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- ItemRestrictedSimulation-Based Peri-Operative Education among Undergraduate Nursing Students at Kamuzu University of Health Sciences: A Mixed-Methods Study(Kamuzu University of Health Sciences, 2022-08-17) Bwanali, RichardProblem Statement In Malawi, lack of access to specialised perioperative nursing training limits perioperative nurses’ ability to effectively provide high-quality nursing care. With pre-service training being the main source of perioperative nursing information, there is a need to strengthen the clinical learning for perioperative nursing in the pre-service programmes for nurses in the country. Simulation-based education has several advantages including, offering opportunities for nurses to practice and gain competence in rare emergencies, providing immediate feedback, and allowing repetition which enables learners to practice more. Study Objectives This study therefore, aims at assessing the feasibility of simulation-based education in perioperative nursing for student nurses in a Malawian context, within the sub-Saharan region. Specifically, the study aims at: 1. Exploring learning gaps in perioperative nursing among undergraduate nursing students. 2. Comparing acquisition of knowledge, self-efficacy, and skills between intervention and control groups before and after exposure to a simulation-based education experience in perioperative nursing. 3. Exploring nurse students’ experiences with simulated-based education in perioperative nursing. Type of Study In order to achieve these objectives, this study utilises multistage mixed methods to collect and analyse quantitative and qualitative data to gain a better understanding of role simulation-based education in perioperative nursing learning in the Malawian context. Methodology The study will utilise a questionnaire survey, a quasi-experimental design, and an exploratory qualitative study. Expected Findings It is expected that the findings of this study will ascertain the practicality and relevance of simulation-based education in perioperative nursing education in a Malawian setting. Dissemination of findings These findings will be published in relevant journals, and a copy of the dissertation will be available in the KUHeS repository for dissertations.
- ItemRestrictedValidation of City Birth Trauma Scale in postnatal clinics in Lilongwe District, Malawi,(Kamuzu University of Health Sciences, 2022-04-11) Kanjedza, HildaExecutive Summary Study type This will be a cross-sectional study that will collect quantitative data at one point in time. The Problem Different studies and systematic reviews that were conducted in High Income Countries (HIC) and Low to Middle Income Countries (LMIC) found Post-Traumatic Stress Disorder (PTSD) to be prevalent among women after childbirth and postnatal mothers experience elevated levels of PostTraumatic Stress symptoms. For instance, it was found that the prevalence of PTSD among women after childbirth ranges from 1.7%-9% related to low partner support and postpartum depressive symptoms (Beck et al., 2011; Donadon et al., 2018). It is also evident from other studies that 3.17% of women report PTSD after childbirth (Abdollanpour et al., 2019; Ayers et al., 2018; CaparrosGonzalez et al., 2021; Donadon et al., 2018; Gankanda et al., 2021). This is the comparable with global prevalence of Postpartum PTSD. The studies demonstrated that postnatal mothers with low stress coping score and lack of social support had a high sensitivity and specificity for predicting a traumatic childbirth leading to Postpartum PTSD. A systematic review and cross-section surveys which were conducted on maternal post-traumatic stress during perinatal period found 4% of women having Postpartum PTSD (Cook et al., 2018; Garthus-Niegel et al., 2018; Yildiz et al., 2017). In France and Nigeria, studies that were conducted found that 5.7% and 5.9% respectively, women develop Postpartum PTSD mothers and associated risk factors were hospital admission due to pregnancy complication, instrumental delivery, manual removal of placenta and maternal experiences of control during childbirth (Adewuya, 2016; (Sentilhes et al., 2017). In Malawi, a study was done on childbirth fear and related factors among pregnant and postpartum women. It was found that demographic and obstetrical characteristics of women are associated with childbirth fear (Kwepeya et al., 2019). Furhermore, there is no published literature located for the prevalence of Postpartum PTSD in Malawi. However, majority of patients with mental health problems present in Primary Health Care (PHC) centers and one study found that 28% of patients had common mental disorders including PTSD (Kauye et al., 2014; Udedi, 2016). Despite of this high rate of mental health problems at PHC, there is no available validated instrument to 11-Apr-2022 Validation of Chichewa Version of City Birth Trauma Scale in Postnatal clinics in Lilongwe, Malawi Version 2, 18th March, 2022. 2 | P a g e assess PTSD associated with childbirth. Therefore, there is a need for use of validated scale to assess Postpartum PTSD in Postnatal clinics. Broad objective of the study The broad objective of this study is to assess diagnostic accuracy of Chichewa Version of City Birth Trauma Scale among postnatal mothers in Postnatal clinics in Lilongwe, Malawi. Specific objectives of the study The specific objectives of this study are to; 1. Determine the prevalence of Post-Traumatic Stress Disorder among postnatal mothers in Lilongwe, Malawi. (This is a supporting objective of assessing the diagnostic accuracy) 2. Eestablish psychometric properties Chichewa Version of the City Birth Trauma Scale among postnatal mothers in Postnatal clinics in Lilongwe, Malawi. Methodology The type of this study will be a cross-sectional study that will use a random sampling with sample size of 384 participants and study population will be postnatal mothers. Data will be collected by the Principal Investigator and the research assistants with the use of data collection questionnaires. Data will be analysed by use of Confirmatory Factor Analysis and SPSS version 23. Expected Findings The study will document the prevalence of Postpartum PTSD and psychometric properties of Chichewa Version of City Birth Trauma Scale among postnatal mothers at postnatal clinics in Lilongwe, Malawi. Dissemination of Findings The report of this study is going to be submitted to Lilongwe District Health Office, Kamuzu University of Health Sciences, College of Medicine Research and Ethics Committee secretariat and INTERSECT Malawi Maternal Mental Health secretariat. The findings will be published in reputable peer reviewed journals and will be presented at conferences.
- ItemRestrictedFactors associated with cannula failure in paediatric patients in Malawi: an observational study(Kamuzu University of Health Sciences, 2022-04-11) Chipeta, Sandra; Matsimbe, Thokozani; Tiyamike, Matsimbe; Kamanga, EneyaEXECUTIVE SUMMARY Background Peripheral Intravenous Cannulas (PIVC) are used in the delivery of medications, blood and blood products and fluids for resuscitation to achieve homeostasis in the paediatric setting in Malawi. Success in the placement and securement of PIVCs along with the type of treatments administered in inpatient care plays an important role in cannula failure rates. High failure rates can predispose children to cannula-related infections and other associated complications. The Type of Research Study This study will be an observational study conducted in Children Ward A, Children Ward B, Children Ward C, the Emergency Department and the Outpatient Paediatric Department in Kamuzu Central Hospital (KCH). The Problem [to be studied] In Malawi, there is no data that describes PIVC success and failure rates. This study seeks to describe the gap in the literature about the PIVC first time insertion success rates, the current practice of securement and dressing of PIVCs, and to ascertain the duration and failure of these devices in paediatric acute care at KCH. Main Objectives The main objective is to evaluate the lifespan of the PIVCs and identify the factors which affect the lifespan of PIVCs in paediatric patients at KCH. Specifically, the study will seek to: 1. To determine the risk factors for cannula failure in paediatric inpatients at KCH 2. To ascertain the reasons for cannula removal and evaluate the lifespan of a cannula in paediatric inpatients at KCH 3. To describe the incidence rates of cannula-related infections and associated complications as a result of periphery intravenous cannulation in paediatric inpatients at KCH 11-Apr-2022 11 Methodology The study will utilize a mixed-methods design involving prospective cohort study design with cross-sectional sampling methods. The population of choice will be all the paediatric patients needing first time cannulation and health personnel cannulating patients in KCH paediatric wards and the outpatient department. Both paediatric participants and health personnel will be recruited based on inclusion and exclusion criteria. The data will be collected by structured observational checklists and questionnaires. Post-cannulation, there will also be continuous follow up and supervision throughout the data collection period. Data will be analysed using EPI-INFO or SPSS. The study period for this research is 6 weeks, in which we shall collect data, analyse it and write a report Ethical Considerations Informed consent, confidentiality, non-maleficence, beneficence, and the right to voluntarily participate or withdraw from the study will be granted to the study participants in order to achieve ethical validity. The proposal will also be submitted to COMREC for approval. Permission to conduct our research at KCH shall also be sought from the hospital director. Expected Findings and their dissemination The expected findings for this study are that PIVC failure rates will be high and these rates will differ in neonates, infants and children. These results shall be presented during the Kamuzu University of Health Sciences 4th year research dissemination which invites all academic staff and members of the University, as well as, undergraduate research coordinator, The College of Medicine Research and Ethics Committee, Kamuzu University of Health Sciences Library, Head of Department of Paediatrics at KCH and the study supervisors
- ItemRestrictedSimulation-based midwifery education on post partum hemorrhage at Kamuzu University of Health Sciences, Malawi(Kamuzu University of Health Sciences, 2022-04-11) Kabondo, CharityType of study This is a descriptive convergent mixed-methods study. Problem Simulation-based education is recommended in midwifery education and practice. Unfortunately, there is limited knowledge and practice of simulation as a teaching strategy at Kamuzu University of Health Sciences in Malawi, School of Maternal, Neonatal and Reproductive Health. Objectives Main Objective: The main objective of the study is to develop knowledge about simulation-based education and its use in teaching post-partum haemorrhage in a midwifery education program at KUHeS in Malawi. Specific objectives: The following are the specific objectives of the study: To identify characteristics that promote and challenge learning of postpartum haemorrhage in the current teaching strategy within the midwifery education program at KUHeS in Malawi; to investigate the practice of debriefing with a focus on reflection between facilitators and midwifery students when learning to take care of patients with PPH; and to explore the experiences of students towards learning of postpartum haemorrhage through simulation-based education in Malawi. 11-Apr-2022 iii Version 2.0. 15th March, 2022 Methodology Study design and approach: The study will follow a descriptive convergent mixed methods design. Study participants: During the first phase of the study, data will be collected through interviews with midwifery faculty members n=10 and focus group discussions among 24 midwifery students. The second phase of the study, data will be collected through observations and field notes among midwifery faculty members with n=10. During third phase of the study, the researcher will concurrently collect qualitative and quantitative data among midwifery students, n=12 and =109 respectively. Study setting: The study will be conducted at Kamuzu University of Health Sciences (KUHeS) in Malawi. Data analysis: Quantitative data will be analysed using IBM SPSS Statistics version 20. Descriptive statistics will be presented. Non-parametric tests will be conducted. Chi-square will be used to analyse the data. Qualitative data will be analysed using thematic analysis. Expected findings and dissemination Results of the study will be disseminated through publication of research results. Thesis will be made available at KUHeS Libraries. Study results will also be presented to COMREC and during KUHeS library conference dissemination meetings.
- ItemRestrictedA critical appraisal on the implementation of facility-based maternal death audits: The case of Ntcheu District, Malawi(Kamuzu University of Health Sciences, 2022-03-16) Sinkhala Mwita, Lumbani1 EXECUTIVE SUMMARY Nearly 349 women per 100000 live birth die with pregnancy-related complications in Malawi. This high maternal deaths prompted the Ministry of Health to adopt maternal death audit, a strategy to reduce these deaths in all district and central hospitals. Maternal death audit reveal causes of deaths. This induces solutions to deaths that are preventable. A facilitybased maternal death audit is one of the approaches mostly practiced by hospitals in Malawi. The implementation of this strategy faces barriers with few facilitators in Ntcheu district. This study will assess the implementation of facility-based maternal death audit to improve the quality of care and to prevent future deaths in Ntcheu district. Broad objective To assess the implementation of the facility-based maternal death audit to improve the quality of maternal care and to prevent future maternal deaths in Ntcheu district, Malawi. Specific objectives 1. To establish the proportion of completed maternal death reviews in Ntcheu district in the 2020/2021 fiscal year. 2. To describe the barriers and facilitators of maternal death audit implementation in Ntcheu district Methodology Qualitative approaches will be used to gather data through key informant interviews, focus group discussions and maternal death reviews. Key informant will include hospital managers directly involved in the implementation of maternal death audit. Three focus group discussions will be conducted with health care team of labour and delivery, postnatal and female wards. The study will also review maternal deaths documents and reports for the 2020/2021 fiscal year. The research runs from May 2021 to 0ctober 2022. The study will recruit participants through convenience sampling. Data will be collected by the principal investigator. All interviews and group discussions will be conducted in English, recorded and transcribed verbatim. The data will be stored in the personal computer and protected by passwords. The data will be analysed using the CFIR framework. Expected findings and their dissemination. The study expect to find a strong level of MDA practice in the district. It is expected that a facility-based maternal death audit is being practices. The assessment expect to find guidelines for conducting MDAs in place and abided to. There should be a formal system of reporting maternal death. The assessment will reveal facilities’ analysis of data and presentation of trends as stipulated in national maternal death audit guidelines. There should be evidence of implementation of recommendations from audit meetings. The research further expect to find linking MDR to other quality improvement activities at the facility. The dissertation will be submitted to the course coordinator and supervisor for partial fulfillment of a Master’s degree in Global Health Implementation. The final report will also be forwarded to COMREC, the Kamuzu University of Health Sciences library, and the Ntcheu district health office. The results will be further disseminated at the College of 16-Mar-2022 3 Medicine research dissemination symposium. Presentation of the findings at the Ntcheu district health office will be presented to the DHMT at an arranged meeting and all members of staff during the morning report.