- ItemRestrictedSexually Transmitted Infection (STI) in Pregnancy and Adverse Birth Outcomes; A Case-control Study(Kamuzu University of Health Sciences, 2023-01-19) Freyner, BridgetType of Research Study: A cross-sectional survey and nested case-control study. The problem: Sexually transmitted infections (STIs) are associated with increased rates of preterm birth, stillbirth and low birth weight (LBW). In Malawi STIs are diagnosed by syndromic ascertainment which has poor sensitivity in antenatal mothers. The prevalence of these diseases in the antenatal period and their contribution to adverse birth outcomes are not known in Malawi. This is critical as they are highly modifiable. This study will be done as part of the DIPLOMATIC collaboration. Through the COMREC approved TUDA study (P06/19/2714), the DIPLOMATIC collaboration has established midwife capacity in antenatal ultrasound for the determination of gestational age at Queen Elizabeth Central Hospital (QECH). This platform will be utilised in the current study to accurately ascertain the outcomes of prematurity and low birth weight. The DIPLOMATIC group is committed to the implementation of evidence-based practices with the aim of reducing preterm birth, stillbirth and neonatal mortality in Malawi and Zambia. Aim: To determine the contribution of sexually transmitted infections (STI) in the antenatal period to adverse birth outcomes at QECH Primary objectives: 1. To determine the prevalence of STIs (N. gonorrhea, C. trachomatis, M. genitalium, T. vaginalis, T. pallidum, Herpes Simplex Virus and HIV in women who attend QECH for delivery of their infants. 2. To determine the attributable fraction of adverse birth outcomes at QECH with a confirmed diagnosis of at least one STI in the peripartum period. Secondary objectives: 1. To generate pilot data on the clinical outcomes of mother-infant pairs co-infected with HIV and any other STI 2. To evaluate the accuracy of the syndromic approach to the diagnosis of STIs in pregnancy compared to gold standard laboratory diagnostics. 3. To determine the coverage of antenatal diagnosis, treatment and partner notification and treatment of STIs. 4. To determine the role of rapid point of care tests (POCT) for the differentiation of early versus latent gestational syphilis and the diagnosis and management of congenital syphilis. 5. To generate pilot data on the role of vaginal microbial composition in preterm birth and mother to child transmission of HIV. Methodology: A cross-sectional survey and nested case-control study of pregnant women, recruited at delivery will be done at Queen Elizabeth Central Hospital, Blantyre, Malawi. A composite case definition for adverse birth outcome will include all stillborn, preterm, low birth weight (LBW) infants or infants admitted to NICU within 24 hours of birth. Each case will be matched with a mother of a healthy term infant. Multiplex PCR will be done on vaginal swabs in cases and controls to screen for all common STIs (N. gonorrhea, C. trachomatis, M. genitalium, T. vaginalis, T. pallidum, Herpes Simplex Virus) and HIV and syphilis status will be determined on maternal and infant serum. There is a planned sub-group analysis by HIV sero-status. We will recruit 650 cases and 650 controls to give 80% power to detect a 50% difference between groups, α=0.05 and allow prevalence estimates for each STI with +/-5% margin of error margin of error. Expected Findings: This study will provide prevalence data for curable STIs among postpartum women and assess their contribution to adverse birth outcomes. In addition, this study will provide information on the burden of neonatal disease in newborns exposed to STIs in the pre- and peri-partum period. Dissemination: Research findings will be shared with health care workers at QECH and with participants with the help of the MLW science communication team. Data will be shared with the Malawi College of Medicine and Malawi College of Medicine Research Ethics Committee, Malawi Ministry of Health and published in peer reviewed publications. Data collected at QECH will be presented as standalone findings in conferences and peer-reviewed publications locally and shared with relevant clinicians and policy makers.
- ItemRestrictedFemale Genital Schistosomiasis Among Adult Women Living With HIV, A Case of Mfera Health Centre in Chikhwawa District(Kamuzu University of Health Sciences, 2022-07-13) Chilewani, DytonThe type of research study We plan to conduct a cross sectional descriptive study. The problem Schistosomiasis is endemic in the SSA and SH is the most common causative agent among the species. Women and girls are at risk due to water collection for household chores. A study has shown that invasive diseases of the genitourinary organs are cofactors of HIV transmission. Women and girls in SSA region carry a triple burden of vulnerability to HIV, cervical cancer and FGS . The study seeks to find the proportion of women living with HIV who have genital schistomiasis. Establish their knowledge on FGS and long-time consequences of this disease 13-Jul-2022 4 The Objectives Broad Objective To estimate the prevalence of Schistosoma Haematobium among women living with HIV at Mfera health Centre in Chikwawa. Specific Objectives • To determine the prevalence of Schistosoma Haematobium among women living with HIV Mfera health Centre in Chikwawa. • To assess the knowledge on Female Genital Schistosomiasis among women living with HIV Mfera health Centre in Chikwawa. Methodology A total of all adult women who attend ART clinic at Mfera Health Centre in Chikwawa will be included in the study of which 68 will be randomly selected to participate. A questionnaire will be administered and after that participants will give urine which will tested for schistosomiasis using serological method (antigen and/or antibody in urine). Quantitative data will be collected and analyzed with Microsoft Office packages. Expected findings and their dissemination. We expect to find 45 % of the women to have a positive Schistosoma result basing on previous study done on mothers in the district, little or no knowledge at all about FGS The study report will be shared with, the HOD MLS department, COMREC, Chikwawa DHO, Mfera Health Centre
- ItemRestrictedInvestigating knowledge and determinants of birth preparedness among pregnant women In Mangochi district(Kamuzu University of Health Sciences, 2022-07-12) Abuduo, Richard; Malipa, Peter; Gondwe, Macdonald; Lanjesi, InnocentThis is a descriptive, cross-sectional study that will utilize both qualitative and quantitative data collection and analysis methods to explore knowledge, practices and men’s support towards birth preparedness and complication readiness among antenatal women. The broad objective of the study is to investigate knowledge and determinants of birth preparedness among pregnant women in Mangochi district. Specific objectives of the study are: to assess the Knowledge of birth preparedness among antenatal care attendees in Mangochi District and to identify the factors associated with birth preparedness among antenatal care attendees in Mangochi District. The study will be conducted in Mangochi district. It will be facility based (ANC Department) of Mangochi District Hospital, Makanjira Health Centre, Monkey Bay Health Centre, Namwera Health Centre and Chilipa Health Centre. The study targets pregnant women who come to attend ANC during study period. The study will run from January 2022 to February, 2023. Every pregnant woman willing to be included during data collection. Pregnant women who presents with danger signs or unable to communicate, and those not willing to be interviewed. The sample size will be 384 participants and participants will be enrolled using random sampling technique. Data will be analyzed using statistical package for social sciences (SPSS) version 21. The expected findings of the study will be at least 50 percent of the participants will be knowledgeable of birth preparedness and complication readiness. The study findings will be disseminated through presentations during meetings such as DHMT, CPD and morning report gatherings, seminars and conferences. Reports will be compiled and submitted to College of Medicine Research Committee.
- ItemRestrictedProtocol for development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth, version 1.0(2022-06-15) Kirkham, Jamie; Chimwaza, AngelaType of research study: Delphi survey for the development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth. Problem statement A stillbirth accounts for about 14 in every 1,000 births globally with the highest rates seen in Sub-Saharan Africa and South Asia. Stillbirth prevention and bereavement care following a stillbirth remains a challenge, particularly in Low and Middle Income Countries (LMiC). One approach to improvement is the prioritization of women/family-centered care. There is a large variety of outcomes measured in stillbirth studies but consensus on the outcomes that matter most to women and families is often lacking, which can impact on the ability to make informed decisions about improved care practices. Objectives The broad objective of this study is to develop standard sets of outcomes for use in interventional studies for stillbirth prevention and improving bereavement care following stillbirths in LMiC settings. The specific objectives are to: identify outcomes used in current stillbirth research including outcomes reported in qualitative literature in LMiC settings relevant to stillbirth; to prioritize outcomes from health care professionals, researchers and parents’ perspectives; and to integrate the outcomes important to all stakeholders in order to ratify a core outcome set (COS). Methodology This study will involve three stages in the development of the COS: (1) a list of outcomes will be identified from multiple sources, specifically existing reviews of outcomes, a search of trial registry data, a targeted qualitative literature review of studies that have interviewed parents who have experienced stillbirth and healthcare professionals working in this field across Sub-Saharan Africa and South Asia. (2) The list of outcomes will be scored by multiple stakeholder groups in a real-time online Delphi survey. (3) The results of the Delphi will be summarised and discussed at a face-to-face or 15-Jun-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 1.0 1/05/2022 8 virtual consensus meeting with representation from all stakeholder groups. Expected findings and their dissemination It is expected that two COS for use in a LMiC setting will be developed, one for stillbirth prevention and one for bereavement care following stillbirth. Both COS will be developed for research and clinical practice and will consider all interventions and care options for stillbirth care within this scope. The development of these COS will be reported according to the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines . We will register the COS with CROWN (Core Outcomes in Women’s & Newborn Health)  and share our findings across the GHRU Network, College of Medicine Research Ethics committee (COMREC), the LAMRN (Lugina Africa Midwives Research Network)  and other relevant international societies and organisations for wider dissemination.
- ItemRestrictedUtilization of antenatal care services in the first trimester of pregnancy: Analysis of facility based barriers and potential interventions in Chikwawa district(Kamuzu University of Health Sciences, 2022-06-15) Baluwa, Patrick ChrissType of study This will be a descriptive cross sectional study that will use qualitative data collection and analysis methods. Study problem Starting antenatal care (ANC) in the first trimester of pregnancy plays a critical role to the positive outcome of the pregnancy to both the mother and the baby. Starting antenatal in second and third trimester of pregnancy contribute to late detection of anticipated complications to both the mother and the unborn baby thus contributing to increased maternal and neonatal deaths, abortions and miscarriages. Chikwawa district is one of the districts with the lowest attendance of antenatal care services in the first trimester of pregnancy in Malawi. Currently, only 11% of pregnant women attend antenatal care services in the first trimester of pregnancy in the district. This study aims at analyzing facility based barriers that are contributing to low turn up of pregnant women to access antenatal care services in the first trimester of pregnancy and potential interventions that can improve service delivery in the facilities to ensure that women are motivated to attend antenatal care (ANC) in the first trimester. Study Objectives The main objective of this study is to analyze facility based barriers that contribute to low utilization of antenatal care services in the first trimester of pregnancy and potential facility interventions that can motivate women to be attending antenatal care in the first trimester of pregnancy. The specific objectives are: 1. Identify facility based issues that prevent women from reporting to antenatal clinic in the first trimester 2. Assess health workers ideas and perspectives that could make first trimester visits more attractive and productive to expectant mothers 3. Explore facility based interventions that can motivate woman to attend antenatal care in the first trimester of pregnancy Methodology This will be a descriptive cross sectional study that will use qualitative data collection and analysis methods. The study will be conducted at Chikwawa district hospital, Bereu health center and St Montfort rural hospital in Chikwawa District. Purposive sampling technique will be used to select women and health workers who will be participants of the study. Data will be collected through in depth interviews using semi structured questionnaire, key informant interview guides and focus group discussions. The data will be tape recorded, transcribed verbatim and analyzed through coded thematic analysis. Expected findings and dissemination of results The findings will show gaps that the facilities have in providing ANC services in the first trimester which make women not to be motivated to attend ANC services in the first trimester of pregnancy. Additionally, the results will help to identify standard care that the service providers should be providing to pregnant women to ensure that they are positively influenced to attend ANC in the first trimester of pregnancy. Copies of the study reports will be submitted to College of Medicine Library, COMREC, Health systems and policy department and Chikwawa district health office so that the findings assist in improving the ANC services in the district