under five years of age, adolescents (15 to 19 years of age,companions/partners of pregnant/breastfeeding women and pregnant/breastfeeding adolescents, community-based health workers, health workers and facility based managers. DATA MANAGEMENT AND ANALYSIS All audio and handwritten data collected from the FGDs and interviews will be stored securely. Electronic notes, transcripts and translations will be stored electronically and protected by a password. Only members of the research team will have access to these documents. As soon as the audio-recordings have been transcribed and verified, they will be destroyed by erasing the voice recordings. Framework analysis will be used for cross-sectional analysis of data from FGDs, IDIs and KIIs. The focus will be on understanding the demand and supply-side barriers to seeking routine and emergency health care services, the extent to which the pandemic has impacted people’s willingness and ability to access MNCH services and how service readiness and provision has changed as a result of COVID- 19 and its effects. A combination of deductive and inductive themes will be included. POSSIBLE CONSTRAINTS COVID-19 situation might require adaptation of study methods using more or only virtual methods for interviews and FDGs; virtual FDGs might be not ideal given that moderators should be physically present to be able to catch the dynamics in the groups and to be able to guide and facilitate appropriately. However, the research teams will only do virtual FDGs in case there is no alternative. RESULTS PRESENTATION Key findings will be presented during a webinar with a UN, participating districts and MoH audience. All data collected, analytical memos and framework analysis files will be de-identified and shared with UNICEF alongside draft reports. The report will also be shared with COMREC. IMPLICATIONS OF THIS STUDY We anticipate that findings from this study will highlight the impact of Covid-19 on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic.
- ItemRestrictedCovid-19 Neurological Disease(Kamuzu University of Health Sciences, 2021-06-16) Phiri, TamaraType of Research This is a prospective case-control study being conducted in Brazil, India and Malawi. The cases will be patients with COVID-19 and neurological disease. Controls will have COVID-19 without neurological disease. Problem Neurological manifestations and complications of COVID-19 are being recognised increasingly, with encephalopathy (mostly delirium) and cerebrovascular disease (predominantly stroke) being reported most commonly. However, the full spectrum, outcomes, and risks of developing neurological disease in COVID-19 are poorly understood. This makes the approach to risk stratification, and pre-emptive or preventative measures, challenging. This study will be conducted in Brazil, India and Malawi to address this gap in low- and middle-income country settings, where the impact of neurological disease and emerging infections is often felt disproportionately. Objectives Aim To describe, and to guide interventions to reduce morbidity from, acute new-onset neurological disease among hospitalised patients with COVID-19. Primary Objective 1. To compare characteristics of patients hospitalised with COVID-19 with and without new onset neurological disease, focusing on stroke, delirium, hypoxia and other potential risk factors for neurological disease which may be modifiable. Secondary Objectives 2. To describe the full spectrum of COVID-19 associated neurological disease including its range and prevalence. 3. To compare outcomes of patients with and without COVID-19 associated neurological disease, focusing on stroke and delirium. 3.4. To examine prognostic indicators for outcomes in patients with COVID-19 associated neurological disease. Methodology The primary objective will be achieved using a case-control design. The cases will be patients with COVID-19 and neurological disease. Controls will have COVID-19 without neurological disease. Secondary objectives will be achieved through a prospective cohort design, including the same cases and controls with longitudinal follow-up to discharge, and at 3 and 9 months. Hospital records of adult (≥18 years) patients will be screened for eligibility, and strict predefined case definitions will be applied by study staff. Consenting patients will have data collected during their admission up to discharge, and at 3 months and 9 months. This may include additional clinical investigations for COVID-19, neurological disease and potential risk factors that are deemed to be indicated and safe by treating clinicians. Final assignment of case vs. control status of participants will be at 30 days from admission to hospital. “Day 1”, for timing of variable measurement for the case-control analysis, will be defined for each participant as the day of presentation with neurological disease in cases, and the day of enrolment in controls. The target number of cases with all types of neurological disease is 227 (projected breakdown of 68 with stroke, 136 with delirium, and 23 other), with 454 controls. This will give >95% power to detect an odds ratio of 2.0 and would give 90% power to detect an odds ratio of 1.6, for the primary exposure of severe vs. non-severe/no hypoxia for overall participants with any neurological disease. It would also achieve ≥80% power to detect an odds ratio of 2.0 in both major disease subgroups of stroke and delirium separately. Expected Findings and Dissemination Study results will be presented and discussed at international scientific meetings and published in open access peer reviewed journals. High impact publications will be aligned with press releases managed by the University of Liverpool press office and local institutional press offices in Brazil, India and Malawi (including College of Medicine-University of Malawi- Research Dissemination Conference, Malawi Liverpool Wellcome Trust, and Queen Elizabeth Central Hospital).
- ItemRestrictedPilot Implementation of a multi-faceted COVID-19 response at the department of paediatrics, QECH(Kamuzu University of Health Sciences, 2020-09-16) Freyner, BridgetType of Study This is a mixed-methods pilot implementation study Problem COVID-19 is the current major disease of concern globally. The guidance developed by the World Health Organisation (WHO) to help in the implementation of infection prevention and case management of COVID-19 must be locally relevant for it to be effective in Malawi. This study will apply the RE-AIM framework to assess key process and implementation outcomes of the QECH Paediatric COVID-19 response. The QECH Paediatric departmental response to COVID-19 has three elements (i) the implementation of WHO guidance on infection prevention, rationale use of PPE and case management of children with suspected COVID-19 disease (ii) ongoing monitoring and evaluation of in-patient case load, case fatality rate and quality of care and (iii) the development of strategies to minimise in-patient length of stay. Underpinning these three elements are ongoing communication strategies, logistics support and real-time data utilisation through audit-feedback. The aim of this study is to describe the implementation of this response and to pilot strategies for (i) real time data utilisation and (ii) reduction of in-patient length of stay to mitigate against both the direct and indirect effects of COVID-19. Specific Objectives I. To evaluate the implementation of COVID-19 specific guidance (infection prevention, environmental cleaning and the rationale use of PPE) and how it changes over the course of the epidemic. II. To evaluate the pilot implementation of a data dashboard and associated learning system on (i) compliance with COVID-19 guidance and (ii) in-patient quality of care. III. To describe the effect of the COVID-19 epidemic on the in-patient caseload, case fatality rate and in-patient quality of care compared to baseline. IV. To determine the optimal strategies for minimising in-patient length of stay in our department with the aim of reducing unnecessary patient exposure to COVID-19. IV.V. To generate pilot effectiveness data on the utility of a “learning system” to support the COVID- 19 response at the QECH paediatric department. Methods: All elements of the COVID-19 response (the intervention) will be described at baseline using the TiDieR checklist. The implementation of this response will be assessed using a modified RE-AIM framework, supplemented with qualitative enquiry based on the Consolidated Framework for Implementation Research. A key element of the intervention is real time data utilisation via implementation of a data dashboard. The dashboard will be updated weekly. The aim of the dashboard is to provide a “learning” system to inform ongoing COVID-19 specific activities and maintain in-patient quality of care through identification of key indicators requiring improvement on a weekly basis which will be entered into a PDSA cycle. The efficacy of the dashboard will be defined as a 20% improvement in the chosen indicator over the following month. A key safety element in the COVID response is minimising unnecessary length of stay (LOS) for in-patients. We will pilot two strategies to reduce inpatient LOS; (i) IV-PO switch antibiotic ward rounds and a (ii) care pathway for complex patients. These interventions will be developed through (i) audit of existing practices including 6 months of retrospective data review and (ii) participatory work-shops with clinicians and nurses in the department. Pilot efficacy of these interventions will be assessed by comparing length of stay and changes in antibiotic prescribing days in the department. The interventions will be refined through feedback from key users and developed for future formal process evaluation.
- ItemRestrictedPrevalence of hyperglycemia among adult patients admitted with Covid-19 at Queen Elizabeth Central Hospital(Kamuzu University of Health Sciences, 2021-09-15) Mvula, BerthaCoronavirus disease 2019 (COVID-19) is a highly infectious disease that is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It was declared a pandemic by the World Health Organization (WHO) in March 2020. The clinical spectrum of COVID-19 is heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple organ failure and death. Among the risk factors, evidence indicates that patients with diabetes mellitus (existing or new diagnosis) are at increased risk of severe disease or death due to COVID-19 than those without diabetes. There is a lack of data on the prevalence, clinical presentation and outcomes of patients with hyperglycaemia and COVID-19 in African countries. Findings from this study will inform clinical guidelines on management of hyperglycaemia in COVID-19 patients in Malawi. Broad objective To determine the prevalence of hyperglycaemia in adult COVID-19 patients admitted with at QECH from 1 July 2021 to 28 February2022. Specific objectives 1. To determine the prevalence of known pre-existing diabetes mellitus in COVID-19 patients. 2. To determine the prevalence of new onset hyperglycaemia/previously undiagnosed type 2 diabetes mellitus in COVID-19 patients. 3. To describe the clinical characteristics of COVID-19 patients with hyperglycaemia. 4. To describe the clinical outcomes of COVID-19 patients with hyperglycaemia Study design: This will be an observational, analytic prospective cohort study. Study place: Queen Elizabeth Central Hospital (QECH), in Blantyre. Study population: All adult patients (aged 18 years or older) diagnosed with COVID-19 via RTPCR on nasopharyngeal swab specimens and admitted to all medical wards and other designated COVID-19 wards at Queen Elizabeth Central Hospital Study duration: 1 July 2021 to 28 February 2022 Data management and analysis: All participant data will be collected and entered on an electronic ODK tablet questionnaire, synced to a secure server, cleaned and consolidated in a password protected database. Prevalence of hyperglycaemia will be computed as the proportion of participants with elevated blood glucose level (≥200mg/dL) at admission. Associated factors for hyperglycaemia will be described, including clinical outcomes, while controlling for important demographic and clinical characteristics, including treatments administered during admission. Expected results We expect to know the prevalence of hyperglycaemia in adult patients with COVID-19 and ascertain the clinical course of and outcome of the patients. Findings from this study will inform clinical guidelines on management of hyperglycaemia in COVID-19 in Malawi. Dissemination of results: The results of this study will be disseminated to QECH, College of Medicine and Ministry of Health. They will also be disseminated at local, regional and international meetings/conferences and will also be published in peer reviewed journals. In addition to a thesis being submitted in fulfilment of a Master of Medicine degree, a copy of the final report and any enduing publications will be submitted to COMREC and the College of Medicine Library.
- ItemRestrictedTo assess quality of care given to Covid-19 patients at QECH Covid isolation centre(Kamuzu University of Health Sciences, 2021-11-18) Mjojo, Dithia; Kacheche, SellahThis study is a cross sectional using qualitative approach, aimed at assessing factors influencing quality of care given to covid 19 patients at QECH Covid 19 isolation center, Blantyre, Malawi. The main objective of this study is to determine quality of care received by Covid-19 patients in isolation center in the period of hospitalization. Little is known about management of COVID-19 in African countries including Malawi. Patient outcomes are significantly impacted by the quality of the medical diagnosis, treatment and ongoing monitoring. It is expected that the quality of care is compromised due to inadequate knowledge, human resource and other resources. The results of this study will be disseminated by firstly presenting to College of Medicine Research Ethical Committee, College of Medicine Library for referencing and then institutions like Malawi Ministry of Health through the National’s covid 19 committee. Objectives The main objective is to determine quality of care received by Covid-19 patients at QECH isolation center in the period of hospitalization. The specific objectives are; to assess level of knowledge of health workers on management of Covid-19 in isolation center. To determine availability of adequate human resource in isolation Centre. To determine the availability of essential drugs and equipment Methods The study will be a facility based cross section qualitative study intending to know the quality of care given to patients in Covid-19 isolation Centre at Queen Elizabeth Central Hospital. Key informant interviews will be used to collect data. Digital voice recorders will be utilized and responses will be transcribed verbatim. Content analysis of case files will be used to analyze the data. Results Expected findings of this study will help to develop, refine and execute the national quality policy and strategy to systematically improve health system performance. The results of the study will be disseminated to COMREC, QECH, and management teams as well as to local dissemination conference. Conclusion There is need to strengthen training of health workers on Covid management Policy, ensure availability and proper use of resources, leadership and governance to combat the Covid-19 as a new emerging disease.