Maternal & Child Health

Permanent URI for this community

https://rscarchive.kuhes.ac.mw/handle/20.500.12988/616

Browse

Now showing 1 - 20 of 71

Restricted
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.
Restricted
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
Restricted
Adapting and implementing group-based postpartum/well-child care at clinics in Blantyre District, Malawi
(Kamuzu University of Health Sciences, 2021-07-29) Gresh, Ashley
Type of Research Study: A mixed methods study. The Problem: Postpartum care, defined in this study from the time of birth through the first year, sets the stage for long-term health and well-being for both the mother and her child; further it is a critical time to reduce maternal and infant morbidity and mortality. The World Health Organization (WHO) recommends that every mother and baby should have at least four postpartum visits within the first six weeks of giving birth. The first year after childbirth is a period of not only physical recovery but is an important time to identify and manage health and social challenges including psychosocial adaptations and transitions to a parental role, that make women and children vulnerable for poor health outcomes. Globally there is no standardized package of care for the first year postpartum. Further, there are low rates of postpartum care attendance, revealing women’s unmet needs during this critical period in their life course. Sub-Saharan Africa, including Malawi, has some of the highest rates of maternal and infant mortality (MMR 439 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births) globally. High rates of maternal and infant morbidity and mortality and preventable illness and disease necessitate transformation in the delivery of postpartum and wellchild care in this critical time in the maternal/infant life course. There is a need to develop through innovative strategies a postpartum/well-child care model that is sensitive to maternal-infant dyads in low resource contexts where rates of maternal and infant morbidity and mortality are high. Objectives: Main objective: The purpose of this study is to adapt, implement, and evaluate the feasibility and acceptability of an integrated postpartum and well-child care group-based healthcare model, called CenteringParenting, in Blantyre District, Malawi. Specific Objective 1: Explore Malawian women’s expectations for culturally appropriate postpartum and well-child clinic care. Specific Objective 2: Co-design with Malawian women, midwives and community volunteers an adapted prototype of group postpartum/well-child care. Specific Objective 3: Examine the acceptability of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi. Specific Objective 4: Examine the feasibility of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi.Methodology: The proposed mixed methods study will use the five-steps of design thinking approach to adapt CenteringParenting: 1) empathize (interviews); 2) define (data analysis); 3) ideate (incubator sessions); 4) prototype (data analysis); and 5) test. This will be done through a rapid ethnographic assessment through interviews and incubator sessions with women, health surveillance workers, community volunteers and providers to create the group postpartum/well-child care prototype. The prototype will then be tested to determine feasibility and acceptability in the Malawian context through interviews, focus groups and surveys. Expected findings: We expect to co-create a prototype for group-based health care for the first year of postpartum and well-child care that will be acceptable and feasible. The findings will inform the next step in future research to determine the effectiveness of the CenteringParenting program model in Malawi. Dissemination of results: Results will be disseminated to the global research community through international journal publications and presentations at international and national research conferences. We also plan to present results at the COMREC conference, an excellent venue that is attended by policy-makers and researchers in Malawi.
Restricted
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.
Restricted
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.
Restricted
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
Restricted
Assessment of burden and risk factors associated with soil transmitted helminth infections among adolescent girls (10-19 years of age) in Katete District of Zambia: A cross-sectional study
(Kamuzu University of Health Sciences, 2021-08-01) Tapisha, Buumba
Type of study-A cross-sectional study The problem: Over 688 million girls and women of reproductive age (WRA) are at risk of STH infections, with 26% of girls and WRA found in Africa. Infections among girls and WRA remain a concern because of their association with anaemia among unpregnant girls and women, maternal anaemia, foetal morbidity, and mortality. Information on subpopulations (like adolescent girls and women of reproductive age) in the district at risk remains unknown, making it difficult to plan and implement interventions as guided in the new NTD roadmap 2021-2030. Objectives: To assess the burden and risk factors associated with Soil-transmitted helminth infections among adolescent girls in Katete District of Zambia. Specifically, to 1. To estimate the prevalence of STH infections among adolescent girls in Katete district, 2. To determine the intensity of STH infections 3. To determine socioeconomic, behavioral, and environmental health factors associated with Soil transmitted helminth Methodology: A cross-sectional study to be conducted in Katete, a rural district in the eastern province of Zambia. Adolescent girls aged between 10 and 19 years will be enrolled in the study as participants. The Sample size is 206 inclusive of a 20% additional number to account for non-response. A multistage sampling will be used to get the study participants. The district has 10 zones that have a total of 105 schools (inclusive of private schools). Cluster random sampling will be used to sample 4 zones and a stratified random method to select 3 schools from each zone to come up with 12 schools. Systematic sampling methods will be used to select 17 study participants from each school (with two schools contributing 18 participants each) to get 206 participants. Primary data will be collected using a structured questionnaire administered by an interviewer/research assistant (to collect demographic, socio-economic, behavioral, environmental-related data). Stool samples will be collected in leak-proof containers from eligible children and analyzed using Kato-Kaz technique to quantify the infections. All statistical analysis will be performed using STATA software version 14. Proportions for infected will be computed to report prevalence and intensity of infection. Crude egg count will be classified light for eggs less than 5000EPG and heavy above 5000 to compare egg count values between different ages, gender and catchment areas. Descriptive data will be analyzed using appropriate summary statistics. Categorical variables will be reported as absolute frequencies with associated percentages, Chi-square test to ascertain the association between categorical independent variable and risk factors associated with soil-transmitted helminth infections. Multivariate Logistic regression to assess factors associated with soil-transmitted helminth infections with 95% confidence interval and significance level set at 5% Expected findings and dissemination: Expected to show the burden of STH by species and intensity of infections and factors associated with soil-transmitted infections. This information will help inform programming against STHs. The findings of the study will be documented in a report and shared with Katete District Health Office, Katete District Education Office, Provincial Health Office, ZNHRA, and COMREC. An oral presentation will be done to Katete District Health Management Team and KUHeS research dissemination conference. The results will be published in a peer-reviewed journal.
Restricted
Assessment of factors associated with retention of HIV exposed infants in early infant diagnosis program in Lilongwe rural: A crosssectional study
(Kamuzu University of Health Sciences, 2021-11-09) Phensere, Julia
The type of research study: This is a cross-sectional study to determine factors associated with retention of infants in the Early Infant Diagnosis program. The problem: The Malawi Country Operational Plan, strategic summary of March, 2020 indicated that rigorous analyses of patient level data and partner performance has identified the retention of clients as the single greatest threat to a sustainable HIV response in Malawi. Data obtained from some health facilities in Lilongwe District shows low retention rates. In the first quarter of 2021, the HIV department reported that Nkhoma Hospital had attrition rate of 17% at 12 months into the EID program and 35% at 24 months, Mitundu had 12% attrition at 12 months and 21% at 24 months, Nathenje had attrition of 15% at 12 months and 22% at 24 months. This study seeks to assess factors associated with retention in the EID Programme in clinics in Lilongwe rural, Malawi. Objectives: Broad objective To assess factors associated with retention of HIV exposed infants in the early infant diagnosis program (EID)in clinics in Lilongwe rural, Malawi. Specific objectives 1. To determine parents/guardians of HIV exposed infants perceived threats associated with retention of HIV exposed infants in EID 2. To Identify the perceived benefits associated with retention of HIV exposed infants in EID 3. To determine the social-cultural factors associated with retention of HIV exposed infants in EID Methodology This Cross-sectional study employing a Barrier Analysis approach will be conducted at Nkhoma Mission Hospital, Ntenthera Health Centre, Nathenje as well as Mitundu Rural Hospital. The study population will be parents/guardians of HIV exposed infants 0-24 months of age. The sample size will be 90, 45 doers and 45 non-doers. Doers are those that do the behavior, in this study doers will be the infants who are consistently retained in the program while non-doers are those that do not do the behavior, in this study non-doers will be those infants that are loss to follow. Data will be collected using a pre-designed barrier analysis questionnaire template, the template will be utilized to develop questions specific for this study. Data will be kept in lockable cabinets. It will be entered on barrier analysis predesigned data analysis software. Expected findings and their dissemination The study expects to find factors that are associated with retention of infant in the EID program. The factors that promote retention as well as those that derail it will be identified through this study. It is expected that the study will uncover sociocultural factors, perceived threats as well as perceived benefits of retaining infants in the EID program. The factors could be socio-economic, religious, cultural, individual/personal factors, community factors, health facility. Studies have shown motivating factors to continue in the Programme to be a wish to have a healthy baby while barriers to be denial of the actual HIV status, lack of disclosure of HIV status, fear of side effects of the drugs, lack of support, unsynchronized hospital appointments for mother and babies among other issues. The findings of the study will be shared with Nkhoma Mission Hospital, Lilongwe District Health Office as well as Kamuzu College of Health Science’s Library. A manuscript will be developed from the findings which will be submitted to a peer review journal for publication
Restricted
Assessment of prescription patterns and cost analysis of oncology drugs used in the Paediatric Unit of Queen Elizabeth Central Hospital, Malawi
(Kamuzu University of Health Sciencies, 6-09-21) Kilowe, Carlos Edwin
Background: Cancer is one of the global leading causes of childhood morbidity and mortality. High childhood cancer mortality rates in developing countries have been linked to irrational chemotherapy prescribing patterns. Irrational prescribing leads to ineffective treatment, occurrence of adverse events, prolonged hospitalization and increased economic burden to patients and their community. Children are more vulnerable to effects of irrational prescribing owing to their underdeveloped pharmacokinetic and pharmacodynamic profiles. Therefore, it is important to follow principles of rational prescribing as well as study prescribing patterns in order to ascertain how drugs are being used. Despite the need for periodical assessment of prescribing patterns and cost analysis, Malawi has a paucity of data on prescribing patterns and cost analysis of pediatric anticancer drugs. Objectives The objective of this study is to assess prescribing patterns and costs analysis of anticancer drugs used in paediatric cancer patients at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methodology A retrospective cohort study will be conducted in pediatric oncology unit at Queen Elizabeth central hospital (QECH). The study will review and abstract data from patients’ files of children aged 0-18 diagnosed with cancer between January 2017 and December 2020. Rationality of prescribing patterns will be assessed using WHO rational prescribing indicators. The WHO indicators include: average number of drugs per encounter, percentage generic prescribing and drugs prescribed from national formulary. Quantity of drugs dispensed from the patient files will be used to compute cost of the drugs using current market prices obtained from Central 21-Aug-9 Version 6 xii Medical Stores catalogue and private wholesale supplier. Descriptive data analysis will be conducted where continuous variables will be summarized as mean and standard deviation. Frequencies and proportions will be computed for categorical variables. Regression analysis will be carried out to summarize possible relationships between anticancer prescribing patterns and predictor variables such as patient’s demographic data, cancer type and stage, and type of medications used. The level of significance will be set at 0.05. Expected findings The study is expected to shed light on rational chemotherapy prescribing patterns and cost of chemotherapy prescription in Malawi. Rational chemotherapy use improves childhood cancer clinical outcomes, reduces occurrence of adverse reactions, and optimizes health expenditure on chemotherapy drugs. Dissemination The findings of this study will be shared with University of Nairobi, Kamuzu university of Health sciences and Queen Elizabeth central hospital. The findings will also be published in peer reviewed journal.
Restricted
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.
Restricted
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
Restricted
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.
Restricted
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.
Restricted
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
Restricted
Child development study (CDS: Evaluation of effectiveness of low cost, high frequency and high-quality data to identify the main constraints and drivers of childhood and adolescence development in Malawi
(Kamuzu University of Health Sciences, 2022-07-26) Phuka, John
This a cohort study with multiple end point to evaluation impact of digital technologies of determinants of child growth and development. Problem In developing countries like Malawi, children are trapped in a cycle that, from the getgo, offers them very limited opportunities to escape poverty and under-development. Malawian children will grow up in an environment without basic nutrients to properly develop and might potentially die from diseases that could have been otherwise prevented at low cost. This cycle can only be broken if the right interventions for each child reach them at the right time. Given hard resource constraints, this requires evaluating tradeoffs based on what are the most cost-effective interventions to address each of the issues hindering child development in each setting. However due poor data collection in poor countries, programs targeted at children and adolescents often have to be scaled up or down in the absence of rigorous evidence about their impacts. Lately poor modelling data from reliable data has made it difficult to reliably model pattern of Malawian epidemics. High frequency social-behavioural data will enable Malawi make more accurate estimations and models based of unbiased data independently determined by digital sensors. Aim and Objectives Our study aims to assess impact of high frequent data collection using wearable digital technologies. Specifically our objective is to evaluate impact of real-time program evaluation through multiple; to assess effectiveness of high frequency data on children’s non-invasive biomarkers (from heart rate and variability to brain waves) and symptoms; and to determine social interaction between parents and children and other social contacts (including caregiver-child interactions); and impact of health promotion For example, we can analyse how handwashing habits can reduce the spread of infections like COVID-19. Further the study will evaluate the impacts of these messages on the behaviours and symptoms tracked by phone surveys, with the ability to understand trends and calibrate interventions in real-time. Methods The study is longitudinal prospective cohort with nested intervention study on health promotion. Data collection includes socioeconomic and behavioural data with end point non-invasive biomarkers. In combination with rapid experimentation, these data allows policies to be evaluated in real time. With the help of machine learning algorithms, the data also feeds earlywarning systems to empower community health workers to detect problems at an early stage – especially when it comes to epidemics like COVID-19 – and to implement immediate and preventive measures to address them. Last, combining experimentation with predictions allows for program personalization, such that each child and adolescent can benefit from the interventions most likely to benefit them. Expected Findings Like during the extensive pilot phase over the course of 2019, we have shown that this approach is able to collect high-frequency, high-quality and inexpensive data by adapting wearable sensors and phone surveys to the local setting specificities. Early results are encouraging, but further investigation to document how real-time program evaluation and personalization can be scaled up with the help of the right technologies and under the appropriate legal and ethical framework. The social-behavioural data based on contact sensors will likely model pattern of care for child stimulation as well as pattern of likely spread of diseases like diarrhoea, upper respiratory tract infection (like COVID 19 and common viral colds). This study will be especially important and beneficial under the current epidemic shock of COVID-19. Health promotion intervention through sending mobile nudges (reminders and encouragement messages) through SMS will allow us determine factors associated with behaviour output and help resolve compliance challenges to adherence to preventive behaviours to infections (lately we see decline in COVID-19 prevention measure irrespective awareness campaigns) Dissemination of Findings The findings will be disseminated through peer research conferences, publication in peer reviewed journals and COMREC. The data will be made public after peer reviewed journal are published for possible re-analysis and teaching.
Restricted
Children’s air pollution profiles in Africa (CAPPA) v1.0, 20/02/21
(Kamuzu University of Health Sciences, 2021-06-03) Rylance, Jamie
Executive Summary - The type of research study This is a multi-centre observational cohort study about air pollution in African children. The centres included are in Malawi, Tanzania, Uganda, Zimbabwe, Ghana, South Africa, and Nigeria. - The problem to be studied There is extensive literature on the wide-ranging health impacts of exposure to air pollution on populations. Children are vulnerable due to their developing bodies (Gehring et al., 2013, Gauderman, 2007); evidence shows that children’s lungs exposed to higher levels of air pollution have less volume than those in cleaner areas (Mudway et al., 2019). While personal exposure studies are becoming established in Europe, no such large-scale studies have yet been carried out on the African continent. This study aims to close that gap, providing valuable evidence to help improve the health of Africa’s young population. - The objectives [i] Broad The study aims to describe the burden of personal air pollution exposure (particulate matter <10 and <2.5 microns (PM10/2.5), and nitrogen dioxide (NO2)) in urban children with asthma symptoms in sub-Saharan Africa, its geographic, and temporal variability, the role of indoor and outdoor microenvironments and activity profiles, and effect of socioeconomic variables. To assess how personal air pollution exposure affect children with asthma symptoms in urban Sub-Saharan Africa, and the influence of socioeconomic factors on the effects. [ii] Specific 1. To collect personal air pollution exposure data, activity profiles, and lung function measurements from 60 children with asthma symptoms aged between 12 and 14 years, in Blantyre, Malawi. 2. To analyse personal air pollution data for exposure patterns and peak exposures. 2.3., and tTo compare air pollution as well as activity profiles of children in relation to their socioeconomic and geographical backgrounds both within and between countries, and compare with measured data from school-age children in London. 3.4.To explore potentially detrimental effects of air pollution, and feasibility of mitigation strategies in children with asthma symptoms identified by ACACIA. - Methodology From March 2021, we will recruit 60 children who participated in the ACACIA study. The participant will be provided a backpack fitted with air monitoring equipment to carry and keep close to them. Each child’s exposure to NO2 and PM2.5, as well as their GPS-location, temperature and humidity, will be collected at a 1-second intervals for 96 hours, and stored on a microchip within the backpacks’ logging unit. The data analysis procedure will follow that developed for a previous similar study in London – ‘Breathe London Wearables’1. Once monitoring at a site is complete, encrypted data will be uploaded from the backpack sensor units to a secure server where it will be decrypted. The digital CAPPA questionnaire will be filled in by each participant and will provide additional information regarding each participant’s personal exposure. Participants will also measure and record their lung function twice a day using a peak flow meter. - Expected findings and their dissemination This study will increase knowledge on air pollution exposure of young people in Blantyre, Malawi. The study will provide data on exposure to harmful pollutants and the risk to children’s health in this increasingly urbanised region. Links between data on respiratory health of young participants who experience asthma symptoms with air pollution exposure data will be explored and will lead to new insights. A copy of the final report, published papers, and conference abstracts will be submitted to; the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences Research Committee, and the University Research and Publication Committee.
Restricted
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.
Restricted
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.
Restricted
Determinants of mortality in neonates with culture negative sepsis: Implications for antimicrobial stewardship
(Kamuzu University of Health Sciences, 2021-09-15) Ghambi, Lughano
Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. This study aims to assess the factors associated with mortality among neonates with culture-negative sepsis by describing their characteristics and comparing the risk factors associated with death amongst those that died and survived. We will conduct a secondary analysis of a cross-sectional study investigating risk factors of neonatal sepsis which was conducted between May 2018 to May 2019 at Queen Elizabeth Central Hospital (QECH), Chatinkha Nursery. Rationale: Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. Primary Objective:To assess the factors associated with mortality among culture negative sepsis neonates in a unit in Malawi. Secondary Objective: To describe the characteristics of the neonates with culture negative sepsis To compare the risk factors associated with death in neonates with culture negative sepsis neonates amongst those that died and survived Study Type: Cross-sectional study (retrospective analysis) Place of study: Queen Elizabeth Central Hospital, Chatinkha Nursery Study population: All neonates with culture negative sepsis from the primary study Sample size: All neonates with culture negative sepsis from the primary study Possible constraints: No major constraints anticipated but the data collection for the study is complete, and therefore the analysis will have to be based on the existing dataset. Dissemination: Results will disseminated through posters, oral presentation and publications
Restricted
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.