Obstetrics & Gynaecology

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Acceptability, feasibility and economic studies in the context of the Improve & improve - 2 trials (MPROVE-ACCEPT)
(Kamuzu University of Health Sciences, 2020-01-28) Manda-Taylor, Lucinda
Title: Acceptability, feasibility, cost and incremental cost-effectiveness of IPTp with dihydroartemisininpiperaquine with or without azithromycin to prevent malaria, sexually transmitted and reproductive tract infections in HIV-uninfected pregnant women (IMPROVE) and HIV-infected women receiving daily CTX (IMPROVE-2 Kenya and Malawi only) in Kenya, Malawi and Tanzania. Short Title: Acceptability, feasibility and economic studies in the context of the IMPROVE & IMPROVE- 2 trials Type of study: Qualitative study employing in-depth interviews and focus group discussions to understand acceptability of IPTp+DP or or without AZ with HIV-uninfected women and HIV-infected women receiving CTX. Problem: Malaria in pregnancy can have devastating consequences for the mother and foetus. Pregnant women are often infected with malaria without showing any outward signs or symptoms which, if left undetected and untreated, can cause anaemia and interfere with the development of the foetus leading to loss of the pregnancy, or premature birth and low birth weight, which in turn increases the risk of early infant death. The World Health Organisation (WHO) therefore recommends a preventive strategy called ‘intermittent preventive treatment in pregnancy’ (IPTp) in which mothers receive a single dose of 3 tablets of medication called sulphadoxine-pyrimethamine (SP) at each scheduled antenatal visit starting in the 2nd and 3rd trimester. However, the effectiveness of this strategy is being compromised due to high levels of resistance to SP in the malaria parasite population in many parts of sub-Saharan Africa. The IMPROVE trials aim to evaluate alternative drugs for the prevention of malaria in both HIV-uninfected (IMPROVE-1) and HIV-infected (IMPROVE-2) pregnant women. The trials will compare the safety, tolerance and beneficial effects of IPTp with DP alone, or combined with azithromycin, to the current strategy with sulphadoxine- pyrimethamine in reducing pregnancy loss, low birthweight, preterm birth and small-for-gestational- age babies, and early infant deaths. In parallel to the trials, we will conduct a series of studies to explore the feasibility, acceptability, cost and cost effectiveness of these two interventions in comparison to the current strategy. Aims and objectives This multi-centre study will enrol about 2,300 pregnant women in Kenya, Tanzania and Malawi and compare the acceptability, feasibility and ‘costs vs benefits’ of IPTp with DP alone, or combined with azithromycin, to the current strategy with sulphadoxine- pyrimethamine. Methods in Brief This is a mixed methods study using a range of quantitative and qualitative techniques. Acceptability among health providers and pregnant women to the two interventions will be assessed by interviewing pregnant women and health providers participating in the trial sites in Kenya, Malawi and Tanzania. In Malawi, only the qualitative techniques to understand acceptability of the interventions will be assessed. Feasibility of implementation will be assessed by delivering the interventions through the routine health system in adjacent sites to the trial in Kenya (only) over a period of 10 months, followed by an evaluation to assess the effectiveness of the health system to deliver the interventions and potential operational hurdles for scale up. Uptake and adherence among pregnant women attending antenatal clinics will be assessed by interviewing women as they leave a health facility and again followed-up at home. Health providers will be interviewed to explore their perceptions and experiences with the new regimens to assess scalability. Collection of cost data will be nested within the feasibility study and the trials and combined with feasibility and data from the trial and use modelling to estimate the incremental costs, benefits and cost-effectiveness of the two interventions compared to IPTp-SP in HIV negative or compared to cotrimoxazole only in HIV positive women. Expected findings: Evidence from qualitative studies in Malawi will provide clarity and useful information on issues around acceptability lity of the delivery and administration of the intervientions so that health care providers and policy makers can make evidence-based decisions on the opportunities and challenges that must be considered when planning for change. Dissemination: Results from this research activity will be disseminated at the CoM Research Dissemination Conference and to specific interest groups, both in meetings / workshops and through conferences, nationally and internationally; and through journal article[s]. Final publications will be shared with COMREC
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Assessing factors that influence service readiness for preterm births in health facilities of Malawi: Evidence from the harmonized health facility assessment survey 2018-2019
(Kamuzu University of Health Sciences, 2021-12-16) Chakholoma, Beatrice Chimwemwe
Type of Research This is a Descriptive Cross-sectional study. Problem statement Preterm birth is a significant cause of death and long-term loss of human potential amongst survivors worldwide. Preterm birth complications are the single most significant direct cause of neonatal deaths, responsible for 35% of the world's 3.1 million deaths a year, and the second most common cause of under-5 deaths after pneumonia [1]. In almost all high- and middle-income countries of the world, preterm birth is the leading cause of child death. While this may be true, disparities exist in the distribution and survival of these babies among regions. However, the burden of preterm births is high in low and middle-income countries, especially those in Sub-Saharan Africa and South Asia [2]. Malawi is one of the countries with a higher incidence of preterm births, estimated at 18.1 percent per 1000 live births [3]. Studies have shown that improving maternal and neonatal care quality would help reduce morbidity and mortality for premature babies. A cross-sectional study conducted in Malawi indicated that delivering at a higher-quality facility is associated with a reduction of 23 deaths per 1,000 live births, which were in line with a study by Winter R et al., which found that facilities that could not provide newborn care in the five countries of the study had a high burden of neonatal deaths. [4,5] Study objectives This study aims at assessing factors that influence service readiness for preterm births in health facilities of Malawi. Specifically, the project will determine the proportion of health facilities that had met the criteria of service readiness for preterm births by the time HHFA was being conducted, identify the characteristics of health facilities with service readiness for preterm births and determine the extent of differences of Service Readiness for preterm birth care by geographical location, Rurality, urban and staff satisfaction and level of health care. Methodology. This is a descriptive cross-sectional study using secondary data from the Health Facility Assessment Survey. The sample for health facilities which were assessed during this survey will be used. Using the Service Availability and Readiness Assessment tool. Variables of interest will be extracted from the HHFA data sets. The outcome of interest is preterm birth Service Readiness Quality and the Predictor outcome are the characteristics of health facilities. A quality index for preterm birth service readiness will be generated from these five domains of Service Readiness. Summary scores of the five domains of service readiness will be made for each health facility. Permission will be sought to use the survey data and the proposal will be sent to College of Medicine Research and Ethics Committee for approval. The extracted variable datasets will be analyzed using STATA version 14.1 Expected findings and their dissemination The investigator expects to find high readiness scores in urban than rural hospitals due to challenges of geographical location which might affect distribution of resources. Government facilities are expected have inadequate medicines and equipment due to challenges in funding The investigator also expects to find out why other facilities will have higher scores or low scores of service readiness despite having same facility characteristics. A copy of the final report of the research findings will be submitted to College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, The Health Sciences Research Committee, The University Research and Publication Committee (URPC) (through the COMREC Secretariat) and to Center for Medical Diagnostics who recommended further analysis of the survey findings. The results will also be presented at conferences.
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Assessing quality of documentation and interpretation of obstetric ultrasound scan performed by midwives at St Martins Hospital and Namwera Health Centre in Mangochi District
(2022-04-11) Kulale Upindi, Thoko
A cross-sectional study design and will employ quantitative method. Quantitative data will be obtained from routine data thus registers and health passport books of women that received obstetric ultrasound scanning services done by midwives. The sample size 220. Quality of care delivered during antenatal affects the health outcome of both the mother and the baby being expected. The introduction of ultrasound scanning services in antenatal clinic is believed to improve both maternal and fetal outcome as ultrasound scan (USS) helps in diagnosis of fetal viability and anomalies, identification of high risk factors such as low lying placenta, determination of gestational age and estimation of date of delivery which helps the mother to plan for delivery in time. World Health Organization recommended that USS should be done in all pregnant mothers before 24 weeks gestation and that midwives can provide the ultrasound USS services. In midwifery practice documentation is very important as it gives a proof of recording and reporting of the care or intervention done. When a midwife has performed an USS, it is expected that the findings should be documented in the register and health passport book. This report will help the next provider to know the findings and help in the plan of care. Therefore, this study seeks to assess quality of documentation and interpretation of obstetrics ultrasound scan performed by midwives at St Martin’s hospital and Namwera health centre in Mangochi district. Methodology This will be a cross - sectional study design using quantitative methods. Data will be collected using routine data collection tools, USS register and ANC mother’s health passport book. Data will be analyzed using excel. Ethical approval will be sought from Kamuzu University of Health Sciences’ College of Medicine Research and Ethics Committee (COMREC). Expected findings and dissemination The researcher is expected to find poor documentation based on other studies in Africa and Malawi related to documentation practice by nurses (1) (2). However there can be a change as this study is assessing documentation practice in relation to ultrasound services since it is a new intervention provided by midwives hey may be motivated to document. The research findings will be presented to Mangochi DHO, Peers at School of Public Health, KUHeS and COMREC. Oral presentation at Consortium for Ultrasound Imaging in Malawi and be published in journal
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Behavioral design for antenatal and postnatal care in Malawi
(Kamuzu University of Health Sciences, 2020-08-25) Mbilizi, Yamikani; Noguchi, Lisa; James, Carlyn
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. Objectives of the study Broad objective: To develop approaches for promoting earlier entry into care, improving continuity of care, and improving quality of care during the antenatal and postnatal periods in Malawi. Specific objectives; To conceptualize new service delivery models or tools / products for antenatal and postnatal care that lead to: a) Earlier entry into care: ensuring that pregnant women are seeking ANC during the first trimester of pregnancy b) Continuity of care: ensuring that mothers are accessing 4-8 ANC visits and delivering in the presence of a skilled provider c) Quality care: ensuring that women receive comprehensive ANC services as outlined in the WHO recommendations. d) Make it desirable for pregnant women to begin ANC within the first 12 weeks of pregnancy e) Enable key influencers at interpersonal and community levels to support pregnant women to begin early and continue with ANC f) Empower women to undertake self-care. According to the WHO, selfcare is the ability of families and communities to promote, maintain and cope with health-related issues with or without the help of a healthcare provider g) Enable formal and informal healthcare workers to understand the need and own the delivery of quality ANC services h) Leverage positive examples of access to care and use these to advise the community to rethink antenatal and postnatal care services Methodology Study Place: The study will take place in rural Blantyre in Mpemba and Mdekha townships. We believe these two locations have few and remotely located health facilities where communities are challenged by limited accessibility to antenatal and postnatal care. We have chosen Limbe and Zingwangwa as peri-urban locations within Blantyre with a diverse community and health facilities that are more accessible, however challenges with antenatal care are present that need exploration and understanding. The interviews, group discussions, and observations will take place in the community at participants’ homes, workplaces, schools and at health facilities. The human centered design workshops will happen at a venue that is convenient for the participants and is appropriate for conducting such activities, such as a community meeting ground, or in a health facility setting. Study Population: Participants will be recruited from among key stakeholders of ANC and PNC services (but not limited to women aged 18-49) and their partners, their parents, community members (including religious and community leaders), teachers, health care workers, and staff of local NGOs.Exclusion Criteria Any individuals who do not meet the inclusion criteria above. Recruitment strategy Three weeks before commencement of data collection, we will work with community mobilisers to approach the local authorities to inform them of the upcoming formative research and the intention to reach out to the various study populations. With the help of community influencers, the mobilisers will thereafter begin to recruit the community members as per the demographic variables described in the inclusion criteria above. The community health workers will provide information on the research purpose and activity and invite them to participate, agreeing on a convenient time and place for individual activities or by sharing details of any group activities. While we have planned to engage potential participants in advance, as above, we will also employ snowball sampling, asking participants who have completed an activity if they could refer us to other community members that may be useful for the formative research On the day of the formative research, the study team will administer the consent forms (availed in Appendix A-C) prior to commencement of the engagement. If the participant agrees to participate in the study, they will indicate by signing the consent form. Recruitment of Formal Antenatal and Postnatal Service Providers Three weeks before commencement of the study, the community mobilisers will inform the formal service providers’ supervisors about this study, so that they can help to identify people within their teams who often provide ANC services, to participate in the study. The selected people will receive a verbal invitation from the community mobiliser, inviting them to participate in the study. They will be given consent documents for one week so that they can have enough time to familiarize with the study objectives and procedures. Before they sign the consent document, they will also have an opportunity to speak to the researchers in order to ask any further questions. Sample Size We will recruit a total of 68 participants to for the study, as detailed in the table below. The justification for engaging these participants is described in the general inclusion criteria above. Data Collection: Through immersive research, we will engage research participants using three main methods which are one on one interactions, group interactive activities and observation. These three methods will employ different techniques which include visual aids, storytelling activities, debates, short dramas and observation guides in addition to the interview guides for each of the three methods. These techniques are aimed at placing the user at the centre of the research process, which ensures that we dig deep into the drivers of current behaviours as well as identify opportunity areas to develop behavioural design interventions. Data Management and Analysis g. Data Management Data collection tools have been developed by ThinkPlace in conjunction with the protocol team. Quality control queries will be routinely generated for study staff resolution. Audio files generated by the in-depth interviews will be transcribed and translated into English by the interviewers at College of Medicine Johns Hopkins Project (COM-JHP). Once the transcripts are cleaned and final, both the transcripts and the interview summaries will be electronically transferred to the central study team at ThinkPlace in Kenya, using a secure file transfer site, where they will be uploaded and managed using a qualitative software package. Video recordings will also be saved on an external hard drive and uploaded and managed using a qualitative software package. The qualitative data from the IDI transcripts, videos and the summary sheets detailing major points of interest from the storytelling and debates will be used to develop prototypes. h. Data Analysis The team will design, prototype and test strategies that build upon the validated hypotheses and address the framed behaviors and decision-making processes. The focus will be to prioritize solutions and develop 3-5-page concept notes for the highest priority solution in each country. The output will be a visual product designed to clearly capture the output and communicate the recommendations in a comprehensive way. The output will be presented in a manner that will give stakeholders the opportunity to get an in-depth understanding of the prototype evolution process. Expected findings We anticipate identifying the most feasible and acceptable interventions for ANC and PNC based on the discussion and interactions with the community participants and identify the most efficient and desirable approach to deliver these interventions. Dissemination plan When study results are available for dissemination COMREC and other relevant stakeholders (Blantyre DHO, representatives from QECH OBGYN department, Community Advisory Board, community gate keepers, health center staff and participants) will be invited to results dissemination sessions at the site. The site will submit an end of study report to COMREC before closing out the study.
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Challenges in implementing the revision of four focused antenatal care visits to eight antenatal care visits in Lilongwe District
(Kamuzu University of Health Sciences, 2021-12-10) Matsuka, Pililani
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. problem. 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 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 in the 8 ANC visits model in health facilities of Lilongwe district. • Specific objectives 1. 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 stratified into urban and rural health facilities. Thereafter, there will be then 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.
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Chatinkha Nursery ultraviolet-C (UV-C) light box use study for disinfection of small medical equipment and devices
(Malawi Liverpool Welcome Trust, 16-03-22) Ginsburg, Amy Sarah
Type of research study Observational and feasibility, usability and acceptability study Problem statement Multi-use, high-touch, shared medical equipment and devices such as thermometers, oxygen saturation probes, stethoscopes, are difficult to clean and provide potential sources of contamination and transmission of antimicrobial-resistant pathogens in healthcare settings. Ultraviolet-C (UV-C) light disinfection has been identified as an effective strategy to potentially decrease hospital-acquired, multidrug-resistant epidemiologically important pathogens. UV-C light box technologies are currently being developed to disinfect masks, gloves, small devices such as mobile phones, tablets, and medical equipment such as stethoscopes. Assessing the feasibility, usability and acceptability of UV-C light boxes for disinfection of multi-use medical equipment and devices in Chatinkha Nursery has the potential to decrease pathogen contamination and enhance infection prevention and control (IPC) measures and warrants further exploration and evaluation. Broad objective To assess the effectiveness of pilot the use of candidate UV-C light boxes for disinfection of frequently used medical equipment and devices for IPC in Chatinkha Nursery. Specific objectives 1. To identify the most frequently touched medical devices in Chatinkha Nursery. 2. To measure the effectiveness of candidate UV-C light boxes to disinfect 2-3 most frequently used small medical equipment/devices used in Chatinkha Nursery. identified by the observations. 3. To determine the feasibility of using , usability, and acceptability of candidate UV-C light boxes for disinfecting multi-use, high-touch, shared medical equipment and devices among health care workers in Chatinkha Nursery. Methodology The study will use observational, quantitative, and qualitative methods including observations, laboratory-based quantitative microbiology protocols, and in-depth interviews with health care workers (HCW) in Chatinkha Nursery and QECH administrators. Expected findings Multi-use, high-touch, shared medical equipment and devices will be identified and it is anticipated that the candidate UV-C light boxes will be effective, feasible, usable, and acceptable for disinfecting multi-use, high-touch, shared medical equipment and devices in Chatinkha Nursery, as a means of IPC interventions. Dissemination Upon completion of our analyses, we will share the data and our findings with Chatinkha Nursery staff, QECH hospital management, KUHES, COMREC and other relevant stakeholders. We will also consider presenting the findings at national and international conferences and in peer-reviewed scientific journals.
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Exploring how to sustain and scale ultrasound scanning during early pregnancy to improve the quality of antenatal care in Malawi and Zambia
(Kamuzu University of Health Sciences, 19-01-22) Lissauer, David
Type of study A mixed methods study design applying qualitative and quantitative methods. The problem The over-arching rationale for DIPLOMATIC is to improve pregnancy care in Malawi and reduce preterm birth, stillbirth and other adverse pregnancy outcomes. The work described here support these aims. First, the Ministry of Health (MoH) of Malawi is committed to the implementation of routine ultrasound dating in early pregnancy to reduce preterm birth and stillbirth. The DIPLOMATIC USS pilot study trained health staff in USS to establish gestational age, the number of foetuses, and Fetal viability. Because staff training will be rolled out widely across Malawi, standardized training tools are paramount. Through participatory workshops, we will develop standardised ultrasound training manuals and identify health systems-related facilitators and barriers to USS in early pregnancy. Second, there is a high prevalence of adolescent pregnancy and associated adverse birth outcomes in Malawi. Through interviews and focus groups with adolescent mothers, their male partners and stakeholders, we will explore provision of USS to adolescents and whether it encourages first trimester attendance. Third, Malawi has committed to halving rates of neonatal mortality and stillbirth by 2030 and adopted World Health Organisation (WHO) guidance on antenatal care. We will use the DIPLOMATIC dataset to describe the quality of antenatal and pregnancy care being delivered against selected WHO guidance. Researchers will co-create a quality improvement (QI) tool to to improve the compliance with WHO recommendations and to empower midwives and pregnant women. Research question DIPLOMATIC in Malawi introduced ultrasound scanning (USS) during early pregnancy. We now seek to understand how scanning can be sustained and scaled up. We will assess the impact of USS on adolescent mothers as an important group who require improved pregnancy services. We will also work with health professionals and policy makers to improve the quality of antenatal care. Broad objective: To exploring approaches to sustain and scale Ultrasound Scanning during early pregnancy to improve antenatal care Specific objectives: Work package 1 1. Assess perceptions of health care workers on the effect of introducing USS service in routine care 2. Identify challenges that implementers and consumers experience with the services 3. Assess facilitators to effective implementation of USS in routine care 4. Explore strategies that enhance uptake, utilization, and availability of the USS services 5. Co-create manuals for successful implementation and scale of USS in routine care. Work package 2 1. Assess the social and contextual factors affecting early Antenatal care attendance for adolescent mothers (aged 10-19) in Malawi 2. Determine effective strategies for promoting early pregnancy dating and correct/appropriate ANC use among adolescent mothers 3. Evaluate impact of adolescence on utilization of USS and correct pregnancy dating Work package 3 1. Assess the quality of pregnancy care being delivered against WHO standards using the DIPLOMATIC dataset and health records 2. Collaborate with providers, patient representatives and policy makers to co-create quality improvement (QI) approaches and tools to improve compliance with WHO guidance 3. Field test the developed tools to enable optimisation prior to evaluation at scale Methodology A mixed-methods research study with qualitative and quantitative methodologies. Qualitative methods include participatory workshops and interviews. Quantitative methods include records review, quantitative survey, and health economics cost consequence analysis. Expected findings This study will identify barriers and facilitators to sustainable implementation of USS during antenatal care. We will develop a clinical training manual, gain insight into the concerns of adolescent pregnant women and construct protocols to ensure clinical practice incorporates key components of WHO guidance.
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Factors affecting utilization of Non-pneumatic Anti-shock Garment (NASG) in management of Postpartum Hemorrhage (PPH) in urban health centers in Blantyre
(Kamuzu University of Health Sciences, 2022-02-09) Nkhula Chauluka, Gloria
Type of research study: Cross-sectional mixed method study. Problem to be studied: Postpartum Hemorrhage is the leading cause of maternal mortality globally and in Malawi. World Health Organisation recommended the use of Non Pneumatic Anti-shock Garment in management of Postpartum Hemorrhage until appropriate advanced medical care is available. Non Pneumatic Anti-shock Garment is a low cost technology that is used on women who have excessive bleeding after delivery. Its purpose is to decreases blood loss in the uterus, hence restore vital signs, and reverse shock in women who have lost excessive blood after delivery until they receive appropriate advanced medical care at Comprehensive Emerency Obtetric Care health facilities. However, in spite of the demonstrated effectiveness and benefits associated with the use of NASG in the management of PPH, its utilization is very low. Therefore, the study will assess the factors affecting utilization of Nonpneumatic Anti-shock Garment in Management of Postpartum hemorrhage. Objectives: The study will assess the factors affecting utilization of Non-pneumatic Anti-shock Garment in Management of Postpartum hemorrhage. Specifically the study will: 1. Assess the prevalence of NASG use among women with PPH. 2. Assess knowledge and practices of midwives on effective use of NASG in management of PPH, 3. Analyze attitude of midwives regarding the use of NASG in management of PPH 4. Examine patients perceptions in use of NASG in the management of PPH. Methodology: The study will sample 83midwives working in health facilities with NASG available: 40 midwives will be included in structured interviews and 43 midwivesin Focus Group Discussions.The study will also sample 12 patients from QECH: 6 patients in structured interviews and 6 patients will be included in Focus Group Discussions. After data collection, data will be entered in a computer using SPSS for analysis.Statistical and thematic analysis will be used to analyse the data. Expected findings and their dissemination: I expect to find out the factors that are affecting utilization of NASG in management of PPH. If found, they can be used to find appropriate measures to increase NASG utilization. The results will help policy makers, program planners and managers, policy implementers and other SRH stakeholders to make informed decisions and to develop strategies that could help Malawi to achieve the SDG of MMR of less than 70 per 100,000 live.Study results will be presented to Blantyre DHO, QECH, KUHeS and COMREC. Results will also be disseminated through professional conferences and events to exchange knowledge and raise awareness of the results.
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A feasibility study of intrapartum GBS testing to guide antibiotic prophylaxis in Malawi
(Kamuzu University of Health Sciences, 2021-06-16) Msefula, Chisomo
Trial Type: Prospective clinical feasibility study Problem: As global child mortality falls, deaths in the first 28 days of life are responsible for a growing proportion of childhood deaths. Infection with Streptococcus agalactiae (Group B Streptococcus; GBS) is recognised as an important cause of meningitis, early onset sepsis and late onset sepsis in neonates. In Malawi, GBS is the most frequently isolated organism detected amongst ill neonates and mortality in those infected with GBS is high. There is a need for a rapid and accurate molecular diagnostic test to detect GBS during labour, so that at-risk pregnant women are identified early enough for effective antibiotic prophylaxis to be used before delivery. Aims and objectives: The aim of the project is to evaluate the feasibility of using the LAMP assay to detect and treat Group B Streptoccci amongst pregnant women in Labour in QECH. Specific of objectives of the study are: I. Determine the proportion of GBS positive women using the LAMP assay, presenting at QECH Labor ward II. Determine the proportion of GBS positive women receiving IAP <4hrs before delivery and any associated adverse events III. Identify logistical factors necessary for routine implementation of the LAMP assay for GBS colonization screening Methodology: This study will be carried out in the Labor ward at Queen Elizabeth Central Hospital. The study population will include all women in active labor, at a gestational age greater than 34 weeks, and the sample size will be 3200. A recto-vaginal swab will be taken at admission and tested for GBS positivity using a molecular diagnostic test (LAMP). If GBS positive, IAP will be administered to the woman prior to delivery and cord blood will be taken upon delivery of the baby. Expected Results and Dissemination: We expect the LAMP assay will be easily implemented by the nurses and help identify women colonized with GBS. The work will likely lead to practical and high-impact clinical interventions to improve child health in Malawi. Results from the study will be presented at local and international conferences and also published in peer-reviewed journals.
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Female Genital Schistosomiasis Among Adult Women Living With HIV, A Case of Mfera Health Centre in Chikhwawa District
(Kamuzu University of Health Sciences, 2022-07-13) Chilewani, Dyton
The type of research study We plan to conduct a cross sectional descriptive study. The problem Schistosomiasis is endemic in the SSA and SH is the most common causative agent among the species. Women and girls are at risk due to water collection for household chores. A study has shown that invasive diseases of the genitourinary organs are cofactors of HIV transmission. Women and girls in SSA region carry a triple burden of vulnerability to HIV, cervical cancer and FGS [4]. The study seeks to find the proportion of women living with HIV who have genital schistomiasis. Establish their knowledge on FGS and long-time consequences of this disease 13-Jul-2022 4 The Objectives Broad Objective To estimate the prevalence of Schistosoma Haematobium among women living with HIV at Mfera health Centre in Chikwawa. Specific Objectives • To determine the prevalence of Schistosoma Haematobium among women living with HIV Mfera health Centre in Chikwawa. • To assess the knowledge on Female Genital Schistosomiasis among women living with HIV Mfera health Centre in Chikwawa. Methodology A total of all adult women who attend ART clinic at Mfera Health Centre in Chikwawa will be included in the study of which 68 will be randomly selected to participate. A questionnaire will be administered and after that participants will give urine which will tested for schistosomiasis using serological method (antigen and/or antibody in urine). Quantitative data will be collected and analyzed with Microsoft Office packages. Expected findings and their dissemination. We expect to find 45 % of the women to have a positive Schistosoma result basing on previous study done on mothers in the district, little or no knowledge at all about FGS The study report will be shared with, the HOD MLS department, COMREC, Chikwawa DHO, Mfera Health Centre
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Health workers' perception and attitudes towards clients seeking post-abortion care services in selected public and private medical facilities in Blantyre, Malawi.
(Kamuzu University of Health Sciences, 2022-01-28) Sokosa, Dalitsolanga
Study Title: Health workers' perception and attitudes towards clients seeking post-abortion care services in selected public and private medical facilities in Blantyre, Malawi. Problem Statement: PAC plays a critical role in reducing maternal morbidity and mortality due to abortion complications globally. Most facilities in Malawi, private or public, offer PAC services; however, it has been noted there is underutilization and most women delay seeking health care after an abortion which has resulted in bad outcomes. Most women prefer to seek PAC services in other places apart from hospitals because of stigma or fear of being stigmatized by health worker providers (1). However, healthcare providers are obligated to provide life-saving medical care to any woman who suffers abortion-related complications, including treating complications from unsafe abortion, regardless of the grounds for abortion. Studies have established that women avoid PAC services because of stigma or fear of stigmatisation of healthcare providers (1–4). Furthermore, the reception of these women at the health facilities is crucial as it determines whether the women will come again or never visit the facility. In addition, no study has looked explicitly at health workers' perceptions towards women who seek PAC services. Therefore, there is a need to explore health workers perceptions towards women seeking PAC services.Postabortion care (PAC) global . workers' perceptions of Health-care providers are obligated to provide life-saving medical care to any woman who suffers abortion-related complications, including treating complications from unsafe abortion, regardless of the grounds for abortion. Broad Objective: To explore health workers' perceptions and attitudes towards women seeking post-abortion care services. Specific objectives 1. To explain health workers' perceptions towards women who seek postabortion care services. 2. To explain healthcare workers' attitudes towards women. seeking post-abortion care services. 3. To compare and contrast public and private health workers' perceptions and attitudes towards women seeking post-abortion care services. Methodology: This study will utilize a grounded theory approach, where data collection will be done through in-depth interviews from health care workers providing post-abortion care services and women above 18 years seeking post-abortion care services from Ndirande health Centre, Chileka health Centre, Sunnyside BLM, Bangwe BLM, Lunzu BLM and Lirangwe Health Centre. Data analysis will be performed following a verbatim transcription followed by manual analysis of the data; themes will be collected from the generated data. First, chunks of data representing the themes will be coded manually. Then the thematic areas will be explored by displaying the detailed information relevant to each category, and then data will be reduced to identify the relationships between them. Ethical consideration: The researcher will seek permission to conduct the study in the facilities from the Blantyre District office and the facilities involved and seek ethical approval from the College of Medicine Research and Ethics Committee as the research will include patients. Lastly, information sheets and informed consent forms will be administered to participants before participating in the study. Trustworthiness, privacy and confidentiality will be exercised throughout the study process. Expected findings: The study will provide healthcare workers' perceptions of women seeking post abortion care. Dissemination of Findings: Results will be distributed to the Ministry of Health reproductive health directorate (RHD), College of Medicine Research and Ethics Committee (COMREC), Blantyre District Health Office and the six clinics where the study will take place.
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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, 2022-02-09) Bakali, Rashid; Davis, Caroline; Chasi, Panashe; Chikumbutso, Casten
Type of Study The study will be a retrospective cross-sectional study, comprising of both qualitative and quantitative data. 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 preeclampsia, 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. 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. 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: 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. 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 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.
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Investigating factors associated with puerperal sepsis and its implications in mothers admitted to maternity ward at Mangochi District Hospital
(Kamuzu University of Health Sciences, 2021-10-08) Mambulu, Chitaukali Chifundo
Type of study: The study will use mixed approach research methods; qualitative and quantitative study. It will investigate the associated factors that may predispose to puerperal sepsis and its implications in mothers admitted to maternity ward at Mangochi District Hospital Statement of the problem: Puerperal sepsis contributes to 15% % of the maternal deaths that occur annually globally and contribute to even more maternal deaths in some low income countries like Malawi. However, puerperal sepsis is preventable if maternal mothers are well taken care of, hence need to establish associated factors to puerperal sepsis and its implications to mothers in order to prevent its occurrence and implications. Objectives: Broad objective: To investigate factors associated with puerperal sepsis and its implications in mothers admitted to maternity ward at Mangochi District Hospital Specific objectives: 1. To explore health care factors associated with puerperal Sepsis to mothers admitted to maternity department at Mangochi District Hospital 2. To determine maternal factors associated with puerperal sepsis at Mangochi District Hospital: Strategy for optimizing identification of associated factors to puerperal sepsis 3. To assess effects of puerperal sepsis on mothers. Methodology: The study will use mixed approach research method. This will be quantitative and qualitative through exploratory and descriptive study to investigate factors associated with puerperal sepsis. The expected sample size for qualitative data will be taken through Key Informants Interviews for 15 participants from the health care workers and this will depend on saturation. Quantitative data will be collected retrospectively from case files of mothers who were diagnosed with puerperal sepsis and were admitted in maternity ward. The expected sample size will be determined by the number of case files available. The sample size has been determined from the total number of files for the target population in the three years which is 440 case files. Using Raosoft, at 95% CI, sampling error of 5% and response distribution of 50%, the minimum desired sample size is 206 files. Proportionate samples will be taken for each year with the multiplication factor that was obtained by dividing total number of files in each year by total number of files for the whole 3 year period as follows: 0.67, 0.15, and 0.18 for 2018/19, 2019/20 and 2020/21 fiscal years respectively giving respective samples of 138, 31 and 37 case files. Using stratified consecutive sampling technique for each year, files will be selected. This will be done using medical extract form. The data will be verified and then entered into a Microsoft Excel file and there-after be imported into STATA Version 14.1 for cleaning and further analysis. For qualitative data, consistency will be maintained by listening to audio recorded KIIs. The verified data will be stored in a password protected file in a USB flash disk, computer and will be backedup in an external driver. Expected findings and dissemination. The research will be conducted on academic requirement to the award of Master of Science Global Health Implementation. Therefore, some copies will be submitted for marking at University of Malawi, College of Medicine. The final dissertation document will be submitted to the College of Medicine Research and Ethics Committee (COMREC) and the College of Medicine Library (COM). The Health Science Research Committee and The University Research and Publication committee through the COMREC secretariat. Furthermore, the intention of the researcher is to take the results and present to Mangochi District Council through Mangochi District Executive Committee (DEC) and the copy will be submitted to the District Health Management Team (DHMT) for Mangochi DHO through Mangochi Research and Ethics Committee. Recommendations will be made to the stakeholders and partners through Mangochi DHO on any improvements that might be suggested to improve the precision of puerperal sepsis.
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Investigating knowledge and determinants of birth preparedness among pregnant women In Mangochi district
(Kamuzu University of Health Sciences, 2022-07-12) Abuduo, Richard; Malipa, Peter; Gondwe, Macdonald; Lanjesi, Innocent
This is a descriptive, cross-sectional study that will utilize both qualitative and quantitative data collection and analysis methods to explore knowledge, practices and men’s support towards birth preparedness and complication readiness among antenatal women. The broad objective of the study is to investigate knowledge and determinants of birth preparedness among pregnant women in Mangochi district. Specific objectives of the study are: to assess the Knowledge of birth preparedness among antenatal care attendees in Mangochi District and to identify the factors associated with birth preparedness among antenatal care attendees in Mangochi District. The study will be conducted in Mangochi district. It will be facility based (ANC Department) of Mangochi District Hospital, Makanjira Health Centre, Monkey Bay Health Centre, Namwera Health Centre and Chilipa Health Centre. The study targets pregnant women who come to attend ANC during study period. The study will run from January 2022 to February, 2023. Every pregnant woman willing to be included during data collection. Pregnant women who presents with danger signs or unable to communicate, and those not willing to be interviewed. The sample size will be 384 participants and participants will be enrolled using random sampling technique. Data will be analyzed using statistical package for social sciences (SPSS) version 21. The expected findings of the study will be at least 50 percent of the participants will be knowledgeable of birth preparedness and complication readiness. The study findings will be disseminated through presentations during meetings such as DHMT, CPD and morning report gatherings, seminars and conferences. Reports will be compiled and submitted to College of Medicine Research Committee.
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Occurrence of menopause symptoms and coping practices among women in Blantyre, Malawi
(2021-11-09) Nyalubwe Kaliati, Thokozani
Type of study This will be a mixed method study. Introduction/background Menopause is a normal physiological event in the life of every woman who lives beyond the age of 52. It is a key transition point of biological and social development which is associated with a wide variety of symptoms which can be very distressing and have considerable effects in a woman’s physical and social life. Problem statement/ justification With global increase in life expectancy issues to do with adult health for example menopause are becoming an area of public health concern. However, to the best of our knowledge there is currently very limited data on menopause in Malawi. Conducting this research will help to contribute towards understanding menopause related issues among women in Malawi and help in establishing contextualized and evidence-based management of these symptoms. Objectives The broad objective is to evaluate the severity of menopause symptoms and the associated coping mechanisms among women in Blantyre, Malawi. The specific objectives are; to determine the prevalence and severity of menopause symptoms among women, to asses knowledge of menopause among women, to assess coping mechanisms of women with menopause symptoms, and finally to describe the effect of menopause symptoms on healthrelated quality of life Methodology This will be a mixed method study in which convergent mixed method study design will be used. The study population are women aged 45 – 59 of which the total sample size is 268 women for the quantitative data and 20 women for the qualitative data. Quantitative data will be analyzed using STATA while thematic analysis and QSR Nvivo software will be used for Qualitative data. Expected Findings and Dissemination We anticipate to find a high prevalence of vasomotor symptoms and a low reporting rate of menopause symptoms among those with low academic and economic status. On experiences of women with menopause symptoms we anticipate to find a reduced sense of femineity, and negative impact on daily activities as seen in studies elsewhere. A dissertation will be compiled and submitted to the department of Obstetrics and Gynaecology,the College of medicine library, College of Medicine Research and Ethics Committee and Blantyre DHO. A presentation will be made to the Association of Obstetrics and Gynaecology Conference and Blantyre district health office and on the findings of the study. A manuscript will be prepared and submitted for publication in a peer reviewed journal.
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Perception of women towards Caesarean Section in Urban Blantyre
(Kamuzu University of Health Sciences, 2022-02-09) Fabiano, Charity; Katawa, Lucy; Bawa, Umar
Caesarean Section (CS) is a lifesaving surgical intervention for women and their babies. However, Sub-Saharan Africa has the lowest rates of CS and the maternal and neonatal mortality rates are also high in this region. The aim of this study is to assess if the negative perceptions of women towards CS is a contributing factor to low rates of CS in our setting. Type of research This is going to be a descriptive cross-sectional study using a questionnaire that will be carried out in the three major health centres in Urban Blantyre, namely Limbe, Bangwe and Ndirande health centres over the period of 6 weeks which includes the dissemination and presentation of the results. The study population is women of reproductive age (15- 49) and the calculated sample size is 264. Problem There are high levels maternal mortality ratio and neonatal death in Malawi of which one of the contributing factors might be poor perception towards CS. Therefore, this study aims at highlighting and proving this hypothesis and possibly opening interventional opportunities to improve both maternal and child health. Objectives The broad objective of this study is to investigate the perceptions of women on caesarean section. The specific objectives of this study are to i) determine women’s understanding of caesarean section. ii)Determine factors that influence women’s perception towards caesarean section. These factors include socioeconomic status, demographics, religion, education, and previous CS history. Methodology A researcher-administered questionnaire will be used which will consist of four sections. Section 1 will collect the Socio-demographic data, Section 2 will assess the knowledge of women regarding CS, Section 3 will collect the obstetric history and Section 4 will be regarding women’s perception of CS. Each participant will be given a unique number and the data collected will be first entered into Microsoft Excel 2010 and then it will be analysed using SPSS software. Copies of the final report will be submitted to, the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and the University Research and Publication Committee (URPC) (through the COMREC Secretariat). The research findings will also be presented at the College of Medicine research dissemination seminar. Expected Results The results of this study will be submitted to The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and The University Research and Publication Committee (URPC) (through the COMREC Secretariat) The research findings will also be presented at the College of Medicine research dissemination seminar.
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Prevalence of prognostic factors in patients with cervical cancer operated at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 21-09-15) Peno, William
1.0 Introduction Cervical cancer is the 4 the leading cancer in the world, with a global incidence of 6.6 percent and mortality rate of 7.5 percent of mortality. In Africa, the incidence and mortality is higher at 40.1 percent and 30 percent respectively [1]. Malawi has a population of approximately 19 million people, with 49.5 percent males and 50.7 percent females. This corresponds to 45 percent of reproductive-aged women, who are at risk from cervical cancer. Cervical cancer is the leading cancer in women, with an age-standardized rate (ASR) incidence and mortality of 79.5 and 49.8 per 100,000 population, respectively [2]. The median survival time from the time of presentation is 10 months with a 5-year survival rate of 2.9 percent [2]. This survival rate is low compared to other regions like Uganda and Zimbabwe, where 5-year survival is 17.7% and 26.5%, respectively [3]. The main risks for a high cervical cancer incidence and mortality are high prevalence of Human immunodeficiency Virus [HIV] at 10.6%, human papilloma virus [HPV] at33.6%, inadequate screening and treatment services for precancerous lesion, late diagnosis limited access to timely standard treatment of cancer and palliative care [4]. Cervical cancer survival and recurrence is dependent on a number of factors described as prognostic factors. These prognostic factors include stage of cervical cancer, lymph node metastases, presence of parametrial invasion and lymphovascular space invasion. These prognostic factors playa significant factor in management of cervical cancer as their presence or absence will determine the course of treatment. Several strategies have been implemented to reduce cervical cancer-related deaths and increase the 5-year survival rates. The Malawi cervical cancer Service delivery guidelines state that the following basic elements are needed to provide an efficient cervical cancer prevention program: logistics and supply management of equipment and supplies for survival cancer screening and treatment, diagnostic services for clients who are cancer suspects, treatment services for clients diagnosed with cervical cancer, training of health care providers in screening and treatment modalities, quality assurance ,monitoring and evaluation, infection prevention and control, referrals and linkages and management of other cervical conditions including STI's [5]. How this sentence starts does not flow from the one before it This includes, increasing the number of screening sites, increasing the number of treatment sites and availability of other treatment modules post-surgery. From 2011 and 2015 the number of cervical cancer screening sites, number of women screened, and coverage increased from 75 to 130, 15,331 to 49,301 and 9.3% to 26.5 percent respectively [6]. Currently there is a total of 357 VIA (visual inspection of the cervix with acetic acid) screening sites of which 211 are active [5]. 15-Sep-2021 Proposal on Prevalence of prognostic factors in patients with cervical cancer operated at QECH. Version 1.21 126/74/2021 6 There are 2 facilities Queen Elizabeth Central Hospital and Kamuzu Central Hospital that provide specialized cervical cancer care. To expand the portfolio of services available to cervical cancer patients, the Ministry of Health through Queen Elizabeth Central Hospital agreed with Médecins Sans Frontières (MSF) to establish a comprehensive cancer services center to serve the southern region. This facility provides diagnostic and treatment services such as surgery and chemotherapy in collaboration with the Oncology Department
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Protocol for development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth, version 1.0
(2022-06-15) Kirkham, Jamie; Chimwaza, Angela
Type of research study: Delphi survey for the development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth. Problem statement A stillbirth accounts for about 14 in every 1,000 births globally with the highest rates seen in Sub-Saharan Africa and South Asia. Stillbirth prevention and bereavement care following a stillbirth remains a challenge, particularly in Low and Middle Income Countries (LMiC). One approach to improvement is the prioritization of women/family-centered care. There is a large variety of outcomes measured in stillbirth studies but consensus on the outcomes that matter most to women and families is often lacking, which can impact on the ability to make informed decisions about improved care practices. Objectives The broad objective of this study is to develop standard sets of outcomes for use in interventional studies for stillbirth prevention and improving bereavement care following stillbirths in LMiC settings. The specific objectives are to: identify outcomes used in current stillbirth research including outcomes reported in qualitative literature in LMiC settings relevant to stillbirth; to prioritize outcomes from health care professionals, researchers and parents’ perspectives; and to integrate the outcomes important to all stakeholders in order to ratify a core outcome set (COS). Methodology This study will involve three stages in the development of the COS: (1) a list of outcomes will be identified from multiple sources, specifically existing reviews of outcomes, a search of trial registry data, a targeted qualitative literature review of studies that have interviewed parents who have experienced stillbirth and healthcare professionals working in this field across Sub-Saharan Africa and South Asia. (2) The list of outcomes will be scored by multiple stakeholder groups in a real-time online Delphi survey. (3) The results of the Delphi will be summarised and discussed at a face-to-face or 15-Jun-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 1.0 1/05/2022 8 virtual consensus meeting with representation from all stakeholder groups. Expected findings and their dissemination It is expected that two COS for use in a LMiC setting will be developed, one for stillbirth prevention and one for bereavement care following stillbirth. Both COS will be developed for research and clinical practice and will consider all interventions and care options for stillbirth care within this scope. The development of these COS will be reported according to the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines [16]. We will register the COS with CROWN (Core Outcomes in Women’s & Newborn Health) [17] and share our findings across the GHRU Network, College of Medicine Research Ethics committee (COMREC), the LAMRN (Lugina Africa Midwives Research Network) [18] and other relevant international societies and organisations for wider dissemination.
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Rates, indications and outcomes of Caesarean sections at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2020-11-09) Matola, Yankho Matola; Mkomba, Susan; Mureko, Charles
Type of study: A retrospective study of caesarean sections at Queen Elizabeth Central Hospital in Blantyre, Malawi. Problem: The World Health Organization (WHO) has over the years recommended that the rate of Caesarean sections (CS) at a population should be between 5-15% [1]. But of late, governments and clinicians have expressed concern over the increase in the rate of CS. Population in this context means the number of patients (pregnant women) served by a health facility [1]. The global rates of CS as of 2014 stood at 19.01%[11], this is higher for other countries and lower for others and also generally higher for private healthcare facilities than government run facilities [10]. In Malawi, the rates of CS stand at a countrywide rate of 6% [8]. In Malawi knowledge on healthcare facility specific rates of CS is limited. It is the aim of this study therefore to review the rates, common indications and outcomes of CS at Queen Elizabeth Central Hospital (QECH) which is a tertiary level healthcare facility in Malawi. Rates of CS below 5% are considered as the service (CS) is being denied to the population while rates above 15% are considered as there being a burden (pressure) on the healthcare facility serving a particular population [1]. If CS rates are within the recommended ideal rate by WHO, there is evidence that they can help to reduce maternal and perinatal morbidity and mortality in as far as the resources required for a CS are available [1]. This study therefore will help to provide up to date information on the rates, common indications and outcomes of Caesarean sections at QECH. Objectives. Broad: To review caesarean section deliveries at Queen Elizabeth Central Hospital (QECH). Specific: To determine the rate of caesarean sections at QECH; To evaluate common indications for caesarean sections at QECH; To assess the common outcomes (positive and negative) associated with caesarean sections at QECH. Methodology. Study design. Study location: Queen Elizabeth Central Hospital, Obstetrics and Gynaecology department. Study population. Women who delivered at Queen Elizabeth Central Hospital for the period from 1st January 2019 to 31st December 2019. Sample size and sampling technique. A sample size of 334 calculated using epi-info statistical software using P of 32% based on a similar study from Republic of South Africa. Expected results and dissemination of results: This study expects to find high rates of Caesarean sections at Queen Elizabeth Central Hospital and with age distribution analysis for both the rates, indications and outcomes, it is expected that most burden will be amongst the young age category as they are not mature enough to mostly undergo vaginal birth. Amongst rural and urban population, it is expected mostly for the outcomes to be worse for most rural populations because of distance factor and the quality health personnel of the entry level facilities that they access. For all aspects of analysis for each objective (Rates, Indications and outcomes), P-values and confidence intervals will be calculated to determine the statistical significances of the different proportions. The findings of the study will be presented at the Obstetrics and gynaecology department of the Queen Elizabeth Central Hospital (QECH) in Blantyre and if possible at the research dissemination conference (RDC) at College of Medicine Blantyre campus. The detailed report for the findings will be submitted to the following departments, Obstetrics and Gynaecology departments of QECH, College of Medicine Library and College of Medicine Research and Ethics Committee (COMREC). We are also hoping to publish our research in the Malawi Medical Journal through Young Researchers Forum (YRC). A retrospective study of caesarean sections at Queen Elizabeth Central Hospital
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Severity of menopause symptoms and coping mechanisms among women in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-11-09) Kaliati Nyalubwe, Thokozani
Type of study This will be a mixed method study. Introduction/background Menopause is a normal physiological event in the life of every woman who lives beyond the age of 52. It is a key transition point of biological and social development which is associated with a wide variety of symptoms which can be very distressing and have considerable effects in a woman’s physical and social life. Problem statement/ justification With global increase in life expectancy issues to do with adult health for example menopause are becoming an area of public health concern. However, to the best of our knowledge there is currently very limited data on menopause in Malawi. Conducting this research will help to contribute towards understanding menopause related issues among women in Malawi and help in establishing contextualized and evidence-based management of these symptoms. Objectives The broad objective is to evaluate the severity of menopause symptoms and the associated coping mechanisms among women in Blantyre, Malawi. The specific objectives are; to determine the prevalence and severity of menopause symptoms among women, to asses knowledge of menopause among women, to assess coping mechanisms of women with menopause symptoms, and finally to describe the effect of menopause symptoms on healthrelated quality of life Methodology This will be a mixed method study in which convergent mixed method study design will be used. The study population are women aged 45 – 59 of which the total sample size is 268 women for the quantitative data and 20 women for the qualitative data. Quantitative data will be analyzed using STATA while thematic analysis and QSR Nvivo software will be used for Qualitative data. Expected Findings and Dissemination We anticipate to find a high prevalence of vasomotor symptoms and a low reporting rate of menopause symptoms among those with low academic and economic status. On experiences of women with menopause symptoms we anticipate to find a reduced sense of femineity, and negative impact on daily activities as seen in studies elsewhere. A dissertation will be compiled and submitted to the department of Obstetrics and Gynaecology, the College of medicine library, College of Medicine Research and Ethics Committee and Blantyre DHO. A presentation will be made to the Association of Obstetrics and Gynaecology Conference and Blantyre district health office and on the findings of the study. A manuscript will be prepared and submitted for publication in a peer reviewed journal.