Covid 19

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Acceptability of covid-19 vaccine and its associated factors among the elderly aged 65 and above in Machinga district
(Kamuzu University of Health Sciences, 2022-02-02) Mbukwa, Kettie
This is a cross-sectional study aimed at exploring the acceptability of COVID 19 vaccine and its associated factors among elderly aged 65 years above in Machinga and it will employ qualitative methods. For its thematic analysis, the study will use a Health Belief Model to analyze the factors that influence the acceptance of COVID 19 vaccine among elderly and which beliefs should be targeted in communication campaigns to cause positive health behaviors. Problem: COVID 19 remain a crucial global pandemic and leading cause of high morbidity and mortality rate among higher risk population. With the development of multiple effective vaccines, reducing the global morbidity and mortality of COVID-19 will depend on the distribution and acceptance of COVID-19 vaccination, while studies generally indicate a low uptake of COVID 19 vaccine among various population, Vaccine hesitancy and refusal are global concerns. According to World Health Organization (WHO) it has been identified as one of the top 10 threats to global health in 2019. Available data for Machinga District by July 2021 it shows that only 3637 received COVID 19 vaccine and only 408 elderly 65 years and above received the vaccine, since the roll out however the vaccine acceptance among elderly is still low. The correct and comprehensive beliefs of the target groups regarding the benefits and barriers of the vaccination must be raised. Various effective social strategies must be adopted to trigger the intention of COVID-19 vaccination. Objectives. – The main objective is to explore the acceptability of Covid 19 vaccine among elderly (aged 65 years above) in Machinga district. Specifically, the study seeks to assess the perceptions, attitude towards Covid 19 vaccine, to assess contextual factors that facilitate and impede the acceptance of Covid 19 vaccine, to assess the health system factors that influence the acceptance of Covid 19 vaccine. Methodology. - A qualitative study design will be used to explore the acceptability of COVID19 vaccine and its associated factors among the elderly people of 65 years above in Machinga District. Study population will include the elderly 65 years and above, residing in both urban and rural communities, both male and female. The sample size will be 36 and the study participants will be purposively selected. The study will collect data in participants own setting using in depth interviews (IDIs) and Key informant Interviews (KII). Collected data will be stored securely in computer data base that have a pass word and only limited access to key study team will be provided. Data analysis will be done using deductive and inductive thematic content analysis. Informed consent will be obtained from each and every study participant before enrollment in the study. Confidentially will be ensured throughout the study and thereafter. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC). Expected findings. –The study anticipates to identify the factors that act as barriers as well as factors that act as facilitators to the uptake of COVID -19 vaccine among the elderly at individual, social as well as health system levels. Dissemination of Expected findings: Research results will be disseminated in writing and presentations as feedback made to the District Health Management Team (DHMT) for Machinga and to COMREC. Recommendations will be made to various level of decision makers, DHOs office and key implementing partner on improvements that need to be made to optimize uptake of COVID 19 vaccine.
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The African Covid-19 critical care outcomes study (ACCCOS)
(Kamuzu University of Health Sciences, 2020-10-08) Kachitsa, Clement Precious
TYPE OF STUDY Multi-centre prospective observational cohort study. PROBLEM The infectious disease COVID-19, caused by coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has been declared a pandemic and an international healthcare emergency by the World Health Organization (WHO). It has spread across the globe, overwhelming healthcare systems by causing high rates of critical illness. Mortality from COVID-19 exceeds 4%, with older people with comorbidities being extremely vulnerable. It is expected that between 50-80% of the world’s population may contract SARS-CoV-2 over the next two years. In Africa there is a limited workforce and there are limited intensive care facilities and critical care resources across to provide sufficient care. It is important therefore to establish what resources, comorbidities and interventions are potentially associated with either mortality or survival in patients with COVID-19 who are referred for critical care in Africa. Rapid dissemination of these findings may help mitigate mortality from COVID-19 in critical care patients in Africa. These points provide the rationale for the African COVID-19 Critical Care Outcomes Study (ACCCOS). STUDY OBJECTIVES The main objectives of this study are to identify critical care resources associated with survival, identify patient comorbidities and other risk factors associated with in-hospital mortality and to identify in hospital interventions associated with in-hospital survival in patients with suspected or known COVID-19 in Africa. METHODS An African multi-centre retrospective and prospective observational cohort study of adult (≥18 years) patients referred to critical care or high-care units with suspected or known COVID-19 infection. Patient follow up will be for a maximum of 30 days in-hospital. The intention is to provide a representative sample of the mortality and the risk factors associated with mortality in adult patients with suspected or known COVID-19 referred for critical care in Africa. This study will run between Aprils to December 2020. EXPECTED FINDINGS AND DISSEMINATION We expect the outcomes to be potentially worse in Africa, because firstly, there is a limited workforce, and secondly there are limited intensive care facilities and critical care resources across Africa to provide sufficient care. A report of the research findings will be submitted to the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences research committee, the University research and publication committee, the Lancet Commission and the Ministry of Health.
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Assessing the association of COVI-19 with under-five children malnutrition in Namphungo and Chambe rural Health Centers of Mulanje District by Carolyn Kang’ombe
(Kamuzu University of Health Sciencies, 13-07-21) Kang'ombe, Carolyn
XECUTIVE SUMMARY Background: Malnutrition contributes significantly to child morbidity and mortality. While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. In this study, we generate information about the burden of Covid-19 towards under-5 child nutrition resulting from the potential disruption of health systems, economic system and decreased access to food. Objectives: The broad objective of the study is to assess the association of covid-19 with underfive child malnutrition in rural health centers of Mulanje District.. To achieve the broad objective, the study will achieve the three specific objectives outlined; 1. To conduct a comparative description of accumulated cases of malnutrition in under-five children cases admitted on Outpatient Therapeutic Program and Supplementary Feeding Program during and before onset on COVID-19 pandemic. 2 To assess the food situation and income security in households of malnourished under five children during and before onset of COVID-19 pandemic. 3 To compare the health services delivery in under five clinics before and during the COVID-19 pandemic in the rural areas of Mulanje. Methods: The study will be conducted at Namphungo and Chambe Health centers. A mixed method design will be used where cross-sectional qualitative and quantitative study design will be employed. For quantitative data, secondary data will be used to address the first objective. Health center under-five clinic registration will be used to extract data. Participants will be care givers to the admitted under five children under Out-patient Therapeutic Program and Supplementary Feeding Program (n=71) that will be randomly sampled from the secondary data in the respective health centers registry. Qualitative data will be collected through in-depth interview with care takers (n=10) that have under-five children on out-patient therapeutic program and supplementary feeding program on food situation analysis. Key informants (n=4) at the respective health centers will be interviewed to understand the working modalities that were applied as COVID-19 response measure. Expected results and dissemination: This study expects to enlighten any association and impact on food production and access, provision of health services and changes in practices and behavior due to the COVID-19 and its contribution towards exacerbation of malnutrition among under five children in the communities. The results will assist in informing policy and advocacy which may 13-Jul-2021 Version 3, revised 22nd June,2021 2 | P a g e lead to the refinement and improvement of maternal and child nutrition preparedness in emergencies. The findings will be disseminated to COMREC, college of medicine school of public health and family medicine, Department of Nutrition, HIV and AIDS (DNHA), Mulanje District Health Office, Mulanje Agriculture Office as well as research dissemination conferences. Results will help to advocate for under-five nutrition measures that will assist in coping with the COVID- 19 pandemic and hence reducing under-five malnutrition.
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Assessment of the Knowledge, Attitudes and Preventive Practice Towards Covid-19 Among People in Blantyre Rural Area
(Kamuzu University of Health Sciences, 2022-05-09) Thompson, Chimwemwe; Kanguwo, Blessings; Tonde, Henry; Tembwe, Horace
TYPE OF STUDY AND STUDY PLACE: This is a qualitative cross sectional study, which will involve structured questionnaires, individual in-depth interviews and direct observation by investigators. The study will be conducted in Blantyre rural areas and specifically Chileka Area. The study will cover Singano and Mdala villages, all located in Chileka. The Problem to be studied is the level of awareness of people living in rural areas about Covid- 19, their attitudes towards the disease and its preventive measures. The research will answer the question “What is the knowledge and attitude among people living in Blantyre rural areas towards Covid-19 and their preventive practices”. 1.2. STUDY OBJECTIVES: The main objective of the study is to assess the knowledge, attitude and preventive practices towards COVID-19 among people in Blantyre rural. The specific objectives are to: 1) explore the level of awareness and knowledge of the people about COVID-19 pandemic, 2) identify the preventive practices that are used by the people in Blantyre rural, 3) assess how the people access information about the COVID-19. 1.3. METHODOLOGY: This study will be conducted in Blantyre rural specifically Chileka area. It is a cross-sectional study and qualitative in nature. Adults residing in rural area will be the target population of the study. Study sample will be identified using the convenient sampling method, the Data about the study will be collected by conducting individual in-depth interviews with the participants, structured questionnaires and observations where people will be observed if they are using COVID-19 preventive measures and informal interviews to probe more. 1.4. DATA MANAGEMENT AND DISSEMINATION: The qualitative data collected will be entered into Microsoft excel, this data will be processed and analyzed into graphs, tables and charts. The research results will be disseminated through oral presentation to the Medicine Department, College of Medicine and the final project report will be submitted to COMREC, Medicine Department, College of Medicine library and academic staff. 1.5. EXPECTED FINDINGS: It is expected that people in rural areas have low levels of knowledge about COVID-19 due to poor access to information about the disease because they live far from reliable sources of information. They also have different attitudes towards the disease with some believing that the disease doesn’t exist and others believe that it’s a sign of 666 Satanism. COVID-19 is regarded as a normal flue in rural areas and people get cured after taking their natural remedies. It is also expected that people in rural areas don’t follow COVID-19 preventive measures as per their beliefs and others due to lack of relevant resources.
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Associated factors among health care workers at Queen Elizabeth Central Hospital, Malawi
(Kamuzu University of Health Sciences, 2021-11-09) Chikhoza, Angella Joseph
The type of research study This is a quantitative, descriptive cross sectional study. The Problem The COVID-19 pandemic has caused high mortality rates worldwide; and this forced scientists to develop COVID-19 vaccine within one year. HCWs are at high risk of contracting the COVID-19 due to nature of their work. Furthermore, HCWs were among the priority groups to receive COVID-19 vaccine. Before COVID-19 vaccination program was rolled out, some studies were conducted to assess the acceptability of COVID-19 vaccine among HCWs in other countries, such as United States of America (USA) and United Kingdom (UK). Research showed that majority of HCWs were hesitant to receive the vaccine; their concerns centered on short and long term side effects. Furthermore, since COVID-19 vaccination program was rolled out, there has been misinformation among the general population on COVID-19 vaccine and its side effects. Study Objectives The main objective To determine factors associated with uptake of COVID-19 vaccine among HCWs at QECH in Blantyre, Malawi. The specific objectives are To determine the proportion of HCWs that received COVID-19 vaccine at QECH in Blantyre, Malawi. To identify social-economic factors associated with uptake of COVID-19 vaccine among HCWs at QECH. Methodology The study participants will be clinical HCWs which includes; nurses, clinicians, doctors and physiotherapy personell; Non clinical HCWs includes; pharmacy, laboratory personell, radiologists and hospital attendants. They will be recruited from the following departments at QECH; COVID-19 isolation units, Ear, Nose and Throat (ENT), High Dependency Respiratory Unit (HDRU),male and female medical (3B and 4A), male and female surgical (5A and 5B), Accidents and Emergency (A and E), Adult Emergency and Trauma Centre (AETC), orthopedic, gynaecological, Chatinkha nursery, peadiatric Moyo, Peadiatric Special Care Ward (PSCW), postnatal, laboratory, pharmacy, radiology and physiotherapy. Expected results and dissemination Lack of adequate knowledge on COVID-19 vaccine among HCWs may result to suboptimal uptake of COVID-19 vaccine. If true, the study results will inform in strategy/ policy making to optimize the uptake of COVID-19 vaccine and of future pandemics. The study results will be presented using tables, graphs and charts. The study findings will be disseminated to study participants, QECH, Ministry of Health (MOH) and College of Medicine Research Ethics Committee (COMREC) among others. The researcher will also attend local conferences to disseminate the study results.
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Availability and level of utilization of Personal Protective Equipment (PPE’s) by Health Care Workers in wards and at the laboratory at Mwanza District Hospital, Southern Malawi
(2021-11-09) M’mangisa, Chifundo Duster; Manja, Sister Florah; Chimozimozi, Sunganani G.
1.1STUDY TYPE The study is a mixed methods design. The qualitative part will use in-depth interviews to understand level of acquaintance of health care workers on proper utilization of PPES. The quantitative component will review pharmacy records in stock cards, wards ordering books and a questionnaire will be used to comprehend health workers on proper use of the PPEs BACK GROUND The novel corona virus (COVID-19) is a viral air-borne disease caused by SARS-CoV-2 (severe acute respiratory syndrome corona virus) [13]. Due to the rapid widespread of the disease, many areas in Malawi continue to record a high number of cases and mortality rate among individ uals and healthcare workers. One of the major factors that contributed to the widespread of this deadly virus in health facilities is indiscriminate use of personal protective equipment (PPE)[10]. In this research project we will assess availability and utilization of Personal protective equipment by healthcare workers during the pandemic, we define PPEs Availability as present or ready to use and utilization of PPEs as effective use of PPEs (health care worker are able to acquire appropriate medical PPEs at a point of health care delivery, in this time of pandemic and also asses level of knowledge they have on proper use of it). However, access to PPEs in many health facilities has become a challenge due to high demand of PPEs both international and local market[12]. The results will be presented to the Department of Health Systems Management and Policy as an examination. The hard copies will be shared through the library at College of Medicine and presentation will be shared through conferences under the College of Medicine. 1.2 problem statement Personal Protective Equipment (PPE) is any material, device, equipment or clothing which is used or worn by a worker to protect them from exposure or contact with any harmful material or energy which may cause injury, infection or even death to the worker [4]. According to Torp, 2005 [5], the PPEs often used in health care settings include gloves, masks, goggles or face shields and aprons[14]. The use of PPE is a universal and legal requirement to protect workers against occupational injuries and illnesses in their workplace. These personalized items are very useful, as without them, workers could be exposed to a variety of toxic substances, chemicals, radiation, or incidents, which could result in occupational diseases, injuries, or even fatalities [6]. Although personal protection is often seen as an inexpensive solution of controlling occupational hazards, little consideration is given to the selection of suitable and effective devices, the maintenance of the devices and to the training of persons using the devices [7]. According to a study by Zingg et al ,2015, Healthcare-associated infections (HAIs) remain as the most frequent adverse event in any healthcare delivery system and affect millions of people each year, leading to significant morbidity and mortality [8]. HAIs are infections acquired within a healthcare facility. The risk of HAIs can be reduced through practicing standard precautions (SPs), including use. In sub–Saharan African countries which Malawi is included annual PPEs needs for health care workers were estimated; surgical masks 213 000 000, Gloves 100 000 000, eye protection (face shields or goggles)3700 000, Gowns 1600 000. Similar Study which was done by, Madziatera et al ,2020[12] at QECH found that PPEs were available in 75.8% of wards, not available in 12.5%. Goggles were absent in 70.8% of wards. PPEs were 71.4% accessible and 28.6% inaccessible to healthcare workers in the wards. The most inaccessible PPEs were goggles (83.2%) and footwear (73.7%) while facemasks, sterile and non-sterile gloves and aprons were readily accessible. Non sterile gloves were 100% available and accessible. Only 13.5% of the HCWs had good compliance with PPE standard procedures. The average PPE compliance score of those who had been trained was 6 % greater than those who were not trained during the peak of the Covid-19 pandemic in Malawi. 1.3 STUDY OBJECTIVES 1.3.1 Main Objective To determine factors influencing availability and utilization of PPEs among health care workers 1.3.2 Specific Objectives 1. To estimate the availability of PPEs at Mwanza District Hospital 2. To assess the level of knowledge on the appropriate use of PPEs among health care workers 3. To identify the factors influencing the use of PPEs among health care worker 1.4 Methodology 1.4.1 STUDY DESIGN The study is a mixed methods design. The qualitative part will use in-depth interviews to understand level of acquaintance of health care workers on proper utilization of PPEs. The quantitative component will review pharmacy records in stock cards, wards ordering books and a questionnaire will be used to comprehend health workers on proper use of the PPEs. Analysis of qualitative data will use thematic approach. Descriptive statistics using tables and graphs will be used to analyze quantitative data. The study population will be health workers in selected sections. The study will use random sampling to select health care workers. conceptual framework will help to understand relationship between the independent, intervening and the dependent variables that affect utilization of PPEs 1.5 EXPECTED FINDINGS The study is expected to be of great importance, not only to Mwanza District Hospital, but to the whole country in that: 1. The findings will help in scaling up infection prevention among health care workers. 2. It will contribute to further research study e.g. availability and use of PPEs in Malawi. 3. It will contribute to the literature for future referencing. 1.6 Results Dissemination For the project to be deemed relevant, it has to be communicated. Therefore, it is for this reason that the researchers decide to submit one copy of the results to the KUHeS Library, KUHeS Research Ethics Committee, department of Health Systems and Policy as well as in our various work places. It is our big hope that we present the findings at this year’s KUHeS Research Dissemination Conference as well as having our work published in Malawi Medical Journal.
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Characterising COVID-19 occupational exposure among healthcare workers through the validation of point-of-care diagnostics
(Kamuzu University of Health Sciences, 2020-06-02) Tonney, Nyirenda
Study type Prospective cohort study Problem A substantial number of COVID-19 infections have been reported in health care workers (HCWs) in over 50 countries. In Malawi, HCWs are particularly vulnerable, owing to the lack of personal protective equipment and infection prevention and control measures in healthcare facilities, fragile healthcare infrastructure and the lowest number of physicians per population. In Malawi, COVID-19 infection amongst HCWs can have devastating effects on an already fragile healthcare system. A key challenge facing Malawi is the lack of access to specialist laboratory infrastructure. If the pandemic takes off in Malawi, these diagnostic facilities will be rapidly overwhelmed. Validation of low-cost rapid diagnostic tests will allow the accurately diagnosis of COVID- 19 infection.Validation of low-cost rapid diagnostic tests that can accurately diagnose current COVID-19 infection. Timely diagnosis of current COVID-19 infection will enable timely health facilities to make investigations and implement institution of containment measures, such as quarantine and contract tracing. Objectives  Characterise COVID-19 occupational exposure among healthcare workers in Blantyre district  Evaluate existing point-of-care (POC) antibody tests, an in-house enzyme-linked immunosorbent assay (ELISA) and a novel POC loop-mediated isothermal amplification (LAMP) assay. The study will recruit 150 HCWs and 150 matching community controls at the following healthy facilities in Blantyre district: Queen Elizabeth Central Hospital (QECH), Kameza Isolation Centre and health centres in Blantyre urban To determine current infection and exposure, nasopharyngeal and serum samples will be screened for SARS-CoV-2 by RT-PCR and immune response (IgM/IgG) evaluated respectively using in-house and commercial SARS-CoV-2 enzyme-linked immunosorbent assays (ELISA). We will also carry out a double-blind investigation to validate a novel RTLAMP assay using RT-PCR as gold standard. Additionally, we will evaluate the performance of other commercially available point-of-care (POC) rapid diagnostic tests (RDTs). We will then use bulk and single cell transcriptomic approaches to try and understand why immunological response varies. Laboratory analyses will be performed at College of Medicine, University of Malawi. Expected findings The risk of HCW to COVID-19 will be established; this will inform guidelines on occupational safety. POC assays will be validated, which will establish the best diagnostics for use in district hospitals and health centres, where there are no RT-PCR facilities. Furthermore, the study will provide guidance on diagnostics for COVID-19. Finally, we will evaluate the immunological response to SARS-CoV-2 and why this varied between individuals and attempt to determine why some individuals exhibit symptoms.
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Characterising COVID-19 occupational exposure among healthcare workers through the validation of point-of-care diagnostics
(Kamuzu University of Health Sciences, 2020-06-02) Nyirenda, Tonney
Study type Prospective cohort study Problem A substantial number of COVID-19 infections have been reported in health care workers (HCWs) in over 50 countries. In Malawi, HCWs are particularly vulnerable, owing to the lack of personal protective equipment and infection prevention and control measures in healthcare facilities, fragile healthcare infrastructure and the lowest number of physicians per population. In Malawi, COVID-19 infection amongst HCWs can have devastating effects on an already fragile healthcare system. A key challenge facing Malawi is the lack of access to specialist laboratory infrastructure. If the pandemic takes off in Malawi, these diagnostic facilities will be rapidly overwhelmed. Validation of low-cost rapid diagnostic tests will allow the accurate diagnosis of COVID- 19 infection.. Timely diagnosis of current COVID-19 infection will enable health facilities to make investigations and implement containment measures, such as quarantine and contact tracing. Objectives • Characterise COVID-19 occupational exposure among healthcare workers in Blantyre district • Evaluate existing point-of-care (POC) antibody tests, an in-house enzyme-linked immunosorbent assay (ELISA) and a novel POC loop-mediated isothermal amplification (LAMP) assay Methodology. The study will recruit 150 HCWs and 150 matching community controls at the following healthy facilities in Blantyre district: Queen Elizabeth Central Hospital (QECH), Kameza Isolation Centre and health centres in Blantyre urban To determine current infection and exposure, nasopharyngeal and serum samples will be screened for SARS-CoV-2 by RT-PCR and immune response (IgM/IgG) evaluated respectively using in-house and commercial SARS-CoV-2 enzyme-linked immunosorbent assays (ELISA). We will also carry out a double-blind investigation to validate a novel RTLAMP assay using RT-PCR as gold standard. Additionally, we will evaluate the performance of other commercially available point-of-care (POC) rapid diagnostic tests (RDTs). We will then use bulk and single cell transcriptomic approaches to try and understand why immunological response varies. Laboratory analyses will be performed at College of Medicine, University of Malawi. Expected findings The risk of HCW to COVID-19 will be established; this will inform guidelines on occupational safety. POC assays will be validated, which will establish the best diagnostics for use in district hospitals and health centres, where there are no RT-PCR facilities. Furthermore, the study will provide guidance on diagnostics for COVID-19. Finally, we will evaluate the immunological response to SARS-CoV-2 and why this varied between individuals and attempt to determine why some individuals do not exhibit symptoms. Dissemination of results Findings of this study will be presented to COMREC and during CoM research in progress meetings at Blantyre DHO, QECH, Public Health Institute of Malawi (PHIM) and the national COVID-19 taskforce. Further findings will be published in peer reviewed journals
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Characterising health care workers’ risk of exposure to SARS-COV-2 compared to non-health care workers in Blantyre, Malawi.
(Kamuzu University of Health Sciences, 2020-06-05) Kateta, Steve Robert
Background: Cases of COVID-19 continue to rise exponentially globally and also in Malawi. Frontline health care workers (HCWs) remain at increased risk of contracting SARS-CoV-2, a virus that causes COVID-19. Sickness and death of HCWs to COVID- 19 will have devastating effects on Malawi’s already fragile health system. This study aims at characterising risk of exposure to SARS-CoV-2 among HCWs compared to non-HCWs. Main Objective To characterize the exposure and risk of HCWs to COVID-19 in Blantyre compared to non-HCWs Specific objectives i) To describe the demographic characteristics of HCW in the frontline of COVID-19 response ii) To establish the incidence (proportion of HCWs with) of COVID-19 among HCW compared to the non-HCWs iii) To ascertain the workplace/ occupational factors associated with/or contributing to health care workers contracting SARS-CoV-2 Study design: Prospective descriptive cohort study Study place: Blantyre District, Malawi Study population: Frontline HCWs and matched non-HCWs in Blantyre Study duration: May to August 2020 Data management and analysis: An electronic, predesigned questionnaire will be used to collect data. Data curation and storage will be GCP compliant. STATA software will be used to analyse the results. Proportions of HCWs and non-HCWs infected with SARS-CoV-2 will be calculated and Chi-square test used to test the difference. Multivariable logistic regression will be performed to explore occupational factors that increase the risk of being infected. Expected results: We expect to understand the risk health care workers have of contracting SARS-CoV-2 and ascertain the workplace factors that increase this risk. This information will assist policy makers in optimising infection prevention control measures in workplaces, contributing to protecting HCWs in Malawi. Dissemination of results: Results of this study will be presented to Blantyre DHO, QECH, College of Medicine and Ministry of Health. Furthermore, results will be disseminated through local, regional and international scientific meetings/conferences/seminars/workshops and by publications in peer-reviewed journals. In addition to a thesis being submitted in fulfilment of a Master of Medicine degree, a copy of the final report and any enduing publications will be submitted to COMREC and the College of Medicine Library.
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Continuity of Essential Health Services (CES) Study
(Kamuzu University of Health Sciences, 2021-06-04) Stones, William
Type of Study This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. BACKGROUND RATIONALE Malawi registered its first Covid-19 cases in March 2020. A Presidential Taskforce on Covid -19 was immediately set up and Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. OBJECTIVES The overall study objective is: • To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services. 2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. METHODS The methodology will include focus group discussions (FGDs) and key informant interviews (KIIs), followed by in-depth interviews (IDIs) to capture respondents of vulnerable groups. The data will be collected from Mchinji and Blantyre Districts (indicative locations to be confirmed following consultation) and the study population will include adult pregnant/breastfeeding women, parents/caretakers of children under five years of age, adolescents (15 to 19 years of age,companions/partners of pregnant/breastfeeding women and pregnant/breastfeeding adolescents, community-based health workers, health workers and facility based managers. DATA MANAGEMENT AND ANALYSIS All audio and handwritten data collected from the FGDs and interviews will be stored securely. Electronic notes, transcripts and translations will be stored electronically and protected by a password. Only members of the research team will have access to these documents. As soon as the audio-recordings have been transcribed and verified, they will be destroyed by erasing the voice recordings. Framework analysis will be used for cross-sectional analysis of data from FGDs, IDIs and KIIs. The focus will be on understanding the demand and supply-side barriers to seeking routine and emergency health care services, the extent to which the pandemic has impacted people’s willingness and ability to access MNCH services and how service readiness and provision has changed as a result of COVID- 19 and its effects. A combination of deductive and inductive themes will be included. POSSIBLE CONSTRAINTS COVID-19 situation might require adaptation of study methods using more or only virtual methods for interviews and FDGs; virtual FDGs might be not ideal given that moderators should be physically present to be able to catch the dynamics in the groups and to be able to guide and facilitate appropriately. However, the research teams will only do virtual FDGs in case there is no alternative. RESULTS PRESENTATION Key findings will be presented during a webinar with a UN, participating districts and MoH audience. All data collected, analytical memos and framework analysis files will be de-identified and shared with UNICEF alongside draft reports. The report will also be shared with COMREC. IMPLICATIONS OF THIS STUDY We anticipate that findings from this study will highlight the impact of Covid-19 on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic.
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Continuity of Essential Health Services (CES) study - Exploring effect of COVID-19 on demand for maternal, newborn and child health services in selected districts in Malawi by William Stones
(Kamuzu University of Health Sciences, 4-06-21) Stones, William
Type of Study This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. BACKGROUND RATIONALE Malawi registered its first Covid-19 cases in March 2020. A Presidential Taskforce on Covid -19 was immediately set up and Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. OBJECTIVES The overall study objective is: • To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services. 2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. METHODS The methodology will include focus group discussions (FGDs) and key informant interviews (KIIs), followed by in-depth interviews (IDIs) to capture respondents of vulnerable groups. The data will be collected from Mchinji and Blantyre Districts (indicative locations to be confirmed following consultation) and the study population will include adult pregnant/breastfeeding women, parents/caretakers of children under five years of age, adolescents (15 to 19 years of age, 7 companions/partners of pregnant/breastfeeding women and pregnant/breastfeeding adolescents, community-based health workers, health workers and facility based managers. DATA MANAGEMENT AND ANALYSIS All audio and handwritten data collected from the FGDs and interviews will be stored securely. Electronic notes, transcripts and translations will be stored electronically and protected by a password. Only members of the research team will have access to these documents. As soon as the audio-recordings have been transcribed and verified, they will be destroyed by erasing the voice recordings. Framework analysis will be used for cross-sectional analysis of data from FGDs, IDIs and KIIs. The focus will be on understanding the demand and supply-side barriers to seeking routine and emergency health care services, the extent to which the pandemic has impacted people’s willingness and ability to access MNCH services and how service readiness and provision has changed as a result of COVID- 19 and its effects. A combination of deductive and inductive themes will be included. POSSIBLE CONSTRAINTS COVID-19 situation might require adaptation of study methods using more or only virtual methods for interviews and FDGs; virtual FDGs might be not ideal given that moderators should be physically present to be able to catch the dynamics in the groups and to be able to guide and facilitate appropriately. However, the research teams will only do virtual FDGs in case there is no alternative. RESULTS PRESENTATION Key findings will be presented during a webinar with a UN, participating districts and MoH audience. All data collected, analytical memos and framework analysis files will be de-identified and shared with UNICEF alongside draft reports. The report will also be shared with COMREC. IMPLICATIONS OF THIS STUDY We anticipate that findings from this study will highlight the impact of Covid-19 on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. 1. Background In Malawi, since March 2020 when the first COVID-19 cases were reported, a Presidential Taskforce on Covid -19 was set up with a mixed membership of Public Health Experts, technocrats and members of the Cabinet. Covid-19 prevention measures were put in place and these included: Closing down of schools, social distancing, wearing of masks, self- quarantine for all who tested COVID positive and all in-coming travelers, public gatherings were initially limited to 100 people and this was suspended due to injunctions. In addition, number of passengers in public vehicles were also limited to 2 people per seat only. Between September and December, 2020, the number of COVID-19 cases reduced which may have fuelled non-adherence to COVID prevention measures. Since January, 2021, Malawi has been hit hard by the second wave of COVID-19 which has caused a sharp rise in the numbers of cases and increase in COVID-19 related deaths. The country has been declared a State of Disaster. The Vice President of Malawi has since led the team to develop new guidelines on COVID response and management. Further restrictions have been made to public gatherings now at 50 people only, the wearing of masks has become mandatory in all public places including markets, shops etc. Restrictions have also been made to trading hours in bars and markets. Since the second wave of COVID-19, more people have tested and hospitalized leading to an overburdened health care system. Government has embarked on efforts to increase the number of health care staff, increase treatment centres and lobby for resources (equipment and supplies) especially oxygen cylinders and accessories and COVID-19 testing kits which are in limited supply. While government public health and social measures have likely forestalled some COVID-19 spread, they also have deleterious indirect social, economic and health impacts. Given relatively limited health care capacity, particularly for critical care, a “bend the curve” paradigm may be less salient in the region and governments need to balance the threat of COVID-19-specific mortality with the potential secondary impacts of mitigation measures, which may also result in excess mortality. The West Africa Ebola epidemic (2014-16) is instructive as it demonstrated that indirect mortality can exceed the direct mortality of the health emergency. Scenario-based modelling of excess maternal and child mortality due to reduced coverage of essential health and nutrition services suggests that the indirect impact of COVID-19 mitigation measures could result in an increase of 9·8% to 44·7% in under-5 child deaths per month, and an 8·3% to 38·6% increase in maternal deaths per month, across 118 countries1. COVID-19 projections estimate that 15 million additional unintended pregnancies could occur over one year if COVID-related service disruptions affected 10% of women in need of sexual and reproductive health (SRH) services in low- and middle-income countries2. Anecdotal evidence from Kenya, Malawi and Mozambique indicates an increase in adolescent pregnancies since the closure of schools due to COVID-19. Within schools, Malawian adolescents have some access to reproductive health information and counselling, presence of mother-groups to support girls in need of services, peer to peer support. The impact of COVID-19 on the availability and quality of MNCH services and social-economic disruption on access to these services requires investigation. The Pulse survey by WHO in 105 responding countries on continuity of essential health services during the COVID-19 pandemic showed disruptions of essential health services reported by nearly all countries, and more so in lower- 1 Timothy Roberton, DrPH. Emily D Carter, PhD. Victoria B Chou, PhD. Angela R Stegmuller, BS. Bianca D Jackson, MSPH. Yvonne Tam, MHS. et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Articles; Volume 8, ISSUE 7, E901-E908, July 01, 2020 2 Riley T, Sully E, Ahmed Z, Biddlecom A. Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health In Low- and Middle-Income Countries. Int Perspect Sex Reprod Health. 2020;46:73–6 income than higher-income countries. The majority of service disruptions were partial defined as a change of 5–50% in service provision or use. All services were affected, including essential services for communicable diseases, non-communicable diseases, mental health, reproductive, maternal, newborn, child and adolescent health, and nutrition services. Emergency services were the least disrupted, although 16 countries reported disruptions across all emergency services. The most severely affected service delivery platforms were mobile services, often suspended by government, and campaigns, for example as used for malaria prevention or immunization. The causes of the disruptions were a mix of demand and supply factors. On the demand side, 76% of countries reported reductions in outpatient care attendance. Other factors, such as lockdowns hindering access and financial difficulties during lockdown were also mentioned. On the supply side, the most commonly reported factor was cancellation of elective services (66%). Other factors mentioned included staff redeployment to provide COVID-19 relief, unavailability of services owing to closures of health facilities or health services, and supply-chain difficulties. 2. RATIONALE While attention is understandably focused on the direct impact of the COVID-19 pandemic, it is essential to see the health crisis from a broader perspective. In Malawi, health systems are already fragile and people often live in extremely precarious conditions. The coronavirus pandemic risks further reducing vulnerable people’s already limited access to healthcare, as resources – both human and financial – get diverted from regular healthcare to the COVID-19 response. During 2020, Malawi experienced that health services were downsized or closed to limit the risk of transmission. Shortage of staff was accelerated as frontline healthcare workers fell sick or died in places where there were already too few to provide essential services. Keeping essential health services available and accessible is vital to prevent losing even more lives, whether from malaria, measles, malnutrition or complicated pregnancies. This study study on Continuity of Essential Health Services (CES) aims at contributing to fill the knowledge gap on the demand and supply-side factors exploring barriers to seeking routine and emergency MNCH services. The immediate target groups include pregnant women, women of reproductive age with newborns and children under five years of age including breast-feeding women and adolescent women. In addition, health personnel, both clinical and management, as well as relevant community members will be included in the study. There is a need to understand the extent to which the pandemic has impacted people’s willingness and ability to access (i.e. availability, accessibility, affordability and acceptability) essential MNCH services and experiences of care during the pandemic. Furthermore, this study will also explore the supply side of health service delivery including the perception of health programme managers and health staff on resiliency of the health system and their view on why people are or are not coming in for care and the impact that the pandemic has on quality and the continuation of routine services delivery. The study will have a specific focus on vulnerable populations groups of women of reproductive age, including those living with HIV/AIDS and adolescents, as well as children under five. 3. Objectives of the study The overall study objective is:  To investigate the effect of COVID-19 pandemic on people’s willingness and ability to access essential MNCH services, their experiences of care and the perspectives of staff on MNCH services’ readiness to provide essential care during the pandemic. Specific study objectives are to: 1. Comprehend how COVID-19 has affected pregnant and breastfeeding women’s access to maternal and newborn health services.2. Comprehend how COVID-19 has affected access to child health services for the under-fives. 3. Comprehend any specific challenges faced by vulnerable groups during COVID-19 with regard to access to MNCH services. Specific research questions: The two main research questions are: (A) What is the influence of demand side factors (intention action/gap drivers, reaching care, and receiving care); (B) what is the influence of supply side factors (providing care). These are further elaborated as below. A. Maternal, newborn and child health: Demand side factors Intention action/gap drivers a. Did the target groups of primary interest (as defined above) during COVID-19 pandemic use essential MNCH services (essential as defined in the national packages of care and provided by skilled personnel) to the same extent (frequency, based on needs/demands) as during non-COVID times? b. What were the main factors / reasons that affected the use of essential MNCH services by the primary target groups during COVID-19 pandemic? What was different to non-COVID times in regard to the topics below? Reaching essential MNCH services a. To what extent and how were the primary target groups able to reach to a health facility / seek essential MNCH services during COVID-19 pandemic compared to non-COVID times? b. What were the main factors/reasons that stopped or made it difficult for the primary target groups to reach essential MNCH care during COVID-19 pandemic compared to non-COVID times? Receiving essential MNCH services when the health facility is reached c. To what extent and why were essential MNCH services not available to the primary target groups when reached? d. What kind of changes were observed or experienced by the primary target groups with regard to the quality of MNCH services provided during COVID-19 pandemic compared to non-COVID times? B. Maternal, newborn and child health: Supply side factors Providing adequate care to the primary target groups according to demand and needs a. To what extent did essential MNCH services become disrupted and/or unavailable during COVD-19? How was the readiness of essential MNCH - to serve the primary target population as needed - affected? b. Which MNCH services were most affected and why? Lessons learned- demand and supply-side The study teams will elaborate based on above raised questions on what were the main lessons learned from the COVID-19 pandemic in regard to demand for, access to and readiness of MNCH services. In addition, the interviews will include a question on what the lessons learned were 11  Health services  Health care providers  Health care users  Community-based health service delivery  Referral pathways/linkages between community systems and health systems, and other. 4.3 Target groups of the study The target groups will include specifically: (1) Adult pregnant/breastfeeding women (20 to 49 years) (2) Adolescent pregnant/breastfeeding women (15-19 years) (3) Pregnant/breastfeeding women (15 – 49 years) living with HIV/AIDS (4) Parents/caretakers of children under five years of age including adolescent mothers and fathers (5) Facility based health care workers and health facility managers (6) Community health workers/volunteers and other community-based health agents such as peer mother supporters etc. (7) Sub-national health care managers (district/subcounty, region/county/province) 4. STUDY DESIGN This is a Qualitative study in selected geographical areas including key informant interviews (KIIs), focus group discussions (FDGs) and in-depth interviews with specific target groups (e.g. women living with HIV/AIDS). The scope will include data collection, data quality monitoring, transcription/translation, data analysis and reports on study results. Conceptual Framework The “Governance and Capacity to Manage Resilience of Health Systems” conceptual framework postulates that health systems have three levels of resilience: absorptive capacity, adaptivecapacity and transformative capacity3. This framework is considered relevant as it arose from African experience of the Ebola outbreaks, that presented certain similar challenges to health systems. The absorptive capacity relates to the capacity of a health system to continue to deliver the same level (quantity, quality and equity) of basic healthcare services and protection to populations despite the shock (in this instance the Covid-19 pandemic) using the same level of resources and capacities. Adaptive capacity is the capacity of the health system actors (such as health workers) to deliver the same level of healthcare services with fewer and/ or different resources, which requires making organisational adaptations. Finally, the transformative capacity describes the ability of health system actors to transform the functions and structure of the health system to respond to a changing environment such as adaptations to Covid-19 guidelines and provision of Covid-19 care without compromising other services.
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Covid 19 transmission and morbidity in Malawi
(2022-06-15) Mathanga, Don
COVID Transmission and Morbidity in Malawi (COVID-TMM) Type of research study: Prospective cohort study The problem to be studied: To assess whether infection rates and morbidity of SARS CoV-2, as well as acquisition and duration of antibody-induced immunity in Malawi may be impacted by a trained and/or tolerant innate immunity, resulting in particular from malaria, helminth infections, anemia and nutrient deficiency Population: A total of 1,200 participants will be recruited in Malawi (300 in the vaccine cohort and 900 in the natural infection cohort). Participants will have 5 to 75 years of age and any sex. Objectives: 1. To determine the risk and predictors of infection and disease among contacts of SARS-CoV-2 infected subjects in Malawi. 2. To determine whether innate immune responses lower the risk of SARS-CoV-2 infection and disease, and acquisition and duration of vaccine responses. 3. To assess whether alterations in innate immune responses relevant to SARS-CoV-2 are associated with malaria or intestinal parasite infections. 4. To assess the acquisition and longevity of Abs and cellular adaptive responses elicited by SARS-CoV-2 infection and vaccination. 5. To assess whether malaria and intestinal parasite infections, chronic/mild undernutrition, and anemia mediate alterations in Ab and other adaptive cellular responses to SARS-CoV-2 through innate immune responses or a different unknown mechanism. Methodology: We will enroll up to 1,200 participants aged 5 to 75 years from four peri-urban health centres in Blantyre district Malawi. SARS-CoV-2 symptomatic individuals (index cases) and their household contacts and recently vaccinated individuals will be selected and screened for eligibility. Specifically, two cohorts will be enrolled: a) Natural infection cohort– 200 symptomatic subjects (index cases) will be enrolled when they seek diagnosis for their symptoms of COVID-19 and have their SARS-CoV-2 infection confirmed. All their household contacts (anticipated 700) aged 5 years or older will be examined for infection. Blood will be drawn from all eligible subjects who provide consent. One week later, SARS-CoV-2 testing will be repeated in household contacts who tested negative in the first visit. Individuals who test negative after this second test will be excluded from visits that take place more 15-Jun-2022 COVID TMM Version 1.1; June 2, 2022 2 than 2 weeks after enrollment. Participants will be followed up for 18 months after enrollment. b) Vaccine cohort – 300 subjects aged 15-75 years will be recruited when they attend a vaccination clinic at any of the study sites for their first dose of the AstraZeneca or the Johnson and Johnson vaccines. Venous blood will be collected at that time. For AstraZeneca vaccinees, when they come for their 2nd vaccine dose, approximately 90 days after the 1st vaccine dose, they will receive material for collection of a stool sample. Johnson and Johnson vaccinees will receive the container for collection of the stool sample when they receive the first vaccine dose. Two weeks after completion of the primary regimen (2 nd dose of the AstraZeneca and 1st dose of the Johnson and Johnson vaccines), a venous blood draw will be repeated. Subsequent visits and procedures will happen at the same schedule of the “Natural Infection” cohort. Venous blood samples from participants in both the natural infection and vaccine cohort will be used to quantify innate immune phenotypes and stimulation, quantification of micronutrients, quantification of antibody magnitude and function, quantification of T cell phenotypes and stimulation, and detection of malaria infection. Total Study Duration: 5 years Subject Participation Duration: 18 months after the first visit. Expected findings and dissemination Our findings will help understand the lower morbidity of SARS CoV-2 that has been registered in Malawi and other sub Saharan African countries and the effect that malaria, helminth infection, anemia, and nutrient deficiency may have on SARS CoV-2 in Malawi. Furthermore, we will assess acquisition and duration of responses to infection and immunity in Malawi. Our study may inform vaccination policy in Malawi by identifying high risk groups, optimal target coverage, and determining intervals at which booster doses should be provided. The results will be distributed and discussed with the local community, Ministry of Health, Kamuzu University of Health Sciences, and the College of Medicine Research Ethics Committee (COMREC). Main findings will be presented in international conferences, College of Medicine Research Dissemination Conference, and published in international peer reviewed journals. 15-Jun-2022 COVID TMM Version 1.1; June
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Covid-19 Neurological Disease
(Kamuzu University of Health Sciences, 2021-06-16) Phiri, Tamara
Type of Research This is a prospective case-control study being conducted in Brazil, India and Malawi. The cases will be patients with COVID-19 and neurological disease. Controls will have COVID-19 without neurological disease. Problem Neurological manifestations and complications of COVID-19 are being recognised increasingly, with encephalopathy (mostly delirium) and cerebrovascular disease (predominantly stroke) being reported most commonly. However, the full spectrum, outcomes, and risks of developing neurological disease in COVID-19 are poorly understood. This makes the approach to risk stratification, and pre-emptive or preventative measures, challenging. This study will be conducted in Brazil, India and Malawi to address this gap in low- and middle-income country settings, where the impact of neurological disease and emerging infections is often felt disproportionately. Objectives Aim To describe, and to guide interventions to reduce morbidity from, acute new-onset neurological disease among hospitalised patients with COVID-19. Primary Objective 1. To compare characteristics of patients hospitalised with COVID-19 with and without new onset neurological disease, focusing on stroke, delirium, hypoxia and other potential risk factors for neurological disease which may be modifiable. Secondary Objectives 2. To describe the full spectrum of COVID-19 associated neurological disease including its range and prevalence. 3. To compare outcomes of patients with and without COVID-19 associated neurological disease, focusing on stroke and delirium. 3.4. To examine prognostic indicators for outcomes in patients with COVID-19 associated neurological disease. Methodology The primary objective will be achieved using a case-control design. The cases will be patients with COVID-19 and neurological disease. Controls will have COVID-19 without neurological disease. Secondary objectives will be achieved through a prospective cohort design, including the same cases and controls with longitudinal follow-up to discharge, and at 3 and 9 months. Hospital records of adult (≥18 years) patients will be screened for eligibility, and strict predefined case definitions will be applied by study staff. Consenting patients will have data collected during their admission up to discharge, and at 3 months and 9 months. This may include additional clinical investigations for COVID-19, neurological disease and potential risk factors that are deemed to be indicated and safe by treating clinicians. Final assignment of case vs. control status of participants will be at 30 days from admission to hospital. “Day 1”, for timing of variable measurement for the case-control analysis, will be defined for each participant as the day of presentation with neurological disease in cases, and the day of enrolment in controls. The target number of cases with all types of neurological disease is 227 (projected breakdown of 68 with stroke, 136 with delirium, and 23 other), with 454 controls. This will give >95% power to detect an odds ratio of 2.0 and would give 90% power to detect an odds ratio of 1.6, for the primary exposure of severe vs. non-severe/no hypoxia for overall participants with any neurological disease. It would also achieve ≥80% power to detect an odds ratio of 2.0 in both major disease subgroups of stroke and delirium separately. Expected Findings and Dissemination Study results will be presented and discussed at international scientific meetings and published in open access peer reviewed journals. High impact publications will be aligned with press releases managed by the University of Liverpool press office and local institutional press offices in Brazil, India and Malawi (including College of Medicine-University of Malawi- Research Dissemination Conference, Malawi Liverpool Wellcome Trust, and Queen Elizabeth Central Hospital).
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Determinants of postpartum disorders following early hospital discharge in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-03-21) Thindwa, Deus
Introduction: Social mixing patterns shape the transmission of respiratory infections such as pneumococcus. Understanding social contact structures may help inform precise prediction of pneumococcal transmission dynamics, and optimise control strategies such as vaccination. Type of research study: A quantitative cross-sectional epidemiological study The problem: What determines social mixing patterns that are relevant for pneumococcal transmission in populations with high HIV prevalence? The objectives were: 1. To determine factors that are associated with Social contact types; Social contact frequency 2. To estimate age-specific rates of social contacts, relevant for pneumococcal transmission in age groups: <1 years (infants), 1-5 (preschool), 6-15 (primary school), 16-19 (secondary school), 20-49 (adults), and 50+ (elderly). 3. To determine the role in social contact rates of social contact place, adult HIV-infection status, spatial distance between place of contact and participant’s household. Data analysis methodology: 1. Multivariate regression analysis for factors associated with contact types and frequency. 2. Computed ratio of measured probability of a contact between individual age-groups to a null model of the probability of that contact under an assumption of random mixing, resulting in social contact matrices representing intensity of contacts between different age groups. 1.3. Stratification of social contact matrices by place of contact and HIV-infection status. Inverse cumulative distribution for spatial distance and the number of contacts. Expected findings: 1. Ratio of the mean number of contacts in each category of the factor (covariate) relative to the reference category for each contact type and frequency. The mean number of daily contacts in age groups: <1 years (infants), 1-5 (preschool), 6-15 (primary school), 16-19 (secondary school), 20-49 (adults), and 50+ (elderly) presented as social contact matrices. 3. Age-specific mean number of daily contacts stratified by place of contact and adult HIV infection status presented as social contact matrices. 4. A cumulation distribution plot of spatial distance between contact place and participant’s household and the mean number of contacts. Dissemination of findings The results of SOMIPA study will be shared with the College of Medicine Research Ethics Committee, LSHTM Research Ethics Committee, Blantyre District Health Office (DHO), host organisation, sponsor, the Malawi Ministry of Health, College of Medicine Library, the University Research and Publication Committee and the Health Sciences Research Committee. The results will also be shared to other researchers through peer-reviewed publication, scientific conferences, dissemination seminar as well as written as a PhD chapter for my PhD thesis.
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The effect of Covid-19 on uptake of HIV and AIDS health services at St Martin’s Community Hospital
(Kamuzu University of Health Sciences, 19-01-22) Lusinje, Alinafe
A cross-sectional study design and will employ both qualitative and quantitative methods. Data will be collected using questionnaires (refer appendix 12.3), review of registers, key informant interviews (refer appendix 12.5) and focus group discussions (refer appendix 12.7) Quantitative sample size will be 123 among HIV and AIDS clients and qualitative sample simple size will be 32 Malawi is one of the most affected countries with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic in the sub-Saharan Africa. The emergency of Corona Virus Disease 2019 (COVID-19) pandemic has disrupted provision of health services globally as well as nationally, and has led to low uptake of health services. This study seeks to assess the effect of COVID-19 pandemic on uptake of HIV and AIDS health services at St Martin’s Community Hospital in Mangochi. Results for this study may help to inform decision and policy makers on how to make HIV and AIDS programs resilient to emerging health issues. Methods This will be a cross-sectional study and will employ both qualitative and quantitative methods. Data will be collected using questionnaires (refer appendix 12.3), review of registers, key informant interviews (refer appendix 12.5) and focus group discussions (refer to appendix 12.7). Quantitative sample size will be 123 among HIV and AIDS clients and qualitative sample simple size will be 32; four key informant interviews with a priest, group village head, a nurse or clinician working at HIV service point of delivery and head of clinical department. Four sessions of focus group discussions comprising seven members who are HIV and AIDS clients will be conducted. Data will be analysed using STATA and thematic content analysis. Ethical approval will be sought from Kamuzu University of Health Sciences’ College of Medicine Research and Ethics Committee (COMREC).
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Effects of Covid 19 on mental health of health workers in Blantyre urban hospitals
(2022-03-04) Mweso, Chigomezgo; Kamanga, Constance; Makoza, Innoncia
their delivery of health services. In an ideal setting, there is little attention paid to the mental health of health care providers. This affects their delivery of health services. Therefore, this study will provide information on the level of damage caused Covid 19 on the mental health of health workers and how it has affected their delivery of service. 3.2 Objectives and Methodologies The broad objective is to assess the relationship between Covid 19 effects on mental health of health workers and their delivery of services in Blantyre urban. The specific objectives are to evaluate on how the general public perception about Covid 19 has affected the mental health and service delivery of health workers, to analyze the relationship between mental health of health workers and service delivery and to assess the coping skills of health workers during the pandemic. In this study, qualitative and quantitative methods will be used. Our study place will be 4 public hospitals in Blantyre urban. The sampling method will be simple random sampling and the target population will be all health workers in all public hospitals in Blantyre urban. The study population will be 4 public hospitals in Blantyre urban and the sample size is 384 which was calculated using Epi Info. Data collection will be through self-administered questionnaires and one on one interviews. Data will be analyzed using the Microsoft excel and Epi Info 7. Graphs and tables will be used to analyze the results and establish the relationships.
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Effects of Covid-19 on Family Planning among Adolescents who have given birth atleast once in Blantyre Urban
(2022-07-22) Kapenda, Peter; Mulinde, Tendai; Nyalugwe, George; Kanyoma, Offerings
This is a sequential mixed study investigating the effects of covid-19 on family planning among adolescents who have atleast given birth in blantyre urban. The problem of unmet needs for family planning among parous adolescents have remained high despite efforts to improve provision. This has led to high rate of unplanned pregnancies among adolescents. Therefore, this study will provide information on how covid-19 has affected family planning among parous adolescents of blantyre urban. Objectives and Methodologies The broad objective is to assess the effect of covid-19 on family planning among parous adolescents of blantyre urban and the specific objectives are; to asess distribution of family planning methods during and before the pandemic, to assess the accessibilty of family planning methods during the pandemic and before, assess adherence to family planning methods during the pandemic and before the pandemic. In this study, both qualitative and quantitative methods will be used and the study place will be four Government health centers. Quantitative data will be obtained from the clinic attendance registers. The sampling methods are simple random sampling and stratified sampling. The target population is parous adolescents in Blantyre urban. The age group is adolescents aged 15 to 19 years. Data collection will be through indepth interviews for the qualitative data and Government health centers (antennatal clinics) attendance registers for the quantitative data. Data will be analysed using content analysis. Expected findings and Dissemination At the end of this study, we expect to find how covid-19 has affected family planning among parous adolescents. This knowledge will help implementing measures that will ensure that11-Jul-2022 9 adolescents in Blantyre and Malawi as a whole have good access to family planning in prevention of unplanned pregnancies. Presentations will be through tables and graphs
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Evaluating pregnant women understand and perception of COVID-19 vaccination among women seeking antenatal care at Kamuzu Central Hospital,
(Kamuzu University of Health Sciences, 2022-03-16) Chigamane, Eugenia Norah
1.1 TYPE OF STUDY This is a qualitative study. 1.2 PROBLEM STATEMENT Pregnant women who contract COVID-19 are more likely to get the severe form of the disease, deliver prematurely and require ICU admission. COVID-19 vaccines have been proven to reduce severe COVID-19 infection and its complications as well as ICU admissions. The vaccines are considered safe in pregnancy. However, there has been low uptake of the COVID-19 vaccines among pregnant women. 1.3 OBJECTIVES 1.3.1 BROAD OBJECTIVE To evaluate the understanding and perception towards the COVID-19 disease and vaccine, among women seeking antenatal care at KCH. 1.3.2 SPECIFIC OBJECTIVES 1) To evaluate pregnant women’s understanding and perception of COVID-19 infection and disease and their pregnancy-related risks. 2) To assess pregnant women’s understanding and perception of the risks and benefits of COVID-19 vaccination during pregnancy. 3) To describe the barriers and facilitators for receiving COVID-19 vaccination among pregnant women 1.4 METHODOLOGY This will be a qualitative study that will conducted at Kamuzu Central Hospital (KCH), Ethel Muntharika Maternity Wing (EMMW). The study population will be all pregnant women attending the antenatal clinic at the facility. Up to 20 recorded in-depth interviews will be conducted. The collected data will be organized using Microsoft Excel software and analyzed by thematic analysis. 1.5 EXPECTED FINDINGS We expect to find that the pregnant women’s understanding of the COVID-19 disease and the vaccine is influenced by social-economic status, education level, community factors and factors relating to the administration of the vaccine 1.6 DISSEMINATION Results of the study will be disseminated though the Research Dissemination Conference organized by the KUHeS, the AOGM annual meeting, KCH-EMMW, the KUHeS Research Ethics Committee, and through peer-reviewed manuscript publication. A compiled dissertation will also be submitted to the department of Obstetrics and Gynaecology of KUHeS.
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Evaluation of vaccine effectiveness amongst adults living with comorbidities (Diabetes, Hypertension & HIV) following routine introduction of COVID-19 Vaccine in Blantyre, Malawi: a prospective cohort study
(Kamuzu University of Health Sciences, 2022-01-19) Jambo, Kondwani
Study design: This is a prospective cohort study Problem: COVID-19 continues to claim lives globally since it was discovered in Wuhan China in December 2019. People with comorbidities like hypertension, diabetes mellitus and HIV have been shown to be at high risk of severe COVID-19 and mortality. To protect against hospitalization, severe disease and death, COVID-19 vaccines have been introduced globally, as well as in Malawi. These vaccines have been deemed highly effective in other settings. However, we do not know their effectiveness in Malawi, especially among high risk individuals. Broad and specific objectives: Broad objective: to assess the effectiveness of COVID-19 vaccination amongst adults living with chronic diseases (Diabetes, Hypertension and HIV) following routine introduction in Malawi. Specific objectives: Primary objective 1. To compare the rate of virologically-confirmed symptomatic COVID-19 disease in vaccinated (after full vaccination) vs. unvaccinated adults (>18 yrs.) with co-morbidities Secondary objectives 1. To determine the rate of virologically-confirmed hospitalised symptomatic COVID-19 disease in vaccinated (after full vaccination) and unvaccinated adults (>18 yrs.) with comorbidities 2. To contrast the rate of virologically-confirmed symptomatic COVID-19 disease in vaccinated (after one-dose) vs. unvaccinated adults (>18 yrs.) with co-morbidities 3. To assess the frequency of adverse events of special interest after immunization Exploratory 1. To compare the risk of virologically-confirmed symptomatic COVID-19 disease in vaccinated (after full vaccination) vs. unvaccinated adults (>18 yrs.) with co-morbidities and documented previous COVID-19 disease 2. To investigate the duration of vaccine-induced immunity in adults with co-morbidities identified by serology 3. To investigate the frequency of new SARS-CoV-2 variants in adults with co-morbidities 4. To assess adherence to COVID-19 vaccination schedule among vaccinated adults(>18yrs.) Methodology: Adult attendees (>18 years) to Blantyre chronic disease clinics (at Limbe, Zingwangwa, Ndirande and QECH) eligible for vaccination, living with co-morbidities (Diabetes, Hypertension & HIV) and are eligible to receive COVID-19 vaccines will be eligible to participate. Participants will be enrolled prior to or during the routine introduction of COVID-19 vaccination in these vulnerable populations, regardless of whether they intend to be vaccinated. Baseline information will be collected on demographics, comorbidities, and work- and community-related infection risk factors. Baseline samples to determine baseline immunity will be collected at enrolment and at 3 months intervals to build a serological profile of the population, testing for antibodies to SARS-CoV-2 that can distinguish between vaccine-induced and natural immunity. Cases of symptomatic and hospitalised COVID-19 will be ascertained through active follow-up, reporting by mobile phone and testing. Case confirmation will be by SARS-CoV-2 RT-PCR of symptomatic participants who meet a suspected case definition. Expected findings: The results of this project will inform strategies of managing COVID-19 in high risk individuals in Malawi, in order to halt the pandemic. Results dissemination: The results will be disseminated at local and international conference and manuscripts will be published in an international peer-reviewed journal, and shared with the Ministry of Health as well as College of Medicine research ethics committee (COMREC) of the Kamuzu University of Health Sciences (KUHeS).
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Exploring factors that affect the uptake of COVID-19 preventive measures among adults aged 18 and above in Zomba rural
(Kamuzu University of Health Sciences, 2022-07-13) Nsuku, Prisca
Type of the study: This is a qualitative grounded theory study that will use in-depth interviews and key informants interviews to collect data. The study will be used in order to investigate factors that affect the uptake of COVID-19 preventive measures. Problem: COVID-19 pandemic is the latest crucial global health crisis and a leading cause of morbidity and mortality rate among the high risk population. The confirmed cases worldwide are more than 307. 9 Million and deaths over 5.5 Million People around the world. Malawi has registered more than 79,000 confirmed cases and over 2,400 deaths from April 2, 2020.Zomba district is fourth highest with more than 3000 cases and over 110 deaths. However, studies done in Africa including Malawi reported that the majority of rural populations are not complying with COVID-19 preventive measures. Hence there is need to investigate factors that contribute to low uptake of COVID-19 measures in order to find out the reasons. Objective: The main objective is to investigate the factors that affect the uptake of COVID- 19 preventive measures among adults in Zomba rural. Specific objectives: i) to assess knowledge of adults on disease and use of preventive measures. ii) To explore the perception of adults towards COVID-19 preventive measures. iii) To evaluate the practice of COVID-19 preventive measures. vi) To identify social factors and cultural beliefs that affect the use of COVID-19 preventive measures. Methodology: A qualitative grounded theory will be used to collect views of adults aged 18 and above residing in rural communities. The sample size will be 30 participants and will be purposively selected. The study will collect data from participants who come to seek health services at facilities using in depth interviews and Key Informants Interviews. The collected data will be stored in computer that has a pass word and will be accessed by key study team only. The data analysis will be done using deductive and inductive thematic content analysis. Informed consent will be obtained from all participants before enrolment in the study. Confidentiality will be ensured throughout the study and thereafter. Ethical approval will be obtained from Collage of Medicine Research and Ethics Committee (COMREC). Expected findings: The study will expect to identify factors that affect use of COVID-19 preventive measures among adults. Dissemination of expected results: The research findings will be disseminated to COMREC and District Health Management Team for Zomba DHO. Recommendations will be made to various stake holders such as DHOs office and partners including policy-makers on improvement that need to be made to increase use COVID-19 preventive measures.