Child Health

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Adapting and implementing group-based postpartum/well-child care at clinics in Blantyre District, Malawi
(Kamuzu University of Health Sciences, 2021-07-29) Gresh, Ashley
Type of Research Study: A mixed methods study. The Problem: Postpartum care, defined in this study from the time of birth through the first year, sets the stage for long-term health and well-being for both the mother and her child; further it is a critical time to reduce maternal and infant morbidity and mortality. The World Health Organization (WHO) recommends that every mother and baby should have at least four postpartum visits within the first six weeks of giving birth. The first year after childbirth is a period of not only physical recovery but is an important time to identify and manage health and social challenges including psychosocial adaptations and transitions to a parental role, that make women and children vulnerable for poor health outcomes. Globally there is no standardized package of care for the first year postpartum. Further, there are low rates of postpartum care attendance, revealing women’s unmet needs during this critical period in their life course. Sub-Saharan Africa, including Malawi, has some of the highest rates of maternal and infant mortality (MMR 439 maternal deaths per 100,000 live births and 42 infant deaths per 1,000 live births) globally. High rates of maternal and infant morbidity and mortality and preventable illness and disease necessitate transformation in the delivery of postpartum and wellchild care in this critical time in the maternal/infant life course. There is a need to develop through innovative strategies a postpartum/well-child care model that is sensitive to maternal-infant dyads in low resource contexts where rates of maternal and infant morbidity and mortality are high. Objectives: Main objective: The purpose of this study is to adapt, implement, and evaluate the feasibility and acceptability of an integrated postpartum and well-child care group-based healthcare model, called CenteringParenting, in Blantyre District, Malawi. Specific Objective 1: Explore Malawian women’s expectations for culturally appropriate postpartum and well-child clinic care. Specific Objective 2: Co-design with Malawian women, midwives and community volunteers an adapted prototype of group postpartum/well-child care. Specific Objective 3: Examine the acceptability of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi. Specific Objective 4: Examine the feasibility of group postpartum/well-child care with Malawian women, midwives, and community volunteers at clinics in Blantyre District, Malawi.Methodology: The proposed mixed methods study will use the five-steps of design thinking approach to adapt CenteringParenting: 1) empathize (interviews); 2) define (data analysis); 3) ideate (incubator sessions); 4) prototype (data analysis); and 5) test. This will be done through a rapid ethnographic assessment through interviews and incubator sessions with women, health surveillance workers, community volunteers and providers to create the group postpartum/well-child care prototype. The prototype will then be tested to determine feasibility and acceptability in the Malawian context through interviews, focus groups and surveys. Expected findings: We expect to co-create a prototype for group-based health care for the first year of postpartum and well-child care that will be acceptable and feasible. The findings will inform the next step in future research to determine the effectiveness of the CenteringParenting program model in Malawi. Dissemination of results: Results will be disseminated to the global research community through international journal publications and presentations at international and national research conferences. We also plan to present results at the COMREC conference, an excellent venue that is attended by policy-makers and researchers in Malawi.
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Assessment of burden and risk factors associated with soil transmitted helminth infections among adolescent girls (10-19 years of age) in Katete District of Zambia: A cross-sectional study
(Kamuzu University of Health Sciences, 2021-08-01) Tapisha, Buumba
Type of study-A cross-sectional study The problem: Over 688 million girls and women of reproductive age (WRA) are at risk of STH infections, with 26% of girls and WRA found in Africa. Infections among girls and WRA remain a concern because of their association with anaemia among unpregnant girls and women, maternal anaemia, foetal morbidity, and mortality. Information on subpopulations (like adolescent girls and women of reproductive age) in the district at risk remains unknown, making it difficult to plan and implement interventions as guided in the new NTD roadmap 2021-2030. Objectives: To assess the burden and risk factors associated with Soil-transmitted helminth infections among adolescent girls in Katete District of Zambia. Specifically, to 1. To estimate the prevalence of STH infections among adolescent girls in Katete district, 2. To determine the intensity of STH infections 3. To determine socioeconomic, behavioral, and environmental health factors associated with Soil transmitted helminth Methodology: A cross-sectional study to be conducted in Katete, a rural district in the eastern province of Zambia. Adolescent girls aged between 10 and 19 years will be enrolled in the study as participants. The Sample size is 206 inclusive of a 20% additional number to account for non-response. A multistage sampling will be used to get the study participants. The district has 10 zones that have a total of 105 schools (inclusive of private schools). Cluster random sampling will be used to sample 4 zones and a stratified random method to select 3 schools from each zone to come up with 12 schools. Systematic sampling methods will be used to select 17 study participants from each school (with two schools contributing 18 participants each) to get 206 participants. Primary data will be collected using a structured questionnaire administered by an interviewer/research assistant (to collect demographic, socio-economic, behavioral, environmental-related data). Stool samples will be collected in leak-proof containers from eligible children and analyzed using Kato-Kaz technique to quantify the infections. All statistical analysis will be performed using STATA software version 14. Proportions for infected will be computed to report prevalence and intensity of infection. Crude egg count will be classified light for eggs less than 5000EPG and heavy above 5000 to compare egg count values between different ages, gender and catchment areas. Descriptive data will be analyzed using appropriate summary statistics. Categorical variables will be reported as absolute frequencies with associated percentages, Chi-square test to ascertain the association between categorical independent variable and risk factors associated with soil-transmitted helminth infections. Multivariate Logistic regression to assess factors associated with soil-transmitted helminth infections with 95% confidence interval and significance level set at 5% Expected findings and dissemination: Expected to show the burden of STH by species and intensity of infections and factors associated with soil-transmitted infections. This information will help inform programming against STHs. The findings of the study will be documented in a report and shared with Katete District Health Office, Katete District Education Office, Provincial Health Office, ZNHRA, and COMREC. An oral presentation will be done to Katete District Health Management Team and KUHeS research dissemination conference. The results will be published in a peer-reviewed journal.
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Assessment of factors associated with retention of HIV exposed infants in early infant diagnosis program in Lilongwe rural: A crosssectional study
(Kamuzu University of Health Sciences, 2021-11-09) Phensere, Julia
The type of research study: This is a cross-sectional study to determine factors associated with retention of infants in the Early Infant Diagnosis program. The problem: The Malawi Country Operational Plan, strategic summary of March, 2020 indicated that rigorous analyses of patient level data and partner performance has identified the retention of clients as the single greatest threat to a sustainable HIV response in Malawi. Data obtained from some health facilities in Lilongwe District shows low retention rates. In the first quarter of 2021, the HIV department reported that Nkhoma Hospital had attrition rate of 17% at 12 months into the EID program and 35% at 24 months, Mitundu had 12% attrition at 12 months and 21% at 24 months, Nathenje had attrition of 15% at 12 months and 22% at 24 months. This study seeks to assess factors associated with retention in the EID Programme in clinics in Lilongwe rural, Malawi. Objectives: Broad objective To assess factors associated with retention of HIV exposed infants in the early infant diagnosis program (EID)in clinics in Lilongwe rural, Malawi. Specific objectives 1. To determine parents/guardians of HIV exposed infants perceived threats associated with retention of HIV exposed infants in EID 2. To Identify the perceived benefits associated with retention of HIV exposed infants in EID 3. To determine the social-cultural factors associated with retention of HIV exposed infants in EID Methodology This Cross-sectional study employing a Barrier Analysis approach will be conducted at Nkhoma Mission Hospital, Ntenthera Health Centre, Nathenje as well as Mitundu Rural Hospital. The study population will be parents/guardians of HIV exposed infants 0-24 months of age. The sample size will be 90, 45 doers and 45 non-doers. Doers are those that do the behavior, in this study doers will be the infants who are consistently retained in the program while non-doers are those that do not do the behavior, in this study non-doers will be those infants that are loss to follow. Data will be collected using a pre-designed barrier analysis questionnaire template, the template will be utilized to develop questions specific for this study. Data will be kept in lockable cabinets. It will be entered on barrier analysis predesigned data analysis software. Expected findings and their dissemination The study expects to find factors that are associated with retention of infant in the EID program. The factors that promote retention as well as those that derail it will be identified through this study. It is expected that the study will uncover sociocultural factors, perceived threats as well as perceived benefits of retaining infants in the EID program. The factors could be socio-economic, religious, cultural, individual/personal factors, community factors, health facility. Studies have shown motivating factors to continue in the Programme to be a wish to have a healthy baby while barriers to be denial of the actual HIV status, lack of disclosure of HIV status, fear of side effects of the drugs, lack of support, unsynchronized hospital appointments for mother and babies among other issues. The findings of the study will be shared with Nkhoma Mission Hospital, Lilongwe District Health Office as well as Kamuzu College of Health Science’s Library. A manuscript will be developed from the findings which will be submitted to a peer review journal for publication
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Assessment of prescription patterns and cost analysis of oncology drugs used in the Paediatric Unit of Queen Elizabeth Central Hospital, Malawi
(Kamuzu University of Health Sciencies, 6-09-21) Kilowe, Carlos Edwin
Background: Cancer is one of the global leading causes of childhood morbidity and mortality. High childhood cancer mortality rates in developing countries have been linked to irrational chemotherapy prescribing patterns. Irrational prescribing leads to ineffective treatment, occurrence of adverse events, prolonged hospitalization and increased economic burden to patients and their community. Children are more vulnerable to effects of irrational prescribing owing to their underdeveloped pharmacokinetic and pharmacodynamic profiles. Therefore, it is important to follow principles of rational prescribing as well as study prescribing patterns in order to ascertain how drugs are being used. Despite the need for periodical assessment of prescribing patterns and cost analysis, Malawi has a paucity of data on prescribing patterns and cost analysis of pediatric anticancer drugs. Objectives The objective of this study is to assess prescribing patterns and costs analysis of anticancer drugs used in paediatric cancer patients at Queen Elizabeth Central Hospital in Blantyre, Malawi. Methodology A retrospective cohort study will be conducted in pediatric oncology unit at Queen Elizabeth central hospital (QECH). The study will review and abstract data from patients’ files of children aged 0-18 diagnosed with cancer between January 2017 and December 2020. Rationality of prescribing patterns will be assessed using WHO rational prescribing indicators. The WHO indicators include: average number of drugs per encounter, percentage generic prescribing and drugs prescribed from national formulary. Quantity of drugs dispensed from the patient files will be used to compute cost of the drugs using current market prices obtained from Central 21-Aug-9 Version 6 xii Medical Stores catalogue and private wholesale supplier. Descriptive data analysis will be conducted where continuous variables will be summarized as mean and standard deviation. Frequencies and proportions will be computed for categorical variables. Regression analysis will be carried out to summarize possible relationships between anticancer prescribing patterns and predictor variables such as patient’s demographic data, cancer type and stage, and type of medications used. The level of significance will be set at 0.05. Expected findings The study is expected to shed light on rational chemotherapy prescribing patterns and cost of chemotherapy prescription in Malawi. Rational chemotherapy use improves childhood cancer clinical outcomes, reduces occurrence of adverse reactions, and optimizes health expenditure on chemotherapy drugs. Dissemination The findings of this study will be shared with University of Nairobi, Kamuzu university of Health sciences and Queen Elizabeth central hospital. The findings will also be published in peer reviewed journal.
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Child development study (CDS: Evaluation of effectiveness of low cost, high frequency and high-quality data to identify the main constraints and drivers of childhood and adolescence development in Malawi
(Kamuzu University of Health Sciences, 2022-07-26) Phuka, John
This a cohort study with multiple end point to evaluation impact of digital technologies of determinants of child growth and development. Problem In developing countries like Malawi, children are trapped in a cycle that, from the getgo, offers them very limited opportunities to escape poverty and under-development. Malawian children will grow up in an environment without basic nutrients to properly develop and might potentially die from diseases that could have been otherwise prevented at low cost. This cycle can only be broken if the right interventions for each child reach them at the right time. Given hard resource constraints, this requires evaluating tradeoffs based on what are the most cost-effective interventions to address each of the issues hindering child development in each setting. However due poor data collection in poor countries, programs targeted at children and adolescents often have to be scaled up or down in the absence of rigorous evidence about their impacts. Lately poor modelling data from reliable data has made it difficult to reliably model pattern of Malawian epidemics. High frequency social-behavioural data will enable Malawi make more accurate estimations and models based of unbiased data independently determined by digital sensors. Aim and Objectives Our study aims to assess impact of high frequent data collection using wearable digital technologies. Specifically our objective is to evaluate impact of real-time program evaluation through multiple; to assess effectiveness of high frequency data on children’s non-invasive biomarkers (from heart rate and variability to brain waves) and symptoms; and to determine social interaction between parents and children and other social contacts (including caregiver-child interactions); and impact of health promotion For example, we can analyse how handwashing habits can reduce the spread of infections like COVID-19. Further the study will evaluate the impacts of these messages on the behaviours and symptoms tracked by phone surveys, with the ability to understand trends and calibrate interventions in real-time. Methods The study is longitudinal prospective cohort with nested intervention study on health promotion. Data collection includes socioeconomic and behavioural data with end point non-invasive biomarkers. In combination with rapid experimentation, these data allows policies to be evaluated in real time. With the help of machine learning algorithms, the data also feeds earlywarning systems to empower community health workers to detect problems at an early stage – especially when it comes to epidemics like COVID-19 – and to implement immediate and preventive measures to address them. Last, combining experimentation with predictions allows for program personalization, such that each child and adolescent can benefit from the interventions most likely to benefit them. Expected Findings Like during the extensive pilot phase over the course of 2019, we have shown that this approach is able to collect high-frequency, high-quality and inexpensive data by adapting wearable sensors and phone surveys to the local setting specificities. Early results are encouraging, but further investigation to document how real-time program evaluation and personalization can be scaled up with the help of the right technologies and under the appropriate legal and ethical framework. The social-behavioural data based on contact sensors will likely model pattern of care for child stimulation as well as pattern of likely spread of diseases like diarrhoea, upper respiratory tract infection (like COVID 19 and common viral colds). This study will be especially important and beneficial under the current epidemic shock of COVID-19. Health promotion intervention through sending mobile nudges (reminders and encouragement messages) through SMS will allow us determine factors associated with behaviour output and help resolve compliance challenges to adherence to preventive behaviours to infections (lately we see decline in COVID-19 prevention measure irrespective awareness campaigns) Dissemination of Findings The findings will be disseminated through peer research conferences, publication in peer reviewed journals and COMREC. The data will be made public after peer reviewed journal are published for possible re-analysis and teaching.
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Children’s air pollution profiles in Africa (CAPPA) v1.0, 20/02/21
(Kamuzu University of Health Sciences, 2021-06-03) Rylance, Jamie
Executive Summary - The type of research study This is a multi-centre observational cohort study about air pollution in African children. The centres included are in Malawi, Tanzania, Uganda, Zimbabwe, Ghana, South Africa, and Nigeria. - The problem to be studied There is extensive literature on the wide-ranging health impacts of exposure to air pollution on populations. Children are vulnerable due to their developing bodies (Gehring et al., 2013, Gauderman, 2007); evidence shows that children’s lungs exposed to higher levels of air pollution have less volume than those in cleaner areas (Mudway et al., 2019). While personal exposure studies are becoming established in Europe, no such large-scale studies have yet been carried out on the African continent. This study aims to close that gap, providing valuable evidence to help improve the health of Africa’s young population. - The objectives [i] Broad The study aims to describe the burden of personal air pollution exposure (particulate matter <10 and <2.5 microns (PM10/2.5), and nitrogen dioxide (NO2)) in urban children with asthma symptoms in sub-Saharan Africa, its geographic, and temporal variability, the role of indoor and outdoor microenvironments and activity profiles, and effect of socioeconomic variables. To assess how personal air pollution exposure affect children with asthma symptoms in urban Sub-Saharan Africa, and the influence of socioeconomic factors on the effects. [ii] Specific 1. To collect personal air pollution exposure data, activity profiles, and lung function measurements from 60 children with asthma symptoms aged between 12 and 14 years, in Blantyre, Malawi. 2. To analyse personal air pollution data for exposure patterns and peak exposures. 2.3., and tTo compare air pollution as well as activity profiles of children in relation to their socioeconomic and geographical backgrounds both within and between countries, and compare with measured data from school-age children in London. 3.4.To explore potentially detrimental effects of air pollution, and feasibility of mitigation strategies in children with asthma symptoms identified by ACACIA. - Methodology From March 2021, we will recruit 60 children who participated in the ACACIA study. The participant will be provided a backpack fitted with air monitoring equipment to carry and keep close to them. Each child’s exposure to NO2 and PM2.5, as well as their GPS-location, temperature and humidity, will be collected at a 1-second intervals for 96 hours, and stored on a microchip within the backpacks’ logging unit. The data analysis procedure will follow that developed for a previous similar study in London – ‘Breathe London Wearables’1. Once monitoring at a site is complete, encrypted data will be uploaded from the backpack sensor units to a secure server where it will be decrypted. The digital CAPPA questionnaire will be filled in by each participant and will provide additional information regarding each participant’s personal exposure. Participants will also measure and record their lung function twice a day using a peak flow meter. - Expected findings and their dissemination This study will increase knowledge on air pollution exposure of young people in Blantyre, Malawi. The study will provide data on exposure to harmful pollutants and the risk to children’s health in this increasingly urbanised region. Links between data on respiratory health of young participants who experience asthma symptoms with air pollution exposure data will be explored and will lead to new insights. A copy of the final report, published papers, and conference abstracts will be submitted to; the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences Research Committee, and the University Research and Publication Committee.
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Determinants of mortality in neonates with culture negative sepsis: Implications for antimicrobial stewardship
(Kamuzu University of Health Sciences, 2021-09-15) Ghambi, Lughano
Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. This study aims to assess the factors associated with mortality among neonates with culture-negative sepsis by describing their characteristics and comparing the risk factors associated with death amongst those that died and survived. We will conduct a secondary analysis of a cross-sectional study investigating risk factors of neonatal sepsis which was conducted between May 2018 to May 2019 at Queen Elizabeth Central Hospital (QECH), Chatinkha Nursery. Rationale: Neonatal sepsis is over diagnosed and overtreated to reduce morbidity and mortality in a setting with limited diagnostics. However, this management approach also contributes to increasing rates of antimicrobial resistance (AMR). Therefore, determining the factors associated with death in neonates with culture-negative sepsis in our setting may minimize antibiotic exposure, by guiding the clinician in low resource settings to decide when to initiate and discontinue antimicrobial therapy in those most at risk for poor outcomes. Primary Objective:To assess the factors associated with mortality among culture negative sepsis neonates in a unit in Malawi. Secondary Objective: To describe the characteristics of the neonates with culture negative sepsis To compare the risk factors associated with death in neonates with culture negative sepsis neonates amongst those that died and survived Study Type: Cross-sectional study (retrospective analysis) Place of study: Queen Elizabeth Central Hospital, Chatinkha Nursery Study population: All neonates with culture negative sepsis from the primary study Sample size: All neonates with culture negative sepsis from the primary study Possible constraints: No major constraints anticipated but the data collection for the study is complete, and therefore the analysis will have to be based on the existing dataset. Dissemination: Results will disseminated through posters, oral presentation and publications
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Drug Adherence Among Children Presenting for Routine Cardiac Clinic Follow Up at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2022-03-16) Nyirenda, Brian; Chabuka, David
1.1 Study design To address the objective of this study, a cross-sectional study will be conducted. 1.2 Problem statement Adherence to medications is a prevalent problem in children with chronic diseases. Congenital and acquired cardiac conditions are among the common chronic diseases in children. Adherence to prescribed medications among children suffering from cardiac diseases is a worldwide problem. Lack of adherence to prescribed medications is associated with adverse outcomes such as high mortality rates, increased hospitalization, poor quality of life and increased healthcare costs. Therefore, it is important for healthcare workers to recognize and address adherence problems to ensure children are getting optimal health care. There is paucity of data on drug adherence among children attending routine cardiac flow clinic at QECH. Hence, this study will generate preliminary data that will bench mark drug adherence issues among children at cardiac clinic 1.3 Rationale and justification Drug adherence problems pause a big challenge in children with chronic illness. Poor drug adherence is associated with substantial increase in morbidity and mortality rates as well as health care costs. Despite the devastating effects of poor drug adherence, very few studies have been done to address this problem. Furthermore, it is argued that research touching on adherence is mainly done in major non communicable diseases and other chronic conditions such as; asthma, HIV/AIDS, diabetes mellitus, and attention deficit hyperactive disorder (ADHD) unlike in children with cardiac conditions which also carry a high lifetime risk of morbidity and mortality Therefore, it is important to assess drug adherence in children in order to generate data that can inform policy as well as improve rational drug use in children at Queen Elizabeth Central hospital. 1.4 Objectives The main objective of this study is to assess factors associated with drug adherence among children presenting for routine paediatric cardiac clinic at Queen Elizabeth central hospital. 1.5 Methodology The study will be conducted at Queen Elizabeth Central Hospital paediatric cardiac clinic. 65 children aged 6 months-18 years will be recruited after obtaining informed consent from the legal guardian and assent from eligible children respectively. Tools to be used to measure adherence rate and level include; self-reported questionnaire and visual analogue scale. Data entry and analysis will be done at college of medicine soon after data collection and this will be done using Microsoft excel and Stata software. Descriptive data analysis will be conducted where continuous variables will be summarized as mean and standard deviation. Frequencies and proportions will be computed for categorical variables. Regression analysis will be carried out to summarize possible relationships between the rate of drug adherence and predictor variables. The level of significance will be set at 0.05 1.6 Expected findings Low adherence rate among children presenting for routine cardiac clinic at Queen Elizabeth Central Hospital and the risk factors associated with them. 1.7 Results dissemination Upon completion of our study, the project report copies will be distributed to the College of Medicine Research and Ethics Committee (COMREC); the Undergraduate Research Projects Coordinator, Kamuzu University of Healthy Sciences (KUHes) Library, and to the Queen Elizabeth Central Hospital Management. Other copies of the study will also be distributed to the Paediatric Department at Queen Elizabeth Central Hospital from where the study will be conducted. The results will further be submitted to a peer-reviewed journal for publication
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An education package to improve health worker communication with women and families after still birth or neonatal death
(Kamuzu University of Health Sciences, 2020-10-08) Chimwaza, Angella Faith
Study type This study will be an action research that will follow the cycles of problem identification, planning change and action to implement the change. The approach will be complemented with use of the Behaviour Change Wheel which is a structured approach to designing behaviour change educational interventions. The problem Stillbirth or neonatal death is acknowledged as among the most traumatic and distressing life experiences with profound and long-lasting impacts for parents. Good communication is identified as being essential. This includes appropriate empathic and compassionate verbal and non-verbal communication and respect for privacy. However, negative experiences feature prominently in the global literature surrounding parents’ views and perceptions surrounding care after stillbirth and neonatal death. Our recent qualitative work across rural and urban facilities in East Africa has confirmed parents in these settings received inadequate information surrounding their care. In the proposed study, we will use our exploratory data to produce, test and refine a stillbirth communication package. We will also assess the acceptability of the package and determine the feasibility of a full-scale trial to assess effectiveness and the possibility of a scale up of the intervention. Broad objective: The broad objective of the study is to investigate the effectiveness of an educational package on health worker communication with women and families after stillbirth or early neonatal death (neonatal deaths that occur before the mother is discharged from the hospital after delivery) in Malawi, Uganda, Zambia and Zimbabwe. The specific objectives of the study are to: • assess knowledge, skills, attitude and confidence of healthcare workers in communication of stillbirth; • develop an education intervention to use in health worker communication of still birth; • assess the impact of an education package on health worker communication of on still birth and early neonatal death; • determine the acceptability of the package with healthcare workers, managers and undergraduate midwifery students; • establish the feasibility of implementing the intervention as a full trial protocol. Methodology : Study design: This study will use mixed methods; a quasi-experimental design, and qualitative methods. The study will take place in four countries: Malawi, Uganda, Zambia and Zimbabwe. In Malawi the study will take place at Queen Elizabeth Hospital. The sample will comprise 120 (30 per 4 countries) healthcare workers; 60 Student midwives (from Malawi and Uganda) and up to 15 clinical trainers (depending on saturation of data) and service managers per country. The Intervention will be a one-day educational workshop focused on ‘Good communication after a stillbirth or neonatal death co-produced with input from stakeholders and Community Engagement and Involvement (CEI) in-country. A pre and post-test questionnaire will be used to collect quantitative data. Qualitative data will be guided by an interview guide. Data analysis of quantitative data will be done using SPSS. Qualitative data will be transcribed verbatim and analysed using framework analysis. This approach allows for analysis of a prior and emergent concepts and themes. Expected findings: We expect that participants will improve on how they communicate to a woman/mother and significant others about a stillbirth or neonatal death. Dissemination: Study findings will be disseminated at COMREC and other research dissemination conferences, to CEI groups, stakeholders and health care workers and nursing /midwifery colleges through facility events. The findings will also be published in appropriate journals
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The effect of child abuse on child health
(Kamuzu University of Health Sciences, 2022-02-09) Molly Koroma Praise Makuluni Talithar Mambo Cecilia, Kanthiti
This is a quantitative and qualitative cross-section study aimed to explore and estimate the impact of child abuse on child health in Blantyre rural areas. Child abuse have a great impact on child health that affect the development of Malawi as nation in many ways, the study will focus on the estimation of the impact of child abuse on child health and determining the child health problems that emerge due to child abuse. Participant will be selected through convenience and simple random sampling technique and data will be collected in two ways, secondary data on child abuse based on the reported cases at Blantyre district social welfare office and primary data through in-depth interviews with people about child abuse according to the areas that have reported cases. Participant questionnaire will be used to collect social demographic data and the forms of child abuse and their related child health problems. The results will be presented at the research dissemination at the College of Medicine. The results of the study will help to reduce some of the child health problems that occur due to child abuse. This will be through establishment of strong and active institutions and guidance that help to deal with issues of child abuse when they occur and public awareness on the impacts of child health problems that occur due to child abuse and policy enforcement. Child abuse or maltreatment has existed for centuries but societies have been very slow to acknowledge it as a problem. Children and young people are vulnerable and cannot protect themselves. Child abuse is highly prevalent and associated with increased risk for a range of health problems. Some of the problems include cancer, cardiovascular disease, diabetes, psychiatric disorders and physical injuries [14]. Child maltreatment or abuse is a significant public health concern given its prevalence and potential impact on health not only during childhood but also later in life [14]. Each year in the United States, approximately three million reports are made to child welfare agencies. These reports only represent the tip of the iceberg, while here in Malawi, statistics at the districts social welfare Office shows that at least 30 cases are recorded every month [13]. Which also represents the tip of the iceberg, this is because most people do not come open in public since this issue is sensitive and some are not aware of what child abuse is [6]. Child abuse is in many forms. These forms are sexual, emotional, physical abuse as well as neglect [1]. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions [10]. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts [12]. 2.0 RATIONALE ”Child abuse in Africa is a major threat to the achievement of the sustainable development goals on the continent and has become increasingly topical with a dramatic increase in recognition and appreciation of the long-term harmful effects on the affected population” [2]. According to Y Madhlopa and J Qin, the occurrence of child abuses causes internalizing and externalizing behavior problems. Child maltreatment particularly emotion abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. In agreement with Andrea Danese 2020, child maltreatment affects mental health. Abused children are more likely to have low self-esteem, poorly progress with school, end up in prison, and develop psychological disorders. Child physical maltreatment can lead to brain damage due to trauma leading to failure of the brain to grow properly and normally function. Controlling the act of ill-treating children could prevent the mental health impairment. Two out of every Malawians experience violence in childhood and most acts of physical violence occur in the context of physical punishment [5]. This may be due to different understandings of ways to correct a child. A knowledge, attitude and practice (KAP) study was undertook in urban Malawi and this research’s one of the specific objectives is to understand peoples’ knowledge of child abuse in rural Blantyre [5]. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future. This research will screen child maltreatment risk in Blantyre and the results will motivate improving this problem. Establishing strong institutions and guidance to tackle abuse when it occurs is also both beneficial to the survivors and the community at large. Training primary school teachers and having medical people on schools would encourage children that are being abused to report. Free telephone help-lines would also be useful to report such cases. In that way, the impact of child abuse on child health would be reduced. 3.0 OBJECTIVES 3.1 Broad objective  To explore and estimate the impact of Child abuse on child health in Blantyre rural 3.2 Specific objectives  To assess the knowledge of child abuse and its impact on child health in Blantyre rural  To determine the most common forms of child abuse in Blantyre rural  To determine the child health problems that emerge due to child abuse  To estimate child mortality rate due to child abuse
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Effect of delay to surgical intervention on outcomes in paediatric patients with Hirschsprung’s disease at Mercy James Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2020-06) Amos, Nelson; Mhembere, Shingirai; Sichinga, Mwabi
This is a mixed method study with the quantitative part employing a retrospective cohort study design. The main objective of the study is to examine the effect of delay from surgical admission to surgical intervention focusing on the period between colostomy creation and definitive surgical management on outcomes and complications for patients with Hirschsprung’s disease at Mercy James, Queen Elizabeth Central Hospital. For the quantitative section of study, secondary data collected from the records will be used. For the qualitative section, primary data which will be collected by the researchers will be used. Data is to be collected from the paediatric and surgery departments at Queen Elizabeth Central Hospital. For the quantitative section, simple random sampling will be used to select the participants while no sampling technique will be employed for the qualitative section. The results of this study will be used to synthesize possible solutions and may set the foundation for initiating feasible interventions for the affected patients. The research findings will be disseminated orally at the dissemination seminar which will be held at The College of Medicine. The results of the study will be sent to the College of Medicine Research and Ethics Committee (COMREC), the University Research and Publication Committee, the Health Sciences Research Committee, the College of Medicine Library and the course coordinator.
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Evaluating the accuracy of point of care ultrasound scan in paediatric department at QECH
(Kamuzu University of Health Sciences, 2022-03-22) Wanda, Watipaso
Background Point of care ultrasound (POCUS) is a low cost, highly effective tool that significantly augments physical examination in making timely diagnosis of acute illness as well as guiding resuscitations and invasive procedures.(1, 2) The exam is focused, goal directed, and quickly performed at the bedside, in order to improve the patient's outcome. (3) However, it is highly operator and equipment dependent which carries implications about its use in guiding moment-to-moment therapeutic decisions when used in a point-of-care context. (4) In recent years there has been an increasing effort to integrate POCUS into clinical care provided in resource-limited settings. (5) Previous studies have demonstrated that physicians can perform effective and accurate scans after as little as 3 hours of didactic training and 5 hours of hands on training with an increase in confidence in use of POCUS with short and focused periodic re-training. (2, 6) There is growing evidence showing the impact of POCUS use in resource limited settings in aiding diagnosis, clinical management of patients and health care cost saving. (7,8). In 2018 a training program on POCUS was initiated in the Department of Medicine at the University of Malawi, College of Medicine, in cooperation with the University of Hamburg. An evaluation of the implementation and practice of the program showed that POCUS relieved the burden of radiologistperformed ultrasound by half and 78% pf POCUS examination conducted had an impact on patient management. (8) In recent years, POCUS training has been incorporated into residency training programs worldwide. In north America, the adoption of the use of POCUS has been progressively increased within paediatric residency training programs from 65% in 2006 to 95% in 2011.(9) Though there are many known benefits relating to the use of POCUS in general paediatric patients, there are limited studies that demonstrate the accuracy of POCUS when comparing non radiologist to radiologistperformed ultrasound examinations in paediatrics in the resource limited setting. The incidence of hydrocephalus is highest in Africa with an estimated annual incidence of more than 225,000 new cases of infant hydrocephalus. (10) The main imaging modality of diagnosis in resource limited setting where access to Computed Tomography is limited, is ultrasonography. There is anecdotally however an approximate average waiting time of 7 days for an ultrasound to confirm this diagnosis at QECH in elective patients. This delay can potentially be reduced by use of POCUS which would aid in a quicker diagnosis and more prompt referral for neurosurgical intervention in certain cases
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Experiences of mothers with critically ill preterm neonates at Mzuzu central hospital, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Elia, Precious Lyton
Study title: Experiences of mothers with critically ill preterm neonates at Mzuzu Central Hospital. Type of study: This is a qualitative descriptive study. Introduction Annually, about 15 million preterm neonates are born worldwide. The majority (85%) of global preterm births occur in Asia and Africa. In Malawi, 18.1% of all babies are born preterm and complications of preterm birth contributes to 33% of neonatal mortality rate (27/1000 live births). And about 75% of preterm neonates end up being hospitalized in neonatal intensive care unit (NICU). Problem Preterm births are a leading cause of admissions in neonatal care unit at Mzuzu Central Hospital. Mothers of preterm neonates play a critical role in the care of the preterm baby. However, information on the mothers’ experiences of having critically ill preterm neonates is scanty. Therefore, this study seeks to explore the experiences of mothers with critically ill preterm neonates in neonatal care unit. Objectives: Main objective of the study is to explore the experiences of mothers with critically ill preterm neonates at Mzuzu Central Hospital. This study will specifically investigate experiences of having critically ill preterm neonate, sources of support as well as challenges that the mothers of critically ill neonates meet as the child is admitted in neonatal care unit. Methodology The study will use descriptive qualitative research design to explore the experiences of the mothers with critically ill preterm neonates at Mzuzu Central Hospital. Fifteen (15) mothers with critically ill preterm neonates admitted in NCU are expected to be purposively recruited in the study. However, principle of data saturation will be applied during data collection to determine the sample size. Data will be collected through face to face in-depth interviews with individual participants. The interviews will be guided by semi structured interview guide with open ended and probe questions. Thematic analysis will be used to analyze the qualitative data and the results will be presented in themes and direct quotations from participants. Tables will also be used to present demographic data of mothers. Expected findings and dissemination of results It is estimated that the current study will find that mothers will have mixed reactions of stress and joy when caring for their preterm baby. Furthermore, limited access to the baby, lack of adequate support, lack of accommodation for mothers within the unit are possible challenges that mothers meet when caring for critically ill preterm neonate. The study results will be disseminated through a research report. Copies of results will be submitted to College of Medicine Research and Ethics Committee (COMREC), University of Malawi Research and Publication Office, KCN library and Mzuzu Central Hospital. The results will be presented in local and international conferences and seminars. In addition, the study results will be published in peer reviewed journals.
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Exploring determinants of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka District: An interpretive phenomenological analysis study
(Kamuzu University of Health Sciences, 2020-06-15) Njolomole, Blessings
Exclusive breastfeeding is the most widely known and effective intervention for preventing earlychildhood illnesses and deaths. Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades .In Malawi despite having some improvements in early initiation of exclusive breast feeding (EIBF), in the last decade there has been a decline in EBF and EIBF rates. This study aims at exploring drivers and barriers of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district. The specific objectives include to;1) assess the level of knowledge of mothers with children aged 0-6 weeks on the importance of exclusive breastfeeding;2) explore the perception of mothers with children aged 0-6 weeks towards exclusive breast feeding;3) assess drivers of exclusive breast feeding among mothers with children aged 0-6 weeks and 4) explore influences on exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district The study will employ a qualitative interpretive phenomenological analysis (IPA) approach. Participants will be recruited using purposive sampling technique to select breast feeding women with children 0-6 weeks while snowballing technique will be used for recruiting significant others. Three focus group discussions (FGD) of 6-8 women with children 0-6 weeks old and nine in-depth interviews with these women will be conducted while eleven in-depth interviews will be conducted with significant others (Spouses, grandparents and siblings of the women with children 0-6 weeks) and key informants involving 2 maternity nurses and 2 clinicians. Data will be analyzed using content thematic analysis.
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Exploring factors that influence of uptake and utilisation of maternity health services among adolescent women to inform designing of novel adolescent friendly maternity health services in Malawi: A formative qualitative study
(Kamuzu University of Health Sciences, 2021-08-02) Chirwa, Marumbo
Type of research study: the study will use a longitudinal qualitative design in the phenomenological tradition. Pregnant adolescents will be recruited in their second or third trimester and they will be followed until 6 weeks postpartum. Data will be collected during the antenatal period, one week postpartum and six weeks postpartum. The problem: Maternal health services in Malawi are provided in all government hospitals, starting right from the primary health care facilities, and are rendered at no cost. Despite the availability of these services, some adolescent women inadequately utilizse them, and do not gain maximum benefits of the services, by reporting late to book for ANC, for labour and delivery, and as well as for their postnatal checkups. This situation increases the risk of infant and maternal morbidity and mortality. Hence, this research proposal seeks to address this challenge by understanding the factors that influence and strategies for improving the utilization of maternal health services among the adolescents in resource resource-limited settings, which is one of the contributing factors to maternal and infant morbiditly and mortality. Objective: To assess the factors that influence and strategies for optimizing utilization of maternity services among adolescent women. in Zomba Malawi. Specific objectives; toally we will assess knowledge and experiences of adolescent women of maternal health services;, to explore factors that influence adolescent women’s decision to utilize maternal health services, and to identify barriers and facilitators to utilization of maternity services and strategies for optimizing utilization of maternity services among adolescents. in Zomba. Methods: the The study will use a longitudinala qualitative design in the phenomenological tradition. Pregnant adolescents in their second or third trimesters, will be purposively selected and upon giving consent to participate in the study, they will be recruited. Data will be collected from participants through Vignettes, pictorial diaries, and In-depth interviews at three three-time intervals; during the antenatal period, one week postpartum, and six weeks postpartum, to help the researcher understand adolescents’ experiences while they were receiving care when they were pregnant, during labour and deliver and after they had delivered. In addition to the above above-mentioned methods, literate participants will also be given diaries in which they will write down their experiences during pregnancy. All the tools for data collection will be presented in the local language and will be recorded on a digital recorder then transcribed in English verbatim. Transcripts will then be imported into Nvivo software. Thematic data analysis will be used in this study. Safety The safety of data will be ensured by using a password to get access into the database. Expected findings and their dissemination; It is expected that the study will provide information on determinants of uptake and strategies of improving the utilizsation of maternity health services among adolescent mothers. Results of this study will be presented at both the district and at the national level through review meetings coordinated by MOH and other stakeholders. Also, at the College of Medicine research dissemination conference. Printed hard copies will be made available to the College of Medicine library Library and COMREC. Finally, the prepared paper will be submitted to peer review journals for publication and summarized in policy briefs and posters. Possible constraints: Conduct The conduct of the study may be challenged with the ongoing COVID-19 pandemic. We propose to conduct both telephonic and face-to-face methods of data collection to mitigate the unintended consequences of COVOD-19
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Factors associated with adherence to physiotherapy clinic attendance among caregivers with children with cerebral palsy
(Kamuzu University of Health Sciences, 2021-05-26) Shadreck, Msowoya; Kanduku, Triza; Chinyama, Violet; Promise, Mtimajere
The study will use cross sectional qualitative method employing an interview guide with probes to conduct in-depth interviews as a tool of collecting data. Children with Cerebral Palsy (CP) may have different deficits which require early and continued physiotherapy intervention for effective outcomes. Caregivers of these children are the key determinants to the participation of their children to physiotherapy treatment (PT Rx). There are many factors that can hinder the compliance of caregivers to PT Rx. Therefore, the aim of this study is to explore the factors related to caregivers’ adherence to PT Rx. Specific objectives will include; (1) To explore challenges faced by the caregivers of children with Cerebral Palsy (CP), (2) To discover factors related to adherence to clinic attendance among caregivers with children with CP and (3) To survey factors affecting caregivers’ adherence to home exercise prescription. The study participants will be caregivers of children with cerebral palsy (aged 1 to 18 years) who will be selected from two sites: Queen Elizabeth Central Hospital (QECH) and Feed the Children. The expected results of the study will be orally presented at the physiotherapy department, electronically shared to College of Medicine Research Ethics Committee (COMREC) and presented at a research dissemination conference and published in peer reviewed journals. 26-May-2021
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Factors associated with mortality of premature babies with respiratory distress syndrome put on bubble continuous positive airway pressure at Kamuzu Central Hospital, Lilongwe-Malawi
(Kamuzu University of Health Sciences, 2022-06-15) Chifisi, Rhoda
Type of study: Retrospective cross-sectional study Background: Respiratory distress syndrome (RDS) is a breathing disorder that often occurs in babies that are born less than 37 gestational weeks (premature babies). It occurs as a result of immature lung development and the clinical features include cyanosis, fast breathing chest in drawings, and grunting respirations. One aspect of management of RDS includes the application of bubble continuous positive airway pressure (bCPAP) to expand the collapsed alveoli, thereby improving the work of breathing. Problem to be studied: The use of bCPAP has shown a decrease in morbidity and mortality for premature babies on global level, however, in Malawi a significant number still die despite receiving bCPAP. While studies have examined the factors associated with mortality of premature babies with RDS who receive bCPAP, few have been done in Malawi, and none have been conducted at Kamuzu Central Hospital, given it’s a new intervention. This study will add evidence to how bCPAP can be used effectively to prevent neonatal death. Broad objective of the study:  To determine maternal and neonatal factors associated with mortality of premature babies with RDS put on bCPAP between January 2019 to December 2021 at Kamuzu Central Hospital in Lilongwe, Malawi Specific objectives of the study:  To examine maternal factors associated with mortality of premature babies with RDS put on bCPAP between January 2019 to December 2021 at Kamuzu Central Hospital in Lilongwe, Malawi  To identify neonatal factors associated with mortality of premature babies with RDS put on bCPAP between January 2019 to December 2021 at Kamuzu Central Hospital in Lilongwe, Malawi Methodology: This study is a retrospective, cross sectional study conducted in the neonatal unit at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. This study will employ retrospective chart reviews of premature neonates to collect both maternal and neonatal factors that can be associated with mortality for premature babies receiving bCPAP. The study population are the premature neonates with RDS that were put on bCPAP at KCH neonatal unit between January 2019 and December 2021.The risk factors will be derived from careful review of the literature with consideration of the routine data collected during the neonate’s hospital stay. Data extraction sheet will be used for data collection. Data will be imported into Stata 16 software package andregression analysis will be performed to identify the statistically significant factors associated with mortality for this population. Expected findings and dissemination: Given the high rate of premature birth in Malawi, the results of this study have the potential to significantly impact neonatal outcomes This study addresses why premature neonates are still dying in Malawi, despite receiving bCPAP. Understanding of these factors will be used to inform changes that will help to improve outcomes of premature babies with respiratory distress syndrome put on bCPAP. The findings of this study will provide evidence to identify premature neonates on bCPAP who are at risk of dying and support a change in interventions to prevent neonatal death. Results will be disseminated to COMREC, KCH, CPAP project through Ministry of Health and an open access publication in a journal.
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Factors associated with stunting among children aged 6-59 months in rural Malawi: A community based comparative cross-sectional study
(Kamuzu University of Health Sciences, 2022-06-15) Nyirenda, Patrick
Type and place of research study The study will be a quantitative type of research study which will use face-to-face interview with primary caregivers of under-five children using a structured paper-based questionnaire in intervention (Kasinje and Sharpevalley catchment areas) and non-intervention (Bwanje catchment area) catchment areas in Ntcheu district. Problem Stunting level in Ntcheu is greater than the national prevalence and doubles that of the recommended WHO standard. High stunting levels in children result in irreversible brain damage, hindering them from reaching their full developmental potential, increasing the risk of developing chronic diseases in adulthood, lower attained schooling and a reduced adult income, and increasing mortality risk. Objectives The study’s primary objective will assess factors associated with the high prevalence of stunting among under-five children in the Ntcheu district. Precisely, the study will determine the level of knowledge of caregivers on infant and child feeding practice; determine the proportion of caregivers with household food security; evaluate the accessibility to nutrition-related health-seeking behaviour; assess the feeding method of under-five children. Methodology Study design: The study will be a community-based comparative quantitative cross-sectional study. Study setting: It will be conducted in Bwanje Area Programme (AP), Kasinje and Sharpe valley catchment areas (Nutrition intervention area) and Bwanje health Centre catchment area (comparison area) in Ntcheu district. Study population: Caregiver/ mother- under-five child pairs will be involved in the study, Sample size: 374 caregiver-child pairs will be selected for the study, with 111 pairs for the intervention group and 263 pairs for the control group. Three GVHs will be randomly selected from both areas, and purposive sampling will be used to determine households with caregivers and under-five child pairs. Data collection technique: Data will be collected from caregivers through face-to-face interviews using a structured questionnaire. While under-five children, anthropometric measurements will be taken and measured. Data management and analysis: Data will therefore be coded, entered and analyzed using SPSS version 20. The association between independent factors and the dependent variable, prevalence of stunting, will be analyzed using multivariable logistic regression. Expected findings The study anticipates finding poor child feeding practices, poor health-seeking behaviors of caregivers/ mothers and household food insecurity as factors associated with stunting predominantly in comparison area than in nutrition counselling intervention. This will help relevant stakeholders to come up with policies for reducing stunting. Dissemination Results will be disseminated to The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library Ntcheu District Hospital Research and Ethics Committee and implementing partner, World Vision International, for decision making. The research findings will be disseminated through holding dissemination seminar/workshop and publication of a manuscript. Formatted: Font color: Red 15
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Factors associated with treatment outcomes of severe acute malnutrition among under five children admitted at Queen Elizabeth Central Hospital (QECH) nutrition unit: A retrospective cross- sectional study
(Kamuzu University of Health Sciences, 2021-12-10) Ndhlovu, Mirriam
Type of the study: A retrospective cross-sectional study. Problem to be studied: Malnutrition is a physiological condition that results from energy, protein and other nutrient deficiencies leading to growth impairment or excess intake of nutrients causing obesity. There are immediate, underlying and basic causes of malnutrition. Under-nutrition may be caused by diseases and or inadequate intake of macronutrients/micronutrients. Severe acute malnutrition is defined as weight for height/ length of <-3z score or MUAC<11.5cm or bilateral pitting oedema of +2 to +3 in children aged 6 to 59 months. Children with severe acute malnutrition are more susceptible to diseases which increases their mortality. Much of the research in severe acute malnutrition has focused on treatment options to improve treatment outcomes. However, mortality estimates in severe acute malnutrition have remained high in Malawi despite government’s effort to reduce child mortality. Objectives of the study are: Broad objective • To assess factors associated with treatment outcomes of severe acute malnutrition among children aged 1 month to 59 months admitted for nutrition feeding at Queen Elizabeth Central Hospital (QECH). Specific objectives I. To determine whether the admission category (new / readmission) is associated with treatment outcomes of severe acute malnutrition among children aged 1 to 59 months admitted at QECH nutrition unit. II. To determine whether the presence of a particular medical comorbidity (pneumonia, anaemia, TB, diarrhoea, malaria, sepsis and neural disability such as cerebral palsy) is associated with treatment outcomes of severe acute malnutrition among children aged 1 month to 59 months admitted at QECH nutrition unit. III. To determine whether socio-demographic characteristics (age, sex, and primary care taker) of the children aged 1 month to 59 months admitted at QECH nutrition unit are associated with treatment outcomes of severe acute malnutrition. Methodology: This will be a retrospective cross-sectional study to be conducted at QECH nutrition unit from July 1, 2017 to July 31, 2020. The study population will be all malnourished children aged 1 month to 59 months admitted at QECH nutrition unit. All children with surgical and orthopedic conditions will be excluded from the study. A sample size of 312 will be used for the study to achieve 90% power at 5% significance level. Data will be extracted from inpatient registration book and patient medical records. The study population will be divided into two strata, namely; recovered and not recovered. Proportionate will be calculated for each stratum based on total number of study population. The desired sample size will be multiplied by the proportion of units in each stratum. Finally, systematic random sampling will be used where every kth unit will be selected from each stratum. Expected findings and dissemination: Recovery rates and death rates of SAM children aged 1 month to 59 months will be established. Factors associated with the outcomes will be identified and association described. Results of this study will be shared with Kamuzu University of Health Sciences (KUHeS), COMREC, and QECH. Dissemination of the results will also be done in conferences and peer reviewed publications.
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Feasibility, non-inferiority and effects of a caregiver-led training program for caregivers of children with cerebral palsy
(Kamuzu University of Health Sciences, 2022-09-28) Bakuwa, Takondwa Connis
Type of Study The proposed study is a convergent parallel mixed methods design that will be conducted in two phases. Problem There is critical shortage of rehabilitation professionals in low-resource settings comprehensive training of caregivers is inadequate. Hence therapeutic inputs for children in these areas remains limited. Despite the emerging use of caregivers to support training of fellow caregivers of children with CP, the strength of this model of caregiver training has not been adequately evaluated. Broad objective To assess the implementation outcomes of a caregiver-led training program for caregivers of children with CP in Namwera, Mangochi, Malawi. Specific objectives 1. To explore the acceptability of the carer-to-carer training program delivered to caregivers of children with CP from Namwera Mangochi Malawi over a period of 5-days 2. To determine change in knowledge on CP among caregivers of children with CP from Namwera Mangochi, Malawi following a 5-day training using the Carer-to-Carer training package 3. To describe adaptations made to the carer-to-carer training package following initial delivery over a 5-day training programme 4. Compare levels of knowledge, skills and quality of life between caregivers trained by a fellow caregiver and caregivers trained by a therapist using the C2CTP in Mangochi Malawi over a period of seven weeks 5. Compare levels activity and participation between children with CP whose caregivers were trained by a fellow caregiver and those whose caregivers were trained by a therapist using the C2CTP in M6. Explore the perceptions of caregivers of children with CP involved in the C2CTP training program either as participants or facilitators regarding the perceived effects of the program delivered over seven weeks in Namwera, Mangochi, Malawi. Methodology Phase one, which is the feasibility study, will describe three things, acceptability, adaptation and ability of training to change caregivers’ level of knowledge on CP. Acceptability will be explored qualitatively using in-depth interviews and reported as themes, adaptation will be analyzed and reported using the template for Intervention Description and Replication. Change in knowledge will be assessed using a questionnaire on Knowledge designed by Malamulele Onward Organisation and reported as means and standard deviation. Phase two will investigate non-inferiority of the caregiver-led training program through a two-armed randomised controlled trial where the active control group will be a therapist-led training program. Paired t-tests will be used to compare changes in caregiver level outcomes such as quality of life (PedsQolFIM), caregiver knowledge on CP (standard CP knowledge questionnaire). Child level outcomes such as Pediatric Inventory of Disability (PEDI) and Participation (CASP, PMP) will also be assessed and compared using paired tests. Non-inferiority of the caregiver-led training program will be tested margin of 4.5 points on the PedsQolFIM. Parallel to the RCT will be a qualitative study that will explore the experience of all participants and facilitators of the training program. Inductive analysis will be employed to generate themes in this regard. Expected Findings This study will describe the feasibility of a caregiver-led training program in Malawi. It will also determine whether the program in not inferior to a therapist-led training program. Therefore, it will provide useful insight that can inform the design and capacity building required to support caregiver-led training programs for caregivers of children with CP. In addition to this, the study will provide useful qualitative insight on the effects and value of a caregiver-led training program for children with CP. Dissemination All data generated from both phases of the study will be orally presented to all stakeholders of the program including Mangochi district hospital, Tiyende Pamodzi group, Malamulele Onward organisation. The results will also be shared with the larger community of practice through attendance of conferences at local regional and international levels. A copy of the results will be shared with the College of Medicine Research Ethics Committee. In addition to that, the results will be sent to a peer review journal for publicationangochi Malawi over a period of seven weeks.