Safe Motherhood

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    An assessment of the factors contributing to increase cases of abortion among women of reproduction age, Mzimba
    (Kamuzu University of Health Sciences, 2023-01-11) Kaipa, Audrino; Khasu, Bridget; Makwinja, Abigail; Gotta, Godfrey
    Introduction: Abortion continues to be a burden in both developing and developed countries. Global and regional studies show that factors like knowledge, finances and religion have great impact on abortion. In Malawi abortion cases accounts for 18.2% of all gynaecology conditions among women of reproductive age and is the most common cause of infertility in women. Despite increased access to family planning method and integrated post abortion care services, cases are still rising each and every year. Aim: This study aims at assessing factors associated with abortion among women of reproductive age at Mzimba District Hospital. The specific objectives are: to discover the influence of marital status on abortion among women, to explore knowledge of abortion of women of reproductive age, to examine financial status of women of reproductive age, to compare influence of religion on women’s belief to keep pregnancy or not. Methodology: Cross sectional research design will be used to assess the factors associated with increased cases of abortion in Mzima, Malawi. A sample size of 50 will be used during data collection. Data will be analysed using SPSS version 23. Expected findings: We expect that women will have little knowledge on abortion, women of low income level will have high rate of abortion and women of strong religious belief will have low abortion rate. Dissemination: The results from the research findings will be printed and disseminated during dissemination seminar to be held at College of Medicine. Both hardcopies and soft copies will be sent to Kamuzu University of Health Sciences library. We will arrange a meeting with female surgical ward health care workers at Mzimba District Hospital to give feedback of the research findings to incorporate them in their interventions including health education and counselling given to the women
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    A Study of the Experience of Sexually Assaulted Pregnant Minors Who Seek Access to Abortion-Related Services Through the Kamuzu Central Hospital One- Stop Centre
    (Kamuzu University of Health Sciences, 2023-01-11) Chipeta, Effie Dr.
    Type of Study: An exploratory cross-sectional qualitative study aimed at examining the experiences of pregnant minors who seek abortion-related care through the Kamuzu Central Hospital (KCH) One Stop Centre (OSC). Background: Girls and young women who have survived rape, defilement, and sexual assault are at high risk of pregnancy. Research has shown that younger unmarried and economically dependent women and girls who receive maternity care in various health facilities report having become pregnant through rape and defilement. For girls aged between 12 and 19 years in Malawi, the risks associated with pregnancy and abortion are high. Abortion is only legal in Malawi when the pregnant woman’s life is in danger and obtaining an abortion, aside from this one condition is punishable by 7-14 years’ imprisonment. Nevertheless, it does not stop abortion from occurring. In an assault report presented by the KCH OSC for the period January-November 2021, cases of defilement, rape, physical assault, emotional assault, and followed by sodomy, abduction, and early child marriages were reported, and there were cases of girls between the ages of 11 and 19 whose sexual violation resulted in pregnancy. In terms of managing pregnancies, the staff at the OSC counsel clients, and provide ante-natal care and delivery services. However, clients who request termination are informed this service is not available because it is illegal. It was also reported that there is a high demand for termination of pregnancy services from girls and women whose pregnancies resulted from sexual violation. Objectives: The overall goal of this research is to explore the experiences of pregnant minors (aged 10-17 years) who seek abortion-related care. The specific objectives are to: 1. Assess the lived experiences of pregnant minors who have been refused access to safe abortion. 2. Evaluate the impact of national laws on the health and well-being of the pregnant minors denied access to safe abortion at the OSC 3. Examine policy/program level and community level stakeholders’ perceptions on the relationship between hospital policies and practices on the provision of safe abortion to minors and the legal framework. Study design, population, sample size and sampling strategy: The study will use an exploratory cross-sectional qualitative design to examine the experiences of pregnant minors who seek abortion-related care. The proposed study will be conducted amongst pregnant and previously minors (10-17 years) following sexual assault; parents/guardians of pregnant minors (10-17 years) recruited in the study; health service providers at the One Stop centre; and key stakeholders. Thirty participants will take part in the study. Pregnant minors will be sampled using a combination of purposive and snowballing methods while the rest of the population will be sampled purposively to ensure rich data is collected. Study Site, Study period and data collection: The study will be conducted in Lilongwe district through the Kamuzu Central Hospital One Stop Centre. It is expected that this study will run fromDecember 2022 to March 2023. In-depth interviews, key informant interviews and semistructured interviews will be used to collect data Data management and analyses: Data collection and analysis will partly be done concurrently and audio-recorded interviews will be translated and transcribed verbatim by trained transcribers. Before analysis, transcripts will be anonymised. Data will be analyzed using qualitative thematic analysis methods. The analysis will use a hybrid of the deductive and inductive approach Dissemination Plans: Initially, the study findings will be shared with Options Consultancy Services Ltd. Subsequently, the study findings will be shared with the participating institutions such as the KCH OSC, MOH-RHD and other key stakeholders. The study findings will also be disseminated to wider audiences such as national, regional and global audiences. The study reports will also be shared with the College of Medicine Research and Ethics Committee (COMREC, as required. The results will also be presented at relevant regional and international conferences and published in relevant peer-reviewed journals. Anticipated challenges: Some of the actors such as service providers may feel uncomfortable when asked questions about the provision of abortion services. The researcher also realizes the sensitivity of the matter such that the minors may not be able to share their experiences. To minimize this, we will inform the participants that participation in this study is voluntary and they can stop participation at any time. Study staff will make every attempt to ensure a comfortable and secure environment in which to interact with participants, and will be trained to protect confidentiality. Potential use of results: The findings of the research will contribute to understanding the impact of laws and policies on the lives of minors who are pregnant due to sexual assault. It will also contribute to clarifying the relationship between hospital practices in the provision of safe abortion to minors and the legal framework. The Research will generate new evidence on barriers to safe abortion services access. This will reignite new discussions, raising the profile and visibility of the importance of legislative and policy reforms to address unsafe abortion.
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    The Active Prevention and Treatment of Maternal Sepsis
    (Kamuzu University of Health Sciences, 2022-07-13) Gadama, Luis
    Hybrid implementation/effectiveness trial. Multi-country, parallel cluster randomised trial with baseline phase. Setting 32 healthcare facilities in Malawi will participate, as part of a multi-country study The problem Maternal infections and sepsis are reported to cause 11% of direct maternal deaths (1), and recently the WHO GLOSS (Global maternal Sepsis) study, although based on small numbers, Formatted: Font: Bold 13-Jul-2022 x APT-Sepsis Protocol Version 1.0 Date, 13 April 20222.0 Date, 06 June 2022 Formatted: Left suggests maternal infection may contribute to over half of all intra-hospital maternal deaths (2), with by far the greatest burden borne by women in Low- and Middle-Income Countries (LMICs). There is an urgent need to identify ways to combat this problem which are implementable at scale, and are clinically effective, cost effective and sustainable. This study which will be conducted in Malawi aims at assessing the effectiveness of implementing APTSepsis bundle which is the quality of care for mothers, and adherence to WHO evidence-based practices in infection prevention and management. APT- Sepsis is a carefully developed programme designed specifically to be used in countries and facilities where there are limited resources available; Malawi and Uganda are the countries identified to participate in this study. It APT-Sepsis aims to change health care workers’ behaviours to ensure mothers get the best care possible to better prevent and manage infections. Broad Objective The broad objective of this study is to examine if the APT-Sepsis programme is effective at reducing infection related maternal mortality and severe maternal morbidity, at any time prior to discharge infrom health care facilities in Malawi and Uganda. Specific Objectives The specific objectives are, to evaluate if the APT-Sepsis programme is effective at reducing secondary clinical outcomes of sStillbirth, early neonatal death, maternal mortality, maternal near miss; to explore differential or subgroup effects of the APT-Sepsis programme; to understand the implementation of the APT-Sepsis programme in Malawi, to facilitate interpretation of trial outcomes and development of a longer-term implementation strategy; and finally to determine if the APT-Sepsis programme is cost effective. Methods The study is a multi-country, parallel cluster randomised trial with a baseline control phase. There is an integrated implementation evaluation and health economic evaluation. The overall trial will include 630 clusters in Malawi and Uganda, each of which is a health facility. This protocol specifies the activities to be conducted in Malawi. During the first six months each cluster will continue with their current practices and data will be collected to establish weekly rates of maternal infection and mortality. After the baseline period, the clusters will be randomly allocated in a 1:1 ratio to the APT-Sepsis programme or current practice with passive guideline dissemination, using a minimisation algorithm. The intervention seeks to change the behaviours of health care providers to improve adherence to WHO guidelines and best practice in infection prevention and management, and detection and management of maternal sepsis. Expected Findings
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    Hypertensive disorders of pregnancy: An assessment of prevalence and care of preeclampsia-eclampsia patients at Queen Elizabeth Central Hospital (QECH)
    (Kamuzu University of Health Sciences, 2022-07-25) Rashid, Bakali; Davis, Caroline; Chasi, Panache; Casten, Chikumbutso
    Type of study: The study will be a retrospective cross-sectional study, comprising of both qualitative and quantitative data. 1.2 Research Problem There is a growing burden of Non-Communicable Diseases (NCDs) including hypertensive disorders of pregnancy. Despite current strides in medicine, hypertensive disorders of pregnancy still cause substantial morbidity and mortality. There is also paucity of local data on prevalence and risk factors for hypertensive disorders of pregnancy. This study will therefore seek to fill the informational gap on prevalence of preeclampsiaeclampsia, and common risk factors, and will seek to understand current disparities in the healthcare system by investigating the facilitators and barriers to care of preeclampsia-eclampsia at Queen Elizabeth Central Hospital. 1.3 Objectives Broad Objective: To assess the prevalence, risk factors and management of gestational hypertension amongst pregnant women attending Queen Elizabeth Central Hospital (QECH), Blantyre. Specific Objectives: 1) To explore the prevalence of preeclampsia and eclampsia amongst pregnant women attending QECH between July and December 2021 2) To investigate the age group most affected by preeclampsia and eclampsia 3) To describe sociodemographic and maternal factors associated with preeclampsia and eclampsia 4) To describe management practices for preeclampsia and eclampsia at QECH maternity unit. 1.4 Methodology The study will include pregnant women admitted and treated at QECH between July and December 2021 diagnosed with a diagnosis of hypertensive disorder of pregnancy. Through objectives 1 and 2: 25-Jul-2022 In patient registers at Antenatal Care (ANC), Labor Ward (LW) and Post Natal Care (PNC) for the period will be reviewed to identify women diagnosed with hypertension and based on the list case notes of the women will be extracted from medical records office as well as those critically ill having either survived or passed. Data on socio demographic profile of the patients such as age, residence and underlining conditions will be extracted from said files. Additionally, data on disease diagnosis, treatment and outcome will also be extracted from the same registers. For objective 3, we will interview clinicians and nurses at the facility on their management as compared to the standard treatment guidelines of preeclampsia and eclampsia. Sampling strategy will be purposive sampling and the sample size will be 40. Data will be collected using questionnaires and interviews. Inclusion criteria will be all patients above 18 years of age diagnosed with preeclampsia and eclampsia. 1.5 Expected Findings • We expect to have a higher prevalence of preeclampsia and eclampsia at QECH compared to any other hypertensive disorders of pregnancy. • We expect that most women will have little knowledge on symptoms and care of preeclampsia and eclampsia • We expect that QECH treats preeclampsia and eclampsia according to the standard treatment guidelines set by the WHO. • We expect that misdiagnosis plays a key role in the mismanagement of the condition 1.6 Dissemination Study results will be presented at the research dissemination conference at KUHES in Blantyre, Malawi. A report submitted to the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, the Health Sciences Research Committee (through the COMREC Secretariat), the University Research and Publication Committee (URPC) (through the COMEC Secretariat) as well as the QECH Paediatrics department.
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    Determinants of long acting reversible contraceptive utilisation among reproductive age women at Balaka district hospital
    (Kamuzu University of Health Sciences, 2022-06-02) Mwalweni, Chank
    Type of Study This will be a facility-based quantitative cross-sectional study whose purpose is to assess utilisation of long acting reversible contraceptives and associated factors among women of reproductive age at Balaka district hospital. The Problem Balaka district has a fertility rate of 4.6 higher than the national fertility rate of 4.4. Additionally, the population growth rate for Balaka district is at 3.2% per annum higher than national 2.9% per annum. Malawi population is growing rapidly and it is stated that if left uncontrolled, the population is expected to reach 45 million by 2050. Consequently, the government of Malawi through Ministry of Health is promoting utilisation of long acting reversible contraceptive methods (implants and intrauterine device) which are highly effective and have less discontinuation rate in order to combat the overgrowing population. However, the utilisation of long acting reversible contraceptives is lower (16.9%) in Balaka district as compared to national utilisation at 21.7%. The utilisation of long acting reversible contraceptive (LARC) methods in Malawi is also lower as compared to sub-Sahara Africa at 36%. Nevertheless, there is limited literature on factors associated with utilisation of long acting reversible contraceptives among women of reproductive age in Malawi. Hence, the need for this study. Broad Objective The purpose of this study is to assess utilisation of long acting reversible contraceptives and associated factors among women of reproductive age at Balaka district hospital. Specific Objectives i. To determine the prevalence of LARC utilisation among women of reproductive age accessing FP services at Balaka district hospital. ii. To assess the sociocultural factors associated with utilisation of LARC among women of reproductive age accessing FP services at Balaka district hospital. iii. To analyse the health-system-related factors associated with utilisation of LARC among women of reproductive age accessing FP services at Balaka district hospital. Methodology The study population will be all women of reproductive age group (15–45 years old) accessing contraceptives methods at Balaka district hospital at the time of the study. The sample size for this study will be 216 and it has been calculated using Cochran formula (n= z2pq/d2). The study participants will be selected using a systematic random sampling technique with an interval of 6. The data will be collected through face-to-face interviews using a structured questionnaire. Data will be analysed using statistical package for social sciences (SPSS) version 22 and logistic regression will be carried out to identify factors associated with LARC utilisation. Ethical approval will be obtained from College of Medicine research and ethics committee (COMREC). The institutional clearance was requested from the Director of health and social services for Balaka district hospital and permission has been granted. Expected Findings The study will document the prevalence of long acting reversible contraceptive utilisation and its associated factors among women of reproductive age accessing family planning services at Balaka district hospital. The results of this study well help to close the knowledge gap that exists on factors associated with LARC utilisation among women of reproductive age in Balaka district and national at large. The results will also serve as baseline data for policy makers, programme managers and decision makers to design and focus on suitable interventions that promote utilisation of LARC. Dissemination of Results The result of this study will be presented to Kamuzu University of Health Sciences, College of Medicine Research and Ethics Committee (COMREC) and Ministry of Health (Directorate of reproductive health) through Balaka District Health Office from where the data will be collected. The study finding will be published in a reputable peer reviewed journals and presented at the conference.