Safe Motherhood

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Acceptability of Self injected contraception (DMPA-SC) among adolescent girls and young women in Lilongwe district
(Kamuzu University of Health Sciences, 2021-09-15) Chipeta, Taonga
Study Type This study will employ a cross sectional mixed methods approach to collect data. Quantitative data will be collected from secondary sources (family planning registers) while interviews will be used to collect qualitative data. The problem to be studied Approximately 1 in every 2 women (49.85) in Malawi uses an injectable contraceptive (Depo- Provera) and is required to travel to a health facility every 3 months to get their next dose [1]. This is according to the 2015 – 16 Malawi Demographic and Health survey (DHS). In the same DHS, distance to a facility was one of the reported problems in accessing health care by 56% of the women aged 15-49 interviewed. Subcutaneous depot medroxyprogesterone acetate or DMPA-SC, a lower dose of Depo-Provera emerged in 2011 as a new option that could increase access to contraception, especially at the community level in low-income countries as women would be able to inject themselves in the home without visiting the health facility [3]. While Malawi reached a milestone and rolled out DMPA-SC in facilities across the country, published literature is unclear on the extent to which women are self-injecting at home or in the presence of a provider. This study builds upon randomized control studies that have been done by Burke et al to explore the practices around self-injected DMPA-SC in a real world setting as Malawi is scaling up distribution in the public sector. Objectives The main objective of this study is to assess the acceptability of self –injection of DMPA SC among adolescent girls and young women. The specific objectives of the study are to assess the attitudes and perceptions of adolescent girls and young women towards self-injected contraceptive, to explore the interest for self-injection of DMPA-SC and to get the perceived self-efficacy in using self-injected DMPA-SC. The study will also establish a profile of current users of DMPA-SC and the proportion of those self-injecting to help guide implementation. Methodology The study is a cross sectional study that will use both qualitative and quantitative means of data collection. Two facilities, one from a rural area (Ngoni Health Centre) and one from an urban area (Area 25 Health Centre) have been identified as the study sites for this research. The study will use the theoretical framework of acceptability according to Sekhon – 2017 where the 7 components of the theoretical framework will be used. These are Affective attitude, Perceived effectiveness, Burden, Ethicality, Coherence, Self-efficacy and opportunity cost. The study will collect data from family planning registers to establish a profile of current users of DMPASC while qualitative data which responds to the theoretical framework will be collected from service providers and clients sampled through a client exit recruitment process. The quantitative data will be managed and analyzed in Stata while the Qualitative data will be analyzed following the themes aligned with Sekhon’s theoretical framework. The qualitative data will managed in Nvivo. Appendix 8.6 provides details of the theoretical framework to be used. Expected findings and dissemination It is expected that most users of DMPA SC chose to be injected by the provider and are women under the age of 24. Insights into the reasons for Clients opting to be injected by the provider despite undergoing counselling will show a need to build client competency in using DMPASC to ensure more client self-inject compared to provider administration. The study findings will help provide a baseline for identifying an implementation gap before scaling up. The findings will be presented before the College of Medicine Research Ethics Board, Lilongwe District Health Office and the Research dissemination conference.
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The Active Prevention and Treatment of Maternal Sepsis
(Kamuzu University of Health Sciences, 2022-07-13) Gadama, Luis
Hybrid implementation/effectiveness trial. Multi-country, parallel cluster randomised trial with baseline phase. Setting 32 healthcare facilities in Malawi will participate, as part of a multi-country study The problem Maternal infections and sepsis are reported to cause 11% of direct maternal deaths (1), and recently the WHO GLOSS (Global maternal Sepsis) study, although based on small numbers, Formatted: Font: Bold 13-Jul-2022 x APT-Sepsis Protocol Version 1.0 Date, 13 April 20222.0 Date, 06 June 2022 Formatted: Left suggests maternal infection may contribute to over half of all intra-hospital maternal deaths (2), with by far the greatest burden borne by women in Low- and Middle-Income Countries (LMICs). There is an urgent need to identify ways to combat this problem which are implementable at scale, and are clinically effective, cost effective and sustainable. This study which will be conducted in Malawi aims at assessing the effectiveness of implementing APTSepsis bundle which is the quality of care for mothers, and adherence to WHO evidence-based practices in infection prevention and management. APT- Sepsis is a carefully developed programme designed specifically to be used in countries and facilities where there are limited resources available; Malawi and Uganda are the countries identified to participate in this study. It APT-Sepsis aims to change health care workers’ behaviours to ensure mothers get the best care possible to better prevent and manage infections. Broad Objective The broad objective of this study is to examine if the APT-Sepsis programme is effective at reducing infection related maternal mortality and severe maternal morbidity, at any time prior to discharge infrom health care facilities in Malawi and Uganda. Specific Objectives The specific objectives are, to evaluate if the APT-Sepsis programme is effective at reducing secondary clinical outcomes of sStillbirth, early neonatal death, maternal mortality, maternal near miss; to explore differential or subgroup effects of the APT-Sepsis programme; to understand the implementation of the APT-Sepsis programme in Malawi, to facilitate interpretation of trial outcomes and development of a longer-term implementation strategy; and finally to determine if the APT-Sepsis programme is cost effective. Methods The study is a multi-country, parallel cluster randomised trial with a baseline control phase. There is an integrated implementation evaluation and health economic evaluation. The overall trial will include 630 clusters in Malawi and Uganda, each of which is a health facility. This protocol specifies the activities to be conducted in Malawi. During the first six months each cluster will continue with their current practices and data will be collected to establish weekly rates of maternal infection and mortality. After the baseline period, the clusters will be randomly allocated in a 1:1 ratio to the APT-Sepsis programme or current practice with passive guideline dissemination, using a minimisation algorithm. The intervention seeks to change the behaviours of health care providers to improve adherence to WHO guidelines and best practice in infection prevention and management, and detection and management of maternal sepsis. Expected Findings
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Assessing an association between utilization of focused antenatal care services and low birthweight at Zomba Central Hospital in Zomba District, Malawi
(2022-02-09) Nyambalo, Lawrence
The prevalence of low birthweight in Malawi stands at 12.1% and is relatively higher compared to other countries in the sub-Saharan region (1). Reproductive health policies and promotion of adequate maternal health initiatives were put in place to encourage adequate antenatal care utilization in Malawi as one way of reducing low birth weight. Antenatal care (ANC) is the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy (2).The traditional antenatal model of care was initially introduced by the WHO and was later replaced by focused antenatal care (FANC) in 2002.The focused antenatal care had four mean visits which antenatal mothers were advised to comply. The focused antenatal care was instituted in an attempt to overcome the challenges posed by the traditional antenatal model of care such as classifying pregnant women into high risk or low risk group based on pre-identified criteria, and the possibility of the low risk group developing complications at delivery (3).Recently, WHO has extended recommendations for more comprehensive coverage of antenatal interventions with up to eight contacts for additional components of care (4) , but in Malawi and many Africa countries in the sub-Saharan region, the challenge remains to achieve the earlier standard of four ANC visits. Globally, during the period 2007–2014, only 64% of pregnant women attended the WHO-recommended minimum four contacts for ANC, suggesting that much more work needs to be done to address ANC utilization and quality (2).In Malawi, the national coverage of first trimester of the WHOrecommended minimum four contacts for ANC is at 12%.The study therefore aims to establish an association that exist between number of antenatal contacts and low birthweight at Zomba to improve early child development and reduce neonatal deaths in Zomba District, Malawi.
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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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Assessing psychological consequences of childbirth-related trauma among postpartum mothers in Thyolo district health facilities in Malawi
(Kamuzu University of Health Sciences, 2022-05-12) Mwangala, Elizabeth
The study will use cross-sectional quantitative design. The Problem Being pregnant and having a baby is a time of huge physiological, psychological and social change for women. Although the birth of a baby is viewed positively, research suggests between 20 and 40% of women find childbirth psychologically traumatic. Some of these women go on to develop post-traumatic stress disorder (PTSD) as a result. Thyolo district, despite that pregnant women give birth in its facilities, but there is no documentation and assessment of consequences of psychological childbirth-related trauma among postpartum mothers. Furthermore, no studies on childbirth related trauma have been done in Thyolo district, hence there is no reported data on the prevalence of childbirth-related trauma and postpartum PTSD among postpartum mothers. Additionally, in other studies that were conducted in Blantyre district on mental health problems that affect women in perinatal and postpartum period, specifically on depression, did not reflect the prevalence and magnitude of childbirth-related trauma among women. Prevalence rates of childbirth-related trauma and PTSD after birth are not established and variation in experiences of birth trauma and the expression of PTSD in mothers are not examined in Thyolo district. Therefore, the researcher intends to conduct this study which will include the assessment of psychological consequences of childbirth-related trauma among postpartum by determining the prevalence, evaluating the symptom presentations and examining the aetiology of the problems in Thyolo district. Henceforth, it is important to identify vulnerability factors affecting women’s psychological experiences of childbirth and know the true extent of childbirth-related trauma and postpartum PTSD in order to raise awareness and provide appropriate interventions, in Thyolo district. Broad objective of the study The broad objective of this study is to assess the psychological consequences of childbirth-related trauma among postpartum mothers in Thyolo District health facilities. 12-May-2022
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Assessment of the effect of malnutrition on adverse pregnancy outcomes on adolescent pregnant women in Mchinji District: A cross sectional study Version 2.0
(Kamuzu University of Health Sciences, 2020-06-10) Zinyemba Chingoli, Manes
Malawi’s teenage pregnancy rate is at 29%[1] and Mchinji district ranks third in the country with teenage pregnancy rate of 37.5% only superseded by Machinga ( 41.1%) and Nsanje (38.8%) [1]. Adolescent pregnancies comprise 25% of all births and 20% of maternal deaths[2]. On the other hand, 7.2% of women of child bearing age (15-49) in Malawi are thin for their height (Body Mass Index (BMI) <18.5), and the situation is worse for adolescent girls aged between 15-19years amongst whom 13% are thin for their height[1]. Problem Studies have shown that in Malawi adolescent pregnancies comprise 25% of all births and contributes 20% of maternal deaths[2]. The country has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100,000 live births[2]. Furthermore, Adolescent pregnancy is associated with higher risks of adverse pregnancy outcomes including neonatal complications such as prematurity, low or very low birth weight, and perinatal mortality[6]. It is also associated with major maternal complications such as hypertensive pregnancy disorders, abortion, urinary infections, and premature rupture of the fetal membranes[6]. Some other studies have further shown that failure to achieve normal delivery is directly related to the height of the mother which is influenced by nutritional status in childhood and adolescence[10]. This could imply that in Malawi, where stunting in under five children is estimated at 37% [1], a substantial percentage of women do not reach their potential height hence difficult to achieve normal delivery. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low‐ and middle‐income countries[7]. Objectives Broad Objectives To determine the effect of malnutrition (wasting- MUAC (Mid Upper Arm Circumference) <22 cm) on pregnancy outcome in adolescent women in Mchinji. Specific Objectives Specifically, the study will address the following objectives:  To describe the prevalence of wasting in adolescent pregnant women receiving antenatal services at Mchinji district hospital from December 2018 to December 2019.  To describe the prevalence of adverse pregnancy outcomes among adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019.  To compare the proportion of adverse pregnancy outcomes (Miscarriage, preterm birth, stillbirth and low birth weight) among wasted and well-nourished adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019. This will be a cross sectional study based on routinely collected facility data that is recorded in the antenatal, supplementary feeding and maternity registers. Type of Study and Methodology A cross sectional study design will be used. The routinely collected facility data for antenatal, supplementary feeding and maternity services will be collected then analysed. Data will be collected from service registers focusing on data from December 2018 to December 2019. Data will be collected using a case report forms (CRF). Data will be analysed using Stata version 14.0. Categorical response variables will be presented using proportions and will be analysed using Chi- square. For objective three, Chisquare test will be done to check whether there is association between nutrition status and proportions of adverse pregnancy outcome. Logistic regression will be run to adjust for confounders affecting the relationship between nutrition status and proportion of adverse pregnancy outcome. Expected results It is expected that there will be significant differences in proportion of adverse pregnancy outcome between malnourished and well-nourished adolescent mothers. Dissemination The results from this study will be shared with COMREC, Mchinji district hospital and College of Medicine through the Research Dissemination Meeting.
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An assessment of the factors contributing to increase cases of abortion among women of reproduction age, Mzimba
(Kamuzu University of Health Sciences, 2023-01-11) Kaipa, Audrino; Khasu, Bridget; Makwinja, Abigail; Gotta, Godfrey
Introduction: Abortion continues to be a burden in both developing and developed countries. Global and regional studies show that factors like knowledge, finances and religion have great impact on abortion. In Malawi abortion cases accounts for 18.2% of all gynaecology conditions among women of reproductive age and is the most common cause of infertility in women. Despite increased access to family planning method and integrated post abortion care services, cases are still rising each and every year. Aim: This study aims at assessing factors associated with abortion among women of reproductive age at Mzimba District Hospital. The specific objectives are: to discover the influence of marital status on abortion among women, to explore knowledge of abortion of women of reproductive age, to examine financial status of women of reproductive age, to compare influence of religion on women’s belief to keep pregnancy or not. Methodology: Cross sectional research design will be used to assess the factors associated with increased cases of abortion in Mzima, Malawi. A sample size of 50 will be used during data collection. Data will be analysed using SPSS version 23. Expected findings: We expect that women will have little knowledge on abortion, women of low income level will have high rate of abortion and women of strong religious belief will have low abortion rate. Dissemination: The results from the research findings will be printed and disseminated during dissemination seminar to be held at College of Medicine. Both hardcopies and soft copies will be sent to Kamuzu University of Health Sciences library. We will arrange a meeting with female surgical ward health care workers at Mzimba District Hospital to give feedback of the research findings to incorporate them in their interventions including health education and counselling given to the women
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Assessment of the implementation of 2016 World Health Organization antenatal care model in Malawi: a case study of Neno District, version 1.0
(Kamuzu University of Health Sciences, 2022-05-09) Sayenda, Mphatso
Type of the study: This is a descriptive cross sectional mixed methods study. Background of the problem: Malawi is one of the countries with high maternal, neonatal mortality. Maternal mortality ratio is 439/100,000, Neonatal Mortality Rate is at 27/1000. Antenatal Care (ANC) is one of the essential elements in helping to reduce the maternal and child mortality. It provides a foundation of a good pregnancy outcomes through screening for health problems and treating them and preparing for birth according to the needs of the pregnant woman. The World Health Organization introduced new ANC schedule in 2016 for a positive pregnancy experience and encouraged nations to move from the previous focused antenatal care to the new schedule to promote quality ANC and prevent pregnancy complications and maternal deaths. This study will assess the implementation of the 2016 World Health Organization (WHO) antenatal care model in Neno, Malawi. Objectives of the study: The main objective of the study is to assess implementation of 2016 World Health Organization Antenatal care model by health care workers in Neno district, Malawi. Specific objectives of the study are to determine the proportion of women who had 8 contacts by the end of their term pregnancy; assess the availability of required equipment, medication and supplies for the implementation of the 2016 WHO ANC model; review the assessments and tests that pregnant women have during their antenatal care contact with the health care workers; explore factors influencing implementation of WHO 2016 ANC model and explore key informant’s perspectives on implementation of WHO 2016 ANC model in Malawi. Methodology: The study will employ a mixed methods research design utilizing both quantitative and qualitative methods. The participants will be health care workers who provide ANC services, pregnant women through their facility records and key stakeholders of the ANC model implementation. In-depth interviews will be conducted with 10 midwives who provide antenatal care in the selected health facilities: Neno district hospital, Zalewa health center and Matope health center and will be conducted by the researcher. Checklists will be used to check if all the required equipment, drugs and supplies for the implementation of the new model are available at a health facility. Antenatal care register reviews will also be done to determine the number of pregnant women who completed 8 contacts at term of their pregnancy. The care provided and documented in the ANC register will also be reviewed. Key informant interviews will also be done to get the perspectives of the key stakeholders in the implementation of 2016 WHO ANC model and these will include ministry of health officials. Ethical approval will be sought from College of Medicine Research and Ethics Committee (COMREC) and permission from the Director of Health and Social Services (DHSS) for Neno district council.Expected findings and dissemination: The findings of this study will establish how the 2016 WHO ANC model is being implemented by the health care workers. It will also find out the enablers and barriers to implementation. These will be useful to inform policy makers and implementers on how best they can improve the implementation strategies so that they are in line with the model and that its implementation ultimately yields the intended outcomes. The results will be shared through a report to COMREC, College of Medicine library and Neno District Health Office. A report will also be shared by means of presentations at conferences organized locally and internationally.
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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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Challenges in implementing the revision of 4 focused antenatal care visits to 8 antenatal care visits in Lilongwe District
(Kamuzu University of Health Sciences, 2021-12-10) Matsuka, Pililani
Executive Summary Type of research study The study will use a cross-sectional descriptive study design, that will employ a phenomenological qualitative approach. The problem to be studied Maternal and neonatal mortality are issues of public health concern globally especially in developing countries, and Malawi is not an exception. Malawi, has high maternal mortality ratio (MMR) and high neonatal mortality rate (NMR) which are currently at 439 per 100,000 live births and 27 per 10000 live births respectively. For that reason, globally and nationally,several interventions have been introduced to Some of these interventions include advocating for health facility birth by a skilled attendant and utilization of antenatal care services that includes starting antenatal care within the first trimester and attaining at least 4 antenatal care visits. Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality through early detection and management of women with and those at risk of pregnancy related complications during labor and delivery. Different models of the antenatal care services have been implemented in Malawi over the past years as recommended by the World Health Organization (WHO). In 2016, WHO recommended that every pregnant woman should have eight ANC visits four scheduled focused antenatal care visits (FANC). The aim of the adjustment is to increase contacts of a pregnant woman with a health care worker to reduce perinatal mortality and improve women’s experience of care. In 2019, Malawi government, through the Ministry of Health and Reproductive Health Directorate, adopted and started implementing thise WHO recommendations in 2019. In 2020, however, out of the 93,801 women who attended antenatal care in Lilongwe District government health facilities, only 6736 (7.2%) attended 5+ visits. Additionally, there is insufficient data to show the impact of this ANC model has had on health care workers and ANC users as well as the challenges encountered with the model. This study, therefore, seeks to unveil/assess the challenges affecting the implementation of 8 ANC visits in public health facilities with a focus on Lilongwe District government health facilities. The results of the study will be instrumental in the efforts of increasing the number of women who attend 5+ ANC visits. The objectives • Broad objective To explore the challenges the 8 ANC visits model in health facilities of Lilongwe district. • Specific objectives To identify health system challenges that impact ANC provision in health facilities of Lilongwe district. 2. To explore sociodemographic factors that influence the timing of ANC start and number of ANC visits amongst childbearing women in Lilongwe district. 3. To explore knowledge, attitudes, beliefs and perceptions of childbearing women towards ANC start and number of ANC visits amongst childbearing women in Lilongwe district. 4. To explore social cultural factors that influence ANC initiation and number of visits amongst childbearing women in Lilongwe district Methodology The study will be conducted in government health facilities of Lilongwe district. Health facilities will be first stratified into urban and rural health facilities. Thereafter, there will be a random selection of health facilities proportionate to their population. The study population will be health care workers (Nurses and/or Clinicians) working at ANC departments and pregnant women found at antenatal care clinics accessing services Purposive sampling method will be used to recruit pregnant women and convenience sampling method will be used to recruit health care workers. Data will be collected through in-depth interviews for health care workers and focus group discussions (FGD) for pregnant women. During data collection, digital voice recorders will be used and all digital recordings will be transcribed and translated into English and coded using NVIVO qualitative software. Themes generated from the data will be analyzed using thematic content analysis. Expected findings and their dissemination The researcher is expecting to provide rigorous local evidence documenting the challenges affecting effective implementation of the new ANC guidelines and their impact towards the delivery of improved maternal and neonatal health care services in the hospitals. Dissemination of the study findings and possible recommendations will be made to College of Medicine Research and Ethics Committee (COMREC), College of Medicine research dissemination seminars, Lilongwe District Health Office and all study sites. A report of the findings will also be published as a journal article
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Determinants of long acting reversible contraceptive utilisation among reproductive age women at Balaka district hospital
(Kamuzu University of Health Sciences, 2022-06-02) Mwalweni, Chank
Type of Study This will be a facility-based quantitative cross-sectional study whose purpose is to assess utilisation of long acting reversible contraceptives and associated factors among women of reproductive age at Balaka district hospital. The Problem Balaka district has a fertility rate of 4.6 higher than the national fertility rate of 4.4. Additionally, the population growth rate for Balaka district is at 3.2% per annum higher than national 2.9% per annum. Malawi population is growing rapidly and it is stated that if left uncontrolled, the population is expected to reach 45 million by 2050. Consequently, the government of Malawi through Ministry of Health is promoting utilisation of long acting reversible contraceptive methods (implants and intrauterine device) which are highly effective and have less discontinuation rate in order to combat the overgrowing population. However, the utilisation of long acting reversible contraceptives is lower (16.9%) in Balaka district as compared to national utilisation at 21.7%. The utilisation of long acting reversible contraceptive (LARC) methods in Malawi is also lower as compared to sub-Sahara Africa at 36%. Nevertheless, there is limited literature on factors associated with utilisation of long acting reversible contraceptives among women of reproductive age in Malawi. Hence, the need for this study. Broad Objective The purpose of this study is to assess utilisation of long acting reversible contraceptives and associated factors among women of reproductive age at Balaka district hospital. Specific Objectives i. To determine the prevalence of LARC utilisation among women of reproductive age accessing FP services at Balaka district hospital. ii. To assess the sociocultural factors associated with utilisation of LARC among women of reproductive age accessing FP services at Balaka district hospital. iii. To analyse the health-system-related factors associated with utilisation of LARC among women of reproductive age accessing FP services at Balaka district hospital. Methodology The study population will be all women of reproductive age group (15–45 years old) accessing contraceptives methods at Balaka district hospital at the time of the study. The sample size for this study will be 216 and it has been calculated using Cochran formula (n= z2pq/d2). The study participants will be selected using a systematic random sampling technique with an interval of 6. The data will be collected through face-to-face interviews using a structured questionnaire. Data will be analysed using statistical package for social sciences (SPSS) version 22 and logistic regression will be carried out to identify factors associated with LARC utilisation. Ethical approval will be obtained from College of Medicine research and ethics committee (COMREC). The institutional clearance was requested from the Director of health and social services for Balaka district hospital and permission has been granted. Expected Findings The study will document the prevalence of long acting reversible contraceptive utilisation and its associated factors among women of reproductive age accessing family planning services at Balaka district hospital. The results of this study well help to close the knowledge gap that exists on factors associated with LARC utilisation among women of reproductive age in Balaka district and national at large. The results will also serve as baseline data for policy makers, programme managers and decision makers to design and focus on suitable interventions that promote utilisation of LARC. Dissemination of Results The result of this study will be presented to Kamuzu University of Health Sciences, College of Medicine Research and Ethics Committee (COMREC) and Ministry of Health (Directorate of reproductive health) through Balaka District Health Office from where the data will be collected. The study finding will be published in a reputable peer reviewed journals and presented at the conference.
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Determinants of long acting reversible contraceptives (LARC) use among 10 to 24 year old youths in Lilongwe
(Kamuzu University of Health Sciences, 2020-11-17) Maruwo, George
Type of research study This is a cross sectional study using secondary data analysis from a youth FP/RH outreach clinics program Problem Statement Despite limited resources, Malawi continues to register substantial progress on key family planning indicators. Demographic Health Survey reports an unmet need for Family Planning of 18.7% with 10.8% unmet need for spacing and 7.9% unmet need for limiting. However, unmet need is highest (22%) among women aged 15-19. Nonetheless, Teenage pregnancy remains a significant public health issue in Malawi. Tailoring LARC services for the youth may assist in attainment of health for all.(1) Objectives The study aims to identify the determinants of Long Acting and Reversible contraceptive uses among youth in Lilongwe. Methodology This is a cross-sectional study using secondary data of clients aged 10-24 years accessing SARC and LARC services from the 64 youth outreach sites within Lilongwe. Factors to be examined will include level of education, marital status, age, number of living children, occupation, and area of residence. Expected findings and their dissemination The study expects to identify key trends of contraceptive use among youth in Lilongwe. Furthermore, the findings from the study will uncover key determinants of LARC and SARC use that might assist Lilongwe district health office, and Banja La Mtsogolo in formulation of new strategies in reaching youth with services. In addition, the report of this study will be submitted to College of Medicine in fulfillment of the completion of Master of Public Health and College of Medicine Research Ethics Committee (COMREC). Furthermore, the results 17-Nov-2020Page 6 of 31 will be shared with the Ministry of Health and Population, in particular, The Reproductive Health Directorate to inform policy in FP/RH programming on youth interventions.
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Determinants of timely access to care for prenatal and postnatal services in Malawi by Liness Kataika
(Kamuzu University of Health Sciencies, 11-08-21) Kataika, Liness
EXECUTIVE SUMMARY Type of study This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi,” 2018-May 2020 Background Problem Timely access to prenatal and postnatal services is a key to maternal health services that can significantly help reduce maternal mortality. However, timely access to maternal and neonatal care services has always been a challenge in Malawi due to several factors. Understanding the factors that hinder timely access to service utilization helps to design appropriate strategies and policies towards improvement of services utilization and thereby reduce maternal mortality. Objective The objective of this study is to determine factors that affect timely access to prenatal and postnatal services in Malawi. Methodology This is the cross sectional qualitative study that will use secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). Data will be taken from the primary owner and will be analyzed thematically. Measures to ensure confidentiality will be followed throughout the period and there after Ethical approval will be sought from ethics committee COMREC Dissemination of expected find. Study design This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). The qualitative study was employed to fully gather the information from parents and guardians of neonates who are receiving care using the interventions under observation. Study Place This was a qualitative study conducted in 3 public Health facilities (Mulanje, Chikwawa and one central hospital in Blantyre Urban (Queen Elizabeth Central Hospital) and one private health facility (Mission hospital) Holy family hospital in Phalombe in Malawi from May 2018- May 2020. Study Population, Study Period, Sample Size, Data collection and management The study targeted Health Care workers, Mothers of Neonates, Fathers of Neonates, and Elderly Women or grandmothers in the southern rejoin of Malawi. The study from Nov 2020- June 2021. Participants were sampled purposively using maximum variation. Data will be taken from primary owner and permission already granted. Data will be managed manually Data analysis Data will be analyzed thematically. The extraction of data from primary data will be done guided by the coding guide which has been developed guided by the conceptual framework of the study [32]. Both inductive and deductive approach to the analysis will be employed.
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Developing a rapid understanding of the impact of Covid-19 on maternity services and pregnant women’s health in rural and urban Malawi
(Kamuzu University of Health Sciences, 2020-06-05) Crampin, Amelia
Type of study: This is a qualitative study exploring the early impact of Covid-19 preparatory work on the maternity services and the experiences of women currently pregnant and women in postpartum periods. Problem statement: There is a lack of knowledge of the effects of novel coronavirus (SARS-COV-2) in pregnancy. Emerging case-reports and case-series have raised uncertainties about risk of pregnancy complications such as higher rates of miscarriage, preterm birth, pre-eclampsia, caesarean delivery and perinatal death. The lack of available evidence has led to advice to treat pregnant women as a vulnerable group. The potential consequences of Covid-19 disruption of maternity services and women’s health in pregnancy in Malawi are devastating. In many countries Covid-19 has led to rapid reshaping of health care services for pregnancy (e.g. reducing all but essential antenatal screening, reducing number of antenatal checks) and for pregnant women (e.g. self-isolating in the third trimester). Much of this will almost certainly be impossible to implement in Malawi. We aim to conduct a rapid evaluation of the situation in order to directly inform and drive best practice. Objectives General objective: To understand the early impact of Covid-19 on maternity services in both rural and urban Malawi. Specific objectives: 1. To acquire views from health care providers looking after pregnant women on the changes that have been made in health service delivery and their working environment during the COVID-19 pandemic. 2. To gain views from women who are currently or recently pregnant about changes that have been made in their antenatal care, birth plans and health seeking behaviours during the COVID-19 pandemic. 3. To find out whether pregnant women and service users have been reached with COVID-19 information, and whether they are able to comply with government advice 4. To understand whether health needs of pregnant women are being met during the COVID-19 pandemic. Methods The study will take place in sites where the DIPLOMATIC partnership (established to evaluate interventions to prevent stillbirth and complications of premature birth) is planning intervention trials. This includes the Malawi Epidemiology and Intervention Research Unit (MEIRU) has well-established infrastructure – Chilumba in Karonga District and Area 25 in Lilongwe and Chileka, Zingwangwa, Limbe and Bangwe in Blantyre District. We will train data collectors to administer telephone questionnaires from their homes, with precautions in place to ensure confidentiality and data security. Potential participants will be identified through our DIPLOMATIC network of participating maternity service providers. We will recruit a sample size of 16 facility staff and 24 women split between the study sites. Expected findings: The data collected will allow us to answer key questions including:  What is the availability of personal protective equipment and how has the Covid-19 pandemic impacted on routine antenatal and delivery care?  What are women’s concerns about being pregnant during the Covid-19 pandemic and are these concerns influencing their choices about their healthcare during pregnancy? Dissemination: The study will be written up and submitted to appropriate peer-reviewed journals. The study results will be presented to relevant conferences. Study results and publications will be shared with COMREC. Interim results will be made available to the Government of Malawi, Ministry of Health to inform the public health response to the COVID-19 pandemic.
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Development, implementation, and evaluation of a respectful maternal and newborn care bundle: A mixed-methods study in Malawi and Tanzania, version 1.0
(Kamuzu University of Health Sciences, 2022-06-15) Chimwaza, Angela
Type of research study Prospective implementation study that will use mixed methods: Quasi experimental and Qualitative Problem statement In many settings, women and their babies fail to receive respectful care during pregnancy, labour and childbirth, and the postnatal period. Mistreatment presents as physical, sexual and/or verbal abuse, stigma and discrimination, poor standards of care, poor rapport between women and providers and health system conditions and constraints. Although condemned for decades, few studies have tested interventions to reduce disrespectful care. The broad objective To determine whether implementation of a sustainable Respectful Care Bundle, co-produced with stakeholders, including health workers, and service users across primary, secondary, and tertiary maternity facilities in Malawi and Tanzania, decreases woman-reported episodes of disrespectful care. Specific objectives The specific objectives of this study are to: evaluate the effectiveness of the care bundle by healthcare workers, women and managers; assess the acceptability, sustainability and impact of the maternal and newborn care bundle roll -out. Methodology We will use a positive organisational approach (appreciative inquiry) alongside the Behaviour Change Wheel (BCW), a theory-based method for the design of interventions. Our study has 3 related phases: pre-implementation, implementation and evaluation. We will use mixed methods, including an interrupted time series (ITS), community surveys, process audit, resource utilization questionnaires, in-depth interviews, and structured observations. TheITS will cover more than 30,000 births in each country. Six hundred women will be included in each community survey: before and following intervention implementation. This study will be conducted in Malawi and Tanzania with three sites per country. In Malawi, the study will be conducted at Bwaila, Ethel Mutharika and Mitundu Hospitals. Observations will be conducted at each of the six sites at five time periods. Approximately 80-120 interviews with women, healthcare workers and hospital managers will be conducted representing 60 in each country. A primary outcome (woman-reported episodes of disrespectful care) analysis will take an interrupted time-series approach to allow for possible underlying changes in the rate of respectful care over the course of the study. Disrespectful care rates will be compared between time points in a centrematched analysis. For the qualitative component, interviews and focus group discussions will be taped, transcribed verbatim and analysed through the framework approach. Observations will be analysed descriptively, providing information on occurrence of disrespect in relation to the different typologies. Routinely collected clinical data on pregnancy outcomes will be aggregated monthly and analysed using an analogous time series approach to the primary outcome. Expected findings and their dissemination It is expected that findings from this study will reduce the incidence of disrespectful care at in Mitundu, Bwaila and Ethel Mutharika hospitals with a high probability of successful roll-out at national level as well as to other lowand middle-income settings. Active dissemination will include conference presentations and publications in academic peer reviewed open access journals balanced with publicly accessible sources. The results will also be disseminated to the College of Medicine Research Ethics committee (COMREC).
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Effects of long-term utilization of hormonal modern contraceptives on fertility among women of child bearing age in Blantyre
(Kamuzu University of Health Sciences, 2022-03-16) Mita, Jean
Type of research study: A quantitative cross sectional study using structured interviewer administered questionnaires. Problem: Use of long acting reversible contraceptives has become increasingly common owing to their notable positive impact on women’s reproductive health. However, less epidemiologic studies on their effect on return of fertility have been done and results have been varying and inconclusive. Practically, fertility return after discontinuation of contraception remains one of the major concerns for women and negatively impacts utilization of modern contraceptives. Infertility is a common experience among women and men worldwide, but remains on the margins of public health and medicine in low-resource settings. However, in African countries, which have a cultural preference for high fertility it can lead to stigma, social ridicule, stress and even divorce which in turn can cause mental health problems. The prevalence of primary infertility rate is at 2%, but secondary infertility rate is at 17% in couples between 20 and 44 years old. This rate is considerable and falls in the upper middle range of infertility rates in sub Saharan Africa, which range from 5% to 23%. Although infertility has an impact on social and mental well-being, the effects of modern contraceptives on fertility in women of childbearing age in Malawi is not known. Objectives: The broad objective of the study is to assess, the effects of modern contraceptives on fertility among women of child bearing age in Blantyre, Malawi. The specific objectives are : to estimate prevalence of women who have had a child before and fail to conceive 2 years after discontinuation of injectable contraceptive method, to estimate prevalence of women who have had a child before and fail to conceive 2 years after discontinuation of oral contraceptive methods, determine child spacing among women who do not use modern contraceptives and compare time taken from discontinuation of contraception to conception between women using oral contraceptives and injectable contraceptives. Methodology: The study will be conducted in Blantyre, at Queen Elizabeth central hospital which is a referral hospital for most clients with infertility problems from all health centers in the district as well as neighboring district hospitals. A total of 246 women of child bearing age between 25 – 49 will be enrolled from gynecology outpatient clinic. Verbal and written consent will be sought from participants before data collection and confidentiality will be maintained throughout by use of codes. Social distancing shall be practiced and face masks shall be worn throughout the interview session. Data will be analyzed using STATA version 14. Descriptive analysis will be used to compute proportions along with their 95% confidence intervals. Expected findings and dissemination: The findings of the study have the potential of informing safety of modern contraceptive methods and allowing informed decision making on choice and duration of use for contraceptive methods. Results from this study will be presented to the College of Medicine Research and Ethics Committee (COMREC) secretariat. The findings will also be communicated to the Blantyre District Health Office and Queen Elizabeth Hospital reproductive health departments /units. In addition, the findings will be disseminated at college and national research dissemination conferences.
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Exploring factors that influence uptake of ferrous sulphate among pregnant women attending antenatal care services at Queen Elizabeth Central Hospital (QECH) in Malawi
(Kamuzu University of Health Sciences, 2021-12-16) Nyika, Lyness
The type of research study This will be a qualitative study which will use phenomenological approach involving in-depth interviews with the health workers and pregnant women attending antenatal care services at Queen Elizabeth Central Hospital in Blantyre, Malawi. The problem to be studied Poor adherence to ferrous sulphate supplementation among pregnant women which contributes to iron deficiency anaemia during pregnancy and eventually leads to maternal and neonatal deaths. The objectives Broad objective:  To explore factors that influence uptake of ferrous sulphate supplementation in Antenatal women at Queen Elizabeth Central Hospital. Specific objectives: 1. To identify the individual and community factors that influence uptake of ferrous sulphate uptake among pregnant women. 2. To explore the health system factors that affect uptake of ferrous sulphate uptake among pregnant women. Methodology Study design: It will be a qualitative study which will use a phenomenological design involving in-depth interviews with the pregnant women and health workers. Study Setting: The study will be done in Blantyre southern part of Malawi. Blantyre is an urban District with an estimated population of 661,256 with 325,022 females. The participants will be recruited from the Antenatal Clinic at Queen Elizabeth Central Hospital. Study population: All health workers and pregnant women attending Antenatal care services at Queen Elizabeth central hospital in their second and third trimester since ferrous sulphate is given in these trimesters. All women who are in first trimester and health workers not working at antenatal care clinic will not be included. Sample size: In-depth interviews with pregnant women. Phenomenological studies recommend 5-25 participants [6]. This study will comprise of 20 participants (15 pregnant women and 5 nurses). but ultimately the number of participants will depend on when saturation is reached. Data collection process: An authorization letter from QECH will be obtained, followed by sensitization of antenatal clinic staff and potential participants on the study in order to gain consent. Thereafter, participants will be recruited into the study. Data management and analysis: Analysis will be thematic in which data collection and analysis will be done concurrently to determine if saturation has been reached. For the protection of participants, all names will be masked during consenting to avoid inclusion of identifiable information in the analysis files. Data collected will be organized into digital files and create a file naming system to ensure materials can be easily located in large databases of text for analysis. Expected findings and their dissemination: The study is expected to find out about facilitators and barriers to ferrous sulphate uptake among pregnant women which will inform policy makers to enhance uptake. The report is going to be submitted to Kamuzu University of Health Sciences Library (formerly College of Medicine), The University Research and Publication Committee (URPC) (through the KUHES Secretariat) and QECH Research committee. The research findings will be disseminated through holding dissemination seminar/workshop and publication of a manuscript.
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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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Factors associated with utilization of intrauterine contraceptive devices (IUCD) among women of child bearing age seeking family planning services at Mangochi district hospital, Version 1.0
(Kamuzu University of Health Sciences, 2022-05-19) Nkonde, Emmanuel; Ndawala, Maria; Machira, Ireen; Sinkala, Charity
Type of study This will be a descriptive cross-sectional study utilizing a mixed method approach. The problem to be studied. Intrauterine contraceptive method involves the use of copper-bearing intrauterine device (IUCD) which is a small, flexible plastic frame with copper sleeves or wire around it. It is a highly effective, reversible and long acting contraceptive method which offers long term pregnancy protection. A specially trained health care provider inserts it into a woman’s uterus through the cervix.(1) If inserted properly, this method proves to be very effective with pregnancy occurring once in every 100 women using an IUCD the first year, 6 per 1000 women who use IUCD perfectly and 8 per 1000 women as commonly used. This entails that 992 to 994 of every 1000 women using IUCD may not become pregnant. It is the best long term family planning method because it is non-hormonal, has less side effects and can easily be reversed (2). An IUCD helps to prevent unplanned pregnancy, endometrial and cervical cancers and also reduces risk of ectopic pregnancy. Once inserted, it does not attract extra cost or frequent visits to the hospital and to keep it effective. Despite the stated benefits, only 1% of women in Malawi are utilizing it (3). Furthermore, Mangochi District Hospital registered 0.48% usage of IUCD from October to December 2021 hence the quest to find out factors associated with the utilization.(4) Objectives. The study aims to assess utilization of Intra Uterine Contraceptive Devices among women of child bearing age at Mangochi district hospital. Specifically the study seeks to; identify the competences of health care workers (HCW) in providing IUCDs, Assess the knowledge of the women on IUCD and to determine women’s perceptions towards use of the IUCD Methodology This is a descriptive cross-sectional study utilizing mixed methods approach. A sample of 171 participants will be recruited in this study using non probability sampling method. Quantitative data will be collected using a structured questionnaire which will be administered by the researchers while qualitative data will be collected using in-depth and focus group discussions guides. The data will be analyzed using SPSS 23 and Nvivo for the quantitative and qualitative components respectively. Expected findings The outcome variables shall be knowledge of women on intrauterine contraceptive devices (IUCD) and their perceptions towards the use of IUCD with independent variables that shall be: Competencies of health care workers in providing IUCDs. Other independent variables shall include age, parity, educational level, religious affiliation and source of information. Dissemination The findings of the study will be disseminated to Kamuzu University of Health Sciences (KUHES) Research and Ethics Committee, KUHES library, and Mangochi District council. Finally, a manuscript will also be submitted to peer reviewed journals for publication.
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Hypertensive disorders of pregnancy: An assessment of prevalence and care of preeclampsia-eclampsia patients at Queen Elizabeth Central Hospital (QECH)
(Kamuzu University of Health Sciences, 2022-07-25) Rashid, Bakali; Davis, Caroline; Chasi, Panache; Casten, Chikumbutso
Type of study: The study will be a retrospective cross-sectional study, comprising of both qualitative and quantitative data. 1.2 Research Problem There is a growing burden of Non-Communicable Diseases (NCDs) including hypertensive disorders of pregnancy. Despite current strides in medicine, hypertensive disorders of pregnancy still cause substantial morbidity and mortality. There is also paucity of local data on prevalence and risk factors for hypertensive disorders of pregnancy. This study will therefore seek to fill the informational gap on prevalence of preeclampsiaeclampsia, and common risk factors, and will seek to understand current disparities in the healthcare system by investigating the facilitators and barriers to care of preeclampsia-eclampsia at Queen Elizabeth Central Hospital. 1.3 Objectives Broad Objective: To assess the prevalence, risk factors and management of gestational hypertension amongst pregnant women attending Queen Elizabeth Central Hospital (QECH), Blantyre. Specific Objectives: 1) To explore the prevalence of preeclampsia and eclampsia amongst pregnant women attending QECH between July and December 2021 2) To investigate the age group most affected by preeclampsia and eclampsia 3) To describe sociodemographic and maternal factors associated with preeclampsia and eclampsia 4) To describe management practices for preeclampsia and eclampsia at QECH maternity unit. 1.4 Methodology The study will include pregnant women admitted and treated at QECH between July and December 2021 diagnosed with a diagnosis of hypertensive disorder of pregnancy. Through objectives 1 and 2: 25-Jul-2022 In patient registers at Antenatal Care (ANC), Labor Ward (LW) and Post Natal Care (PNC) for the period will be reviewed to identify women diagnosed with hypertension and based on the list case notes of the women will be extracted from medical records office as well as those critically ill having either survived or passed. Data on socio demographic profile of the patients such as age, residence and underlining conditions will be extracted from said files. Additionally, data on disease diagnosis, treatment and outcome will also be extracted from the same registers. For objective 3, we will interview clinicians and nurses at the facility on their management as compared to the standard treatment guidelines of preeclampsia and eclampsia. Sampling strategy will be purposive sampling and the sample size will be 40. Data will be collected using questionnaires and interviews. Inclusion criteria will be all patients above 18 years of age diagnosed with preeclampsia and eclampsia. 1.5 Expected Findings • We expect to have a higher prevalence of preeclampsia and eclampsia at QECH compared to any other hypertensive disorders of pregnancy. • We expect that most women will have little knowledge on symptoms and care of preeclampsia and eclampsia • We expect that QECH treats preeclampsia and eclampsia according to the standard treatment guidelines set by the WHO. • We expect that misdiagnosis plays a key role in the mismanagement of the condition 1.6 Dissemination Study results will be presented at the research dissemination conference at KUHES in Blantyre, Malawi. A report submitted to the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, the Health Sciences Research Committee (through the COMREC Secretariat), the University Research and Publication Committee (URPC) (through the COMEC Secretariat) as well as the QECH Paediatrics department.