Implementation Science

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Access to early bubble Continuous positive airway pressure in Neonatal Intensive Care Unit at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-02-05) Kamanga, Emmanuel; Sichinga, Tuntufye; Mbwana, Zainab
Objective: The main aim of this study is to evaluate accessibility of bubble Continuous Positive Airway Pressure by preterm infants in Neonatal Intensive Care Unit at a large referral hospital of central region. Methods: Study design: The study is going to be a quantitative cross-section study. We will use secondary data recorded in daily running of the neonatal unit from January through December 2019. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit admits about 400 preterm infants requiring Continuous Positive Airway Pressure therapy annually. Research Problem: Prematurity accounts for over a half of neonatal mortality in Malawi and mainly due to RDS respiratory distress syndrome. Low-cost bubble bCPAP is being implemented in hospitals to treat respiratory distress syndromeRDS.. There is limited data on the accessibility of the therapy and the rolled out low-cost bubble Continuous Positive Airway Pressure bCPAP Pumani devices. This study will evaluate the accessibility of early Continuous Positive Airway Pressure CPAP intervention on the preterm infants. Methodology: The study will be conducted at Kamuzu Central Hospital, in the Neonatal Intensive Care Unit. The ward is commonly known as Ethel Mutharika Nursery Wing. Participants will include all preterm births born between 28 and 36 weeks of gestation. Neonatal Intensive Care Unit NICU admits about 400 preterm infants requiring Continuous Positive Airway Pressure CPAP therapy annually. Expected outcomes: The study will provides up-to-date information on the need and utilization of low-cost Continuous Positive Airway Pressure CPAP devices rolled out in NICU Neonatal Intensive Care Unit at Kamuzu Central Hospital.
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Apredictive monitoring system for criticaly ill children in Malawi. A mixed methods usability and implentation research
(2022-03-22) Manda Taylor, Lucinda
Type of Research: This study will employ qualitative and quantitative research methods from the social sciences and human-centred design to assess the usability and implementation determinants of a predictive vital sign monitoring system for critically ill children in Queen Elizabeth Central and Zomba Central hospitals in Malawi. The problem: Each year in low-income countries, millions of children die because high-quality healthcare is not provided. Many of these deaths result from poverty-related diseases that are recognized too late. The monitoring of vital signs is essential to detect critical illness promptly. However, the monitoring systems widely and effectively used in high-resource settings are not suitable for lowincome settings because of their high up-front and ongoing costs, and limited adaptation to the socioeconomic background, working conditions and workflows. To address this problem, a consortium of Malawian and European researchers is developing an affordable, durable, and user-friendly monitoring system (IMPALA) for hospitalised children in lowincome countries. The IMPALA system combines innovative sensors, predictive machine learning algorithms, and point-of-care biomarkers within a simple monitoring system that enables health workers to detect and predict critical illness quickly. The implementation and usability research will run prior to and in parallel with clinical research on the IMPALA system. The setting often complicates the implementation and ultimate impact of health interventions: even interventions that may seem simple, such as the mass rollout of malaria rapid diagnostic tests, can fail to deliver the desired effects and have unintended consequences. Usability and implementation research seeks to examine the acceptability, accessibility, feasibility, and appropriateness of interventions in real-life circumstances and the factors (barriers and drivers) that influence their impact. Such research hence enables health interventions such as IMPALA to maximize the desired impact, in this case, improving critical care for children and their health outcomes. The objectives: The study's broad aim is to explore the (healthcare system, social and cultural) context-related factors to be considered in the design and implementation of the IMPALA system to optimise its feasibility, usability and impact on clinical care. The methodology: A mixed-methods approach, combining qualitative and quantitative methods from the social sciences and user-centered design, will be used. The study comprises three stages (pre- IMPALA, IMPALA 2.0 and IMPALA 3.0). During pre-IMPALA, the current context of care for critically ill children in Zomba Central Hospital will be studied. In stage 2.0, alongside clinical research on the IMPALA system 2.0 (described in a separate protocol), the implementation of the monitoring system will be studied. Stage 3.0 focuses on the updated IMPALA system with monitoring based on predictive algorithms. Methods include questionnaire-based surveys, in-depth interview, focus group discussions/co-design sessions, cognitive walkthroughs, heuristic evaluation, analysis of de-identified routine monitoring data and medical records, and ethnographic and structured observations. Data will be collected with healthcare providers, support staff, and the parents/guardians of critically ill children. Expected findings: The study results will be used to adapt the system during its ongoing development and make recommendations to ensure that its implementation has the desired impact on clinical practice and the health outcomes of critically ill children.
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Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Harnish, Christopher
This study seeks to describe and assess the architectural design factors of delivery suites that influence the maternal birth experience and peripartum health outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. The factors of quality of care and patient outcomes which will be assessed are: maternal privacy; peripartum maternal mental health; paternal and guardian involvement and spatial efficiency at Queen Elizabeth Central Hospital. This information will inform evidence-based maternity ward architectural guidelines to improve quality of health care, patient outcomes and patient satisfaction. Assessing architectural design factors of maternity ward that influence quality of health care and patient outcomes at Queen Elizabeth Central Hospital in Blantyre, Malawi. These findings may lead to improvements in architectural designs of maternity wards in health facilities in Malawi; health worker flow and efficiency; patient outcomes; and satisfaction for themselves and their families.
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Assessing evidence based practice among pharmacists in Blantyre urban community pharmacies
(Kamuzu University of Health Sciences, 2021-03-17) Banda, Luke; Kawanga, Iman; Kachingwe, Austin
Evidence based practice (EBP) has become obligatory worldwide as this helps to improve the quality of health care provided to the patients. The major purpose of EBP is to optimise clinical decision making and keep knowledge and skills updated and evidence based(1). Due to constantly changing knowledge of medicine, health care professionals including pharmacists and pharmacy technicians are encouraged to base their decisions on strong evidences in order to remain competitive in health care provision. In relation to this, a study was conducted here in Malawi among nurses where it aimed to explore and describe the knowledge, attitudes and practices of nurses regarding evidence-based practice in PMTCT. This indicates the relevance of EBP among different health care professionals(2). On the other hand, SDL has become the most efficient technique that helps health care practitioners in obtaining their clinical learning needs and obtain information from different sources including research. It is defined as any increase in knowledge, skill, accomplishment, or personal development that an individual brings about by his or her own efforts using any method in any circumstances at any time(3). The study will be based on assessing EBP among among pharmacists in Blantyre community pharmacies and the relevance of SDL in EBP. This study will be a descriptive cross-sectional study through a self-administered questionnaire that will be done in Blantyre community pharmacies. Pharmacists who are practising in community pharmacists will be the target population. The broad objective of the study will be to assess EBP among pharmacists in Blantyre community pharmacies. Specifically, the study will try to; explore the knowledge and perception of pharmacists on evidence based practice, to find out the resources pharmacists use in EBP, to find out the role of pharmacists in promoting EBP among other community pharmacy personnel, examining the importance of Self-directed learning in EBP and to find out the barriers to successful EBP. The expectation from the study is that most pharmacists do not base their decisions on evidence from relevant literature in the course of their practice and that most of them do not find SDL as relevant to EBP. After completion of the study, the results will be presented to the academic staff and students during and final copies will be submitted to the College of Medicine Research and Ethics Committee (COMREC); College of Medicine Library and to the pharmacy department and these results will be disseminated at College of Medicine.
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Assessing health status among inmates in malawian prisons
(Kamuzu University of Health Sciences, 2022-04-11) Mvula, Ireen; Mponda, James; Chipeta, Lisa; Nyamuka, Dingaan
Overcrowded Malawian prisons put a lot of inmates at a higher risk of getting infected with various infectious diseases like TB and Covid-19. Malawi has 30 prison facilities with a capacity that has been overwhelmed with inmates hence the need to probe more on the status of health among inmates and how healthcare issues are sorted out. A cross-sectional qualitative study involving about 42 participants from three prisons (14 from each) will be conducted to assess the current health status among inmates in Malawian prisons. The main objective of this study is to assess the status of health care being provided in prisons with regard to them being at higher risk of contracting diseases. The specific objectives included the following; exploring the common diseases affecting inmates, interventions put in place to treat and prevent the common diseases, assess the quality of the services delivered to inmates and also to discuss possible challenges faced in accessing quality healthcare. The study will be conducted in southern region Prisons in Malawi: Zomba Maximum, Chichiri and Domasi prisons. Participants involved will include prison officers and inmates that are willing to take part. The information gathered will disseminated at Kamuzu University of Health sciences (KUHES) research dissemination seminar during the 2022/23 academic year. The final report will be submitted to relevant authorities including the research supervisor, College of Medicine Research Committee (COMREC) and the KUHES Library.1.1 Introduction and Background Globally, provision of healthcare services to prison inmates poses a range of challenges which results to poor quality healthcare for the inmates especially in developing countries. A lack of both financial and human resources has led to a system of task-sharing in the prisons to support healthcare services. There are 30 prison facilities in Malawi with a capacity of 7,000 inmates, but there are over 14,000 inmates currently being held nationwide. An operational toolkit was put in place to provide information on comprehensive medical services through a three-phase model, where prisoners are screened upon entry, their stay in prison and when they exit. Healthcare in prisons is managed by the Malawi Prison Health Services (MPHS). This toolkit was designed to be used as a practical tool to assist the MPHS in the scale up of a minimum package of health services as recommended by Southern African Development Community (SADC) in prisons across Malawi. The components of the prison healthcare package are screening services, therapeutic services and referral services between the prison healthcare service and the local Ministry of Health which is required to ensure continuity of care for more complicated cases and those needing hospital admissions. Major morbidities presenting within the prison context which are screened for at entry, stay and at exit include HIV, TB, STIs, malnutrition and mental health problems. Hepatitis B vaccination is also offered to all prisoners. In addition, malaria, diarrheal infections and skin diseases present more commonly due to the high levels of congestion within the cells. Medical and psychological services for victims of physical and sexual violence is also recognized as an integral part of the package of care.1.2. Justification of the study Good health and well-being for all is one of sustainable development goals which aims at ensuring healthy lives and promoting wellbeing for all ages by the year 2030. Prisoners being a vulnerable population, due to overcrowding and being confined in one place and may not have a say on matters that are of concern to them. Therefore, it is important they have good health and good health services so that Malawi can move towards equitable access to quality healthcare. This can be achieved by assessing their state of health to check how they are faring so that if they are lagging behind, changes be made to improve their health. In addition, many studies on the healthcare of prisoners on specific diseases such as HIV and TB have been done such as the ‘Prisoners’ Access to HIV Services in Southern Malawi’ published on the 28th of April 2021, and in 2012 a survey on the Surveillance of Tuberculosis in Malawian Prisons was done but few studies on the overall healthcare system in prisons have been done.This study aims at generally assessing the overall status of health in Malawian prisons which may review various factors that are of concern to prisoners as far as health is concerned that may have been neglected. 1.3 Objectives of the study 1.3.1 Broad objectives The study intends to assess the status of healthcare among inmates in Malawian prisons. 1.3.2 Specific objectives  To identify common diseases in prisons  To establish methods on how diseases are prevented and managed  To assess the quality of healthcare delivery in Malawi prisons  To investigate challenges of providing healthcare services in Malawi prisons  To examines interventions that have/had been put in place to prevent and control diseases 1.3 Scope and Limitations This study focuses on the status of healthcare of prison inmates at Zomba, Chichiri and Domasi prisons. The study includes southern region prisons because of proximity, since they are close to Blantyre and this may entail the researchers not travelling long distance to collect data. The study excludes other prison because, the study has limited funds, including other prisons could have escalated the cost of conducting the study. Also, being student researchers, as such novices at research, including prisons from other regions could result into failing to manage time with equally other important academic activities. 1.4 Significance of the Study It is hoped that the results of this study may help come up with an understanding of the status of the healthcare system in prisons and hopefully some intervention in what is lacking on the health provision. The study may also contribute to literature on the topic under study.
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Assessing implementation of infection prevention and control practices among maternity ward healthcare workers at QECH
(Kamuzu University of Health Sciences, 2021-01-13) Chitimbi, Zacheus; Magombo, Michael; Kamkwanya, Mike
Type of study: This is a cross section qualitative study design. Research Problem: Healthcare associated infections are one of the major contributing factors to the high mortality rates in maternity wards despite different efforts in hospital infection prevention and control measures. Proper implementation and adherence to the standard measures of infection prevention and control by healthcare workers is an effective means to minimize the risk of transmission of these HAIs in hospitals. Objective: The main objective is to assess how the infection prevention and control practices are being implemented amongst maternity ward healthcare workers at QECH. Methodology: The study participants are clinicians, nurses, hospital cleaners and hospital management. A sample size of 20 participants, selected using purposive sampling method. Data to be collected using in depth interviews facilitated by an interview guide and observation of healthcare workers and their work environment with an audit checklist. Expected results and dissemination: We expect to find out the knowledge of healthcare workers on IPC measures, their perception, attitudes and adherence towards IPC measures and identify barriers to compliance with the IPC measures. The results will be presented at College of Medicine research dissemination presentations and a report is going to be sent to the College of Medicine library. We would also like to publish the study in the Malawi medical journal.
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Assessing the capacity of district hospitals in mobilizing and allocating resources after health care decentralization
(Kamuzu University of Health Sciences, 2020-09-16) Udedi, Evelyn
qualitative cross sectional study aimed at assessing whether district hospitals have the capacity to mobilize and allocate resources in light of decentralization, in Kasungu and Nkhotakota District Hospital(s). Key informant interviews will be conducted using a flexible interview guide. b. The problem It is common knowledge that the delivery of efficient health services requires adequate and consistent availability of the right resources, be it human, financial, equipment or material resources. This is the more reason Malawi is a signatory to the Abuja declaration where it pledged to allocate 15% of the national budget towards the health sector. Over the years the Ministry of Health, has put in place various strategies to aid in resource mobilization for the health sector as a means to the Abuja declaration and one of such strategies is decentralization of the health care system. However, despite the positive gains that have been attributed to decentralization and health delivery systems, there still remains a gap in addressing the limits of decentralization vis a vie authority accorded district health management teams in health financing. In realizing this gap, this paper will look at how decentralization has capacitated District hospitals in mobilizing and allocating resources. This will assist the Ministry of Health through the Local Governments to address gaps in resources usually associated with less than adequate service delivery in district health facilities. c. The Objectives The specific objectives of the study are: i.To explore the capacity of the hospitals in revenue generation and availability of essential medicines and supplies. ii. To explore perceptions on hospitals human resources management regarding recruitment and retention measures. iii. To explore perceptions of health personnel on their autonomy in light of decentralization at district hospital. 16-Sep-2020. The study will employ a qualitative approach which will enable us to have in-depth understanding of the capacities of district health management teams in mobilizing and allocating resources within their districts. To have rich data on the perceptions of managers, key informant interviews will be conducted. Purposive sampling will be used to recruit 16 participants ranging from district health office managers, planning, administrative and finance managers from the district assembly as well as 3-4 policy makers at Ministry of Local government, Min of Health and Min of Finance/Treasury. e. Expected Findings and Dissemination It is anticipated that the study will generate findings that are well enriched with adequate data that provides a deep understanding of the subject and contribute meaningfully to the body of knowledge in health financing. We expect to determine whether capacitating district health managers with authority would result in more opportunities arising, improvements in resources such as essential medicine, equipment and supplies, noticeable changes in revenue generation, and human resource attrition trends due to decentralization. Final research data will be made available to other interested investigators, and stakeholders. It is the intention of the investigator to submit findings to peer-reviewed journals, present at national and international forums, and hold dissemination meetings amongst important stakeholders including the Ministry of Health, through the District Health Office and the Ministry Local Government through the District Councils.
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Assessing the impact of training and remodeling of adverse drug reaction reporting systems on the practice of pharmacovigilance in Malawi
(Kamuzu University of Health Sciences, 2021-06-16) Chimimba, Frider T.
Pharmacovigilance (PV) system is essential in every country to ensure patient safety and public health in relation to medication. Strong and effective PV is achievable if there are collective efforts from well trained and informed health care professionals who are able to monitor, detect and report suspected adverse drug reactions (ADRs) using convenient and effective reporting tools. Type of the study This is a cross sectional survey that will use quantitative approach to assess the ADR reporting rates, knowledge, attitudes and practices and qualitative approach to seek opinions of healthcare workers on pharmacovigilance. Problem In Malawi and other low- and middle-income counties (LMICs), PV systems are weak and reporting of adverse drug reactions is still low. Furthermore, the currently used traditional paper-based ADR reporting tools face logistical challenges which result in delays in transmission of information and compromise confidentiality. As a way of continued efforts to counter these challenges, the Malawi Pharmacy and Medicines Regulatory Authority (PMRA) with support from the World Health Organization (WHO) have been conducting PV training among Health Care Professionals (HCPs) on basic principles of PV. They are also in the process of establishing Unstructured Supplementary Service Data (USSD) system for reporting of adverse drug reactions and other medicine related problems. However, the impact of the training and use of USSD reporting system on PV in Malawi is not known. Objectives Our main objective of this study is therefore to assess the impact of the training on knowledge, attitudes and practices (KAP) of Pharmacovigilance and use of USSD reporting system on the ADRs reporting rate. The specific objectives are to:  To assess the KAP of healthcare professionals on Pharmacovigilance after undergoing PV training  To investigate the preferences of healthcare professionals on the reporting tools for ADRs  To evaluate the improvement on ADR reporting rate after introducing USSD system training HCP on PV Methodology We will recruit HCPs who participated in PV trainings conducted by PMRA, from randomly selected districts in Malawi. Quantitative data will be collected using a structured questionnaire from all participants who participated and responded to a similar questionnaire before the training to assess the KAP after the training. Face-to-face interviews will be conducted to conveniently sampled participants using a semi-structured questionnaire to collect qualitative data on the usability of USSD system and preferences of HCPs on ADR reporting tools. Quantitative data will be analyzed using both descriptive and analytical statistics in Statistical Package for Social Sciences (SPSS) while qualitative data will be analyzed manually or using NVivo by content thematic analysis. Expected findings We hope that there will be improved level of knowledge, attitudes and practices among healthcare workers after undergoing training and also an improved rate of ADR reporting after launching USSD system as compared to the paper-based reports. In addition, the opinions and preferences of healthcare workers on PV tools will also be known from the study. Dissemination of results The results of this study will be shared with stakeholders such as WHO, Ministry of Health, Pharmacy and Medicines Regulatory authority, members of the academia and COMREC through conferences, meetings and publications.
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Assessing the knowledge attitude and utilisation of emergency contraception among female university students at Kamuzu University of Health Sciences, Malawi
(2022-02-09) Patrick, Felesia; Pendame, Brodget; Nkhata, Dorica; Sadala, Nancy
This is a both qualitative and quantitative institutional based cross-sectional study aimed at assessing the knowledge of female university students on emergency contraception at Kamuzu University of Health Sciences. The study will also assess the students‟ attitude towards emergency contraceptives and the prevalence of utilization of emergency contraceptives among these students. This study has been designed since it has been noted that there is a rise in the number of unplanned pregnancies among female university students. This in turn has led to poor performance, increase in school drop-out rates and unsafe abortions. The targeted population is all female university students from Kamuzu University of Health Sciences. Participants will be selected through stratified random sampling method. A sample size of 333 students will be drawn including adjustment of 10% for nonresponse. The data will be collected using a self-administered questionnaire. Microsoft 2016 Excel will be used for data entry and Strata for data analysis. Data and information will be backed up using external and Google drives. The expected results are that a lot of university students have adequate knowledge on emergency contraception than other youths with no or less educational attainment, but many are not using them due to some other factors The results of the study will be presented during the 2022 Kamuzu University of Health Sciences Research Dissemination Seminar.
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Assessing the readiness of a tertiary health facility (Queen Elizabeth Hospital) to antimicrobial stewardship programme
(Kamuzu University of Health Sciences, 2021-03-21) Reuben, Zeress; Mkwate, Weston
In this cross-sectional study, we will find out how different health care professionals contribute to antimicrobial resistance specifically antibiotics at Queen Elizabeth Central Hospital, Blantyre Malawi and access if antimicrobial stewardship program would be a tool to address this problem at the facility. Antibiotics have been chosen due to increased rate of drug resistance while the rate of new medication discovery to substitute those that the bacteria have developed tolerance or resistance is very low. Antibiotic resistance occurs naturally but misuse of antibiotics in humans and animals exacerbates it. Therefore, special training, knowledge acquisition and awareness campaign among health care professional and the public concerning antimicrobial resistance will help to reduce further increase in drug resistance as they will have true and useful information. The main objective of this study is to implement antimicrobial stewardship program at Queen Elizabeth Central Hospital. The study will further attempt to assess enablers of Antimicrobial Stewardship Program (AMSP); assess barriers of AMSP; determining feasibility of antimicrobial stewardship program and assessing the expected benefits of AMSP. A four-week cross sectional study will be conducted at Queen Elizabeth Central Hospital under Pharmacy department, Laboratory department, |Medical wards (3B and 5A wards) and the data will include all information gathered from pharmacy personnel, nurses, laboratory scientists and medical doctors which are of a priority to this research. The questionnaires will be used to collect data from different health care professionals concerning antibiotic use and antimicrobial resistance and the collected data will be analysed using a software SPSS. The expected finding is that antimicrobial resistance is on rise due to lack of clear and proper information about antimicrobial stewardship program and its implementation among health care professionals at Queens central hospital would help to minimise this problem. The collected results will be submitted to COMREC and published to try to narrow the gap that exists among health care professionals (as most of the time they work independently) in order to deal with antimicrobial resistance.
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Assessing the use of contraceptives among female University student in Blantyre basing on knowledge, attitude and practice (KAP)
(2022-03-16) Simsokwe, Happy; Makwangwala, Thandie
Malawi is one of the developing countries with a high fertility rate resulting in an increased population over the years to about 17 million as of 2018. Barriers, attitudes and lack of knowledge of contraceptives has lead to high prevalence of unintended pregnancies among university female students due to an increased rate of unprotected sexual activity hence arbotions and high mortality rate. This has negatively affected the health and socio-economic status of the women and the country. Contraception use can help reduce birth rate and improve the economic status of the country. There has been a gap noted in addressing the contraceptive needs for the youth especially females in tertiary education here in Malawi either due to misconception, lack of proper and adequate knowledge on contraceptives due to assumption that they are already familiar with contraception, bias in services distribution and discrimination among the students. This study will try to address that gap and give an insight to different individuals especially organizations on the need to provide contraception for females in tertiary education. OBJECTIVES This study will be based on assessing the knowledge, attitude and practice (KAP) of contraceptives use among female university students in Blantyre. Specific objectives include to identify the number of female students currently using family planning methods, to identify the common types of contraceptives methods used, to compare the rate of use of different contraceptive methods in accordance to preference, to determine the barriers to contraceptives access at different tertiary schools and to unfold the attitudes towards contraceptives use. METHODOLOGY This study will be conducted based on a quantitative method cross-sectional study design. Convenience sampling method will be used as the sampling technique. Self-administered questionnaires extracted from a similar study will be used for data collection. Institutions involved in the study are BIU, KUHeS and MUBAS. Data collected will be analysed using Microsoft Excel® and Epi Info. 1
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Assessing therapeutic turnaround time of creatinine, urea and FBC from emergency departments at Queens central hospital
(Kamuzu University of Health Science, 2021-01-16) Gondwe, Yilinase
Type of research An observational descriptive study will be conducted on creatinine, urea and full blood count testing requests from the adult emergency department delivered at the Clinical Chemistry and hematology section of the Queens Elizabeth Central hospital (QECH) laboratory department The problem to be studied Therapeutic turnaround time is the period from test ordering to the time the results for the test are given. Clinicians rely on shortness of turnaround time (TAT) to achieve early diagnosis, treatment of the patients and early patient discharge from emergency departments or hospital in-patient services and the hospital as a whole. A clear knowledge of Laboratory Turnaround Time (LTAT) will enable critical assessment of laboratory services and improve therapeutic turnaround time (TTAT), thus improve care provision and shorten the length of stay in the emergency department. Objectives This study will define the therapeutic turnaround time for creatinine, blood urea nitrogen (BUN) and full blood count (FBC) tests from the adult emergency department at Queen Elizabeth Central Hospital (QECH). Specifically, this study will quantify the demand for creatinine, urea and full blood count tests from the adult emergency department; and further identify factors affecting the turnaround time for these tests in the emergency department and at in a clinical laboratory. Methodology Blood samples will be received at the Clinical Chemistry Department for creatinine and urea and at hematology department for full blood count within the QECH laboratory department. A number of tests will be observed in a time period of a month and a sample size of 196 will be observed. Average time taken to complete each phase of the test will be measured and overall turnaround time for each test will be calculated. Clinical data. Emergency department and laboratory issues identified as affecting the turnaround time will be categorized and reported in proportions to define the demand and describe the factors affecting the TTAT. EPI Info 7.0 will be used for data analysis. 163.5 Expected findings and dissemination The expectation is that the TTAT identified in this study will be more than 60 minutes which is the acceptable TTAT as described by Robert Hawkins. The study findings will be presented to the Medical laboratory science (MLS) department, QECH emergency and laboratory departments. The final study report will be submitted to College of Medicine Research and Ethics Committee (COMREC) and college of medicine library. These results will be disseminated through attendance of local conferences/seminars and publication in peer-reviewed journal.
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Assessing viral load testing adherence and coverage and the related client outcomes in the 90:90:90 era: A case study of Ntchisi District Hospital
(Kamuzu University of Health Sciences, 2020-06-05) Kholomana, Thokozani
This will be a retrospective quantitative cohort study. The problem to be studied: Viral load (VL) testing is one of the essential measure of HIV client progress in regards to ART where suppression shows treatment success. So this study intends to find out the level of VL coverage and adherence to protocol and describe the relationship between those clinical factors and the development of Tuberculosis (TB), infantile deaths and miscarriages. Main objectives: To assess the viral load testing adherence and coverage and the related client outcomes Specific objectives 1. To assess the level of clinical adherence and coverage in regards to viral load time frames 2. To measure the prevalence of Tuberculosis in HIV care enrolled clients and the related VL adherence and coverage before diagnosis 3. To estimate the rate of miscarriages in HIV clients and the related VL adherence and coverage prior to incident 4. To determine the prevalence of infantile deaths and the related VL adherence and coverage prior to the incident Methodology Study design: The study will employ a retrospective quantitative cohort design. Study place: This will be conducted in Ntchisi district. Respondents will be recruited from Ntchisi district hospital ART clinic. Study population: HIV reactive clients attending Ntchisi district hospital ART clinic will be eligible for this study. Study Period: The study will run from April 2019 to July 2020. This is a 16-month period which conceptualization of the proposal to thesis submission will be done. Data collection procedures: This study will utilize a checklist to extract data following the subjects consent. The checklist will look at such variables as age, sex, marital status of HIV positive patients, TB status, infantile deaths status, miscarriages, the number of VL tests and the times when their viral load testing was done. Mainly the clients master cards, and the prevention of mother to child transmission (PMTCT) registers utilized will be used to extract such data. Data management and analysis: All data will be kept in Microsoft excel with a passcode for safety. So, these data will be exported to Stata wherein cleaning and analysis will occur. Moreover, respondents’ identities will not be identifiable since they will be represented by codes. Data analysis will involve both descriptive and inferential statistics. Constraints: The researcher supposes there might be missing VL results in other study participants. In regards to this, the researcher plans to rectify this by following up with the central laboratory. Implications of the study: Results from this study are expected to contribute knowledge to the body of research in HIV medicine. For that cause, this information will be important when developing interventions for HIV clients’ care, providers protocol, including mentorship and supervision schedules. Expected findings and their dissemination: This study will find the period prevalence of Tuberculosis, miscarriages, and infantile deaths in people living with HIV (PLHIV). Moreover, this will show coverage and adherence frequencies in regards to VL testing in PLHIV and the relationship and association between the dependent and independent variables. Moreover, the results be contained in the author’s Master of Global Health thesis that will be submitted to COMREC and college library.
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Assessment of the utilization of HIV self-testing (HIVST) services among female sex workers (FSW) in Machinga district, Malawi by Khumbo Ngóna Namachapa
(Kamuzu University of Health Sciences, 2022-02-09) Namachapa, Khumbo
Type of study Utilization of HIV Self -Testing (HIVST) services among Female Sex Workers (FSW) in Machinga district, rural Malawi.- Problem Statement In Malawi, HIVST policy was adopted in 2018 to ensure that hard to reach populations such as FSWs know their HIV status contributing to case finding and get linked to treatment, care and support services. However, since it`s inception, an evaluation has not yet been done to determine utilization of HIVST services. Most data presented are from studies conducted in other African countries with an upper middle-income level and from urban Malawi. It is not conclusive that these studies findings may apply to Malawi`s local context in places such as Machinga which is predominantly rural. Objectives • Broad Objective To assess the utilization of HIVST among FSW in Machinga district, Malawi. • Specific Objectives i. To explore the knowledge and attitudes of FSW towards utilization of HIVST service ii. To describe how the attitude of HIVST distributors affects HIVST utilization among FSW iii. To examine if the experience of stigma and discrimination affects utilization of HIVST among FSW iv. To explore the views of FSWs on whether linkage to treatment and care affects utilization of HIVST services. Methodology On methodology, the study will use qualitative research methods. Purposive sampling method will be used to recruit FSW aged 13 years and above. Data will be collected through Focus Group Discussions and in-depth interviews and thematic content analysis will be used to analyse data using NVivo software version 11.0. Expected findings and dissemination This study expects to unearth the depth of knowledge possessed by FSWs on HIVST services and how their level of knowledge influences their attitude towards HIVST. This study expects to uncover the attitudinal influence of the service providers on the end users. lastly the study expects to find out the societal influence on the uptake of HIVST services of FSWs albeit numerous efforts that have been undertaken to address stigma and discrimination. the probable findings of this research will be disseminated in various forums such as Kamuzu University of Health Sciences (KUHES), School of Public Health and Family Medicine (SPHFM) faculty, College of Medicine Research and Ethics Committee (COMREC) and College of Medicine Research Dissemination Conference, the DHA, and Machinga DistrictHospital management. The dissemination process will be in various forms thus written and oral (presentations).
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An audit of pain management in cancer patients at the Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2021-03-17) Damson, Carolyn; Dias, Peter; Mwale, Gillian
Introduction: Pain can be a debilitating symptom and should be assessed and managed with the gravity it deserves. If not properly managed, it severely impacts quality of life. Many studies however, have shown that globally, most patients have uncontrolled pain despite the policies and guidelines that have been put in place to approach it. Pain is especially common in cancer patients with each patient having a unique experience, thus necessitating an individualized approach in management. Objectives: To conduct a survey of pain management in cancer patients admitted to different wards at the Queen Elizabeth Central Hospital. Specific objectives: 1. To assess the type of pain among cancer patients 2. To measure the severity of pain experienced by cancer patients 3. To assess type of prescribed analgesia for cancer patients 4. To assess the prevalence of controlled pain among cancer patients Methodology: The survey will be a quantitative method study with a cross sectional study design. It will be carried out over 6 weeks. Both primary and secondary data will be collected from 73 participants using interviewer administered questionnaires, participant’s health files and drug charts. Expected results: Given that QECH is a tertiary institution with different specialties and many expertly trained health personnel, there should be quality management of pain. However, Malawi is one of the most economically challenged countries and so has limited resources and a high doctor to patient ratio of 1:33,000 [1]. Doctors may then be pressured to rush through the proper assessment methods and use of standard tools that guide the analgesia prescription. Scarcity of resources may also prompt them to prescribe the next best analgesia instead of the recommended one. Therefore, we expect a high percentage of patients with mismanaged pain. Dissemination: The findings of our audit will be presented orally at the College of Medicine Year 4 research dissemination sessions.
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An audit of the clinical cases and outcomes on patients admitted to the intensive care unit (ICU) at Kamuzu Central Hospital (KCH), Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Munthali, Leonard; Napolo, Upile; Bwanali, Akim
Since its introduction, in the 1950's critical care medicine has significantly improved the quality of care and outcomes of the critically ill [1] However, the same cannot be said of the developing countries; lack of financial resources, equipment and well trained staff has limited its impact especially in Sub Saharan Africa. [2,3]. This deems as a problem as the demand for critical care medicine increases due to the rise in population coupled with the rise in incidence of critical illnesses. Multiple studies have shown inefficiencies in ICUs within the developing countries with alarming mortality rates. However, only few studies have been done in Malawi. Methods A quantitative retrospective cohort study at Kamuzu Central Hospital, ICU. That will be Looking at the clinical cases and treatment outcomes of patients admitted to the ICU spanning from 1stJanuary to 31st December 2019. Participants will be selected by consecutive sampling method. Preliminary analysis of records, revealed that the ICU admits an average of 22 patients per month, thus we expect to a study about 264 participants. The study is expected to take place for no more than 6 weeks. All data will be entered into Microsoft excel and analysis will be done using Epi info. Expected findings It is expected that findings will help to understand patterns of admission and factors associated with mortality in the ICU. This will guide interventions aimed that reducing the mortality Problem statement. In low resource settings, such as ours, the allocation of ICU facilities is determined by perceived patient outcome. It is up to the physician to decide if the patient is too sick or not sick enough to be admitted to the ICU. This often results in the admission of patients with a poor prognosis while other patients with a better chance of survival are unable to access the care they need and deserve. Previous studies have shown that the mortality rate of patients that are admitted to the ICU is high. In 201 2, a study was conducted at the KCH ICU, it showed a general mortality rate of 60.9 % with sepsis being the commonest cause of death. Finally, there has been limited published research on the resources and performance of the ICU. In fact, since the construction of the current ICU at the hospital, little to no research has been done. Therefore, we are unaware the ICU's efficiency.
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Awareness and practice of patients’ rights and responsibilities amongst patients at Chiradzulu District Hospital, Southern Malawi.
(Kamuzu University of Health Sciences, 2020-06-25) Mataka, Raphael; Chamatambe, Peter; Demera, Emmanuel
This study is designed to assess the awareness and practice of patients’ rights and responsibilities amongst patients. It will be a quantitative cross-sectional study which will be done at Chiradzulu District Hospital, Southern Malawi. 237 patients will be selected using convenient random sampling. Social demographic factors will be collected from the study participants using questionnaires that will be administered by the researchers. This study will help the Ministry of Health, policy advocates, and other stakeholders to assess the effectiveness of awareness of program activities and put in place strategies to reinforce awareness and practice of patients’ rights and responsibilities.
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Barriers and facilitators to screening for dyslipidaemia, hypertension and diabetes among people living with HIV aged 40 years and above at ART clinics in district hospitals in Southern Malawi
(2021-11-18) Katundu, Kondwani
Study Type: The study will utilise a mixed-methods (convergent) approach. Background: Malawi is ranked among the countries in the world with the highest burden of atherosclerotic cardiovascular diseases (ASCD) among people living with HIV (PLWH). Dyslipidaemia, Hypertension, and diabetes mellitus (DM) are major risk factors for ASCD and lead to debilitating consequences such as stroke. There is a gap in the effectiveness in identifying and managing hypertension dyslipidaemia and DM among PLWH in many public health facilities across Malawi. Investigating the local barriers and facilitators in the Malawian setting is critical to creating better implementation strategies for the effective screening and management of these cardiovascular risk factors in district hospitals of the country. Study Objectives: The objectives of this study are: (a) to determine the proportion of PLWH aged 40 years and older who are evaluated for dyslipidaemia, hypertension and DM in routine care at district hospital ART clinics in Southern Malawi (b) to identify the barriers and facilitators to screening for dyslipidaemia, hypertension and DM among PLWH) aged 40 years and older at ART clinics in district hospitals in Southern Malawi. Methods: A mixed-methods (convergence) approach will be used to collect the study data. Firstly, we will quantitatively collect retrospective data on the performance of five randomly selected district hospital ART clinics in Southern Malawi to screen for hypertension, dyslipidaemia and DM in routine care. From these clinics, we will purposefully select three clinics rated as highest, intermediate and low on the screening performance for hypertension, which is the expected standard routine assessment in these clinics, according to Malawi standard clinical guidelines for the management of PLWH. In the three clinics we will collect qualitative data guided by the Consolidated Framework for Implementation Research (CFIR), and we will assess for three major domains namely the intervention, the inner setting and the characteristics of individuals. Expected findings and dissemination: We expect to find a relatively high prevalence of screening for hypertension since it is in the national management guidelines. However, we hypothesize that the prevalence for screening for DM and dyslipidaemia will be lower due to the lack of inclusion in the national guidelines and screening resources in district hospitals. We expect to identify the barriers and facilitators to the integration of screening of hypertension, DM and dyslipidaemia in the ART clinics. The results once analysed will be published in an international scientific journal and will be presented both at local and regional or international conferences. Published results will also be submitted to the district hospitals engaged, the HIV and non-communicable diseases units of the MalawiMinistry of Health, the College of Medicine Research and Ethics Committee (COMREC) and the Kamuzu University of Health Sciences Library.
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Before BREATHE: A baseline audit of hypoxemia in Malawi
(2022-09-16) Rylance, Jamie
Executive summary 4.1 Type of research study The study is a prospective audit. 4.2 Problem to be addressed Our team’s study at Queen Elizabeth Central Hospital (QECH) in 2012 showed tha one third of medical patients had a respiratory diagnosis, and hypoxia was not identified in 21% of these. Furthermore, only one third of those requiring oxygen by WHO guidelines were receiving it.1z Due to the COVID-19 pandemic, interest in improving outcomes for all hypoxemic patients in LICs has increased, with proposals including increases in oxygen supplies, improvements in systems for monitoring hypoxemia and titrating oxygen therapy, and testing of various oxygen delivery devices. This audit will provide updated information on the practices, and outcomes for oxygen monitoring and titration at QECH. The information collected for this audit will provide the necessary platform from which future quality improvement and research studies can be developed. Parallel data collection will occur in Rwanda and Kenya as part of the assessment of potential sites for a prospective trial of high flow oxygen. 4.3 Broad objective To understand oxygen supply and demand at Queen Elizabeth Central Hospital, Malawi. 4.4 Specific objectives 1. To describe the physical resources and current practices for oxygen therapy for hypoxemic adults at QECH. 2. To measure the baseline performance of key indicators for optimal oxygen monitoring, documentation, and titration. 3. To assess in-hospital outcomes of mortality and length of stay for all hypoxemic adults. 4.5 Methodology Prospective audit of data recorded in the patient medical notes and charts. The audit will continue for three months to give information on an estimated 300 patients (based on local patterns), which will allow confidence in the representativeness, and ability to detect low levels of non-compliance with hospital guidelines. To estimate mortality, this number gives a 5.7% precision around a prior estimate of 50%.16-Sep-2022 Before BREATHE: a baseline audit of hypoxaemia protocol (version 1.0)Before BREATHE: a baseline audit of hypoxaemia protocol (version 2.0) - 06/03/202201/09/2022 Page 6 of 16 4.6 Findings and dissemination Data collected by the audit team will be freely available to, and owned by, the hospital. We hope that this will allow an assessment of current practice, and inform repeated quality- improvement cycles. The audit data will be used to power a future randomised controlled trial of alternative (high flow) oxygen therapy. We will work with our team to present the findings to hospital grand rounds, and to publish, for example, in the Malawi Medical Journal. We will also feedback directly to COMREC.
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Building capacity to understand, and to communicate genomics data, information, and research, version 1.0
(Malawi Wellcome Trust, 2022-08-17) Mijumbi, Rhona
Type of Study: Case Study Problem There is a growing recognition of the importance of engaging the decision-making public on genomics-related research. However, multiple challenges exist in approaching this engagement among which include the potential purveyors’ understanding of the information. A report that traced how genomics findings were reported from their source in a scientific journal through to press publications found that the reports along the continuum differed in what was said (rather than how it was said). The report premises the fact that the public needs a clear understanding of the context of reported results to make an informed judgment about their meaning. Within this public are decision-makers expected to act on data and research findings. Involving the public in genomics research is important as it is expected that a quarter of the world’s population (2 billion people) will have had their DNA sequenced by the year 2025. This study aims at improving the understanding of genomics information and building the capacity of select purveyors of this information. Specific Objectives a) To explore and improve the public’s understanding of genomics in the context of Covid-19 b) To build the capacity of a select group of researchers, journalists, knowledge brokers, and policymakers around the communication of genomics research and findings to the public Methodology The study will involve conducting two citizen panels for decision-makers within the public,and two training sessions coupled with mentorship for selected purveyors of genomics data,information, and research. Number of participants: 52 participants Duration: 15 months Expected results Out of this study, we hope to obtain a good understanding of the policy and decision-making public’s understanding of genomics and related information and their associated social attachments. This information will be used to craft messages, guidance, and pathways for appropriate communication, hence improving understanding. From the participants, the study will also seek to train trainers on public communication of genomics research and findings. Lastly, information from the study will be used to theorize the appropriate communication of complex technical science which will be tested further and beyond this study. Dissemination of findings A citizen panel report will be shared with pertinent stakeholders including COMREC, heads of research groups, research institutions, and knowledge brokerage institutions. Furthermore, we will publish our work to share lessons with peers in the academic field. We will also have a policy dialogue at the end of this work to share our findings with policy, media, and other stakeholders interested in the outcomes including representation from COMREC. Findings will also be shared with the wider consortium of genomics researchers that is held between KEMRI and OUCRU who are doing similar work on communicating complex science to non-science audiences.