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- ItemRestrictedFactors influencing retention and attrition of community health volunteers engaged in Malawi(2022-08-05) Kamiza, CeceliaExecutive summary Type of research The study will use a mixed method descriptive research design to estimate community health worker retention and understand factors affecting retention. Quantitative questionnaire will be supported by qualitative data collection through key informant interviews and focus group discussions with key stakeholders at community and district levels. Problem statement The human resource for health in Malawi is below the recommended standards by the World Health Organization (WHO). A focus on factors influencing retention and attrition of health workers is of importance in ensuring that the sector delivers quality health services. Globally, there is a close association between the concentrations of qualified health workers and key health outcomes, such as immunization and infant, child and maternal survival. This study therefore aims to bridge this gap by assessing the factors affecting retention and attrition of community health volunteers in three districts of Malawi with a case study on volunteers working on Malaria programs across Malawi in districts of Phalombe, Lilongwe, and Machinga. Objectives The main objective of this study is to assess the factors influencing retention and attrition of community health volunteers in Malawi. Specifically, the study will: 1. To determine the rate of retention of community volunteers on the Malaria Vaccine Implementation Program (MVIP) in Malawi 2. To assess factors associated with retention and attrition of village health volunteers on the MVIP.05-Aug-2022 11th July,2022Version 1 13 3. To assess how expectations of future employment affect retention of village health volunteers on the malaria program in Malawi Methodology The researcher will use mixed methods to undertake this study. A questionnaire, key informant interviews and FGDs will be used to collect data. The collected data will be coded and transcribed using N Vivo software. Expected findings and dissemination Findings from this study will be used by policy makers to design better community volunteer programs and will be disseminated through peer-reviewed publications, presentations at scientific conferences including the Kamuzu university of Health Sciences annual dissemination conference. The researcher will submit a project completion report to the College of Medicine Research and Ethics Committee and the Malaria Alert Centre.
- ItemRestrictedStakeholder’s (Implementers and beneficiaries) Perceptions On The Facilitators, Barriers And Effectiveness, Of Engaging Faith-Based Organizations In Reaching Men With HIV Testing And Treatment Services In Malawi, version 1.0(2022-08-17) Limited, JohnType of Research Study: This will be post-implementation retrospective qualitative evaluation to be conducted in the districts where CDC through PEPFAR was implementing Faith and Community Initiative (FCI) by providing funding to Christian Health Association of Malawi (CHAM) and Health Policy Plus Malawi (HP+). Problem Statement: Faith-based organizations (FBOs) have been considered as of great influence in mobilizing HIV/AIDS efforts by both multilateral and governmental agencies. Despite this widespread acknowledgement, there are limited analytic assessments of these FBO activities. In the interest of better informing the dialogue surrounding FBO involvement, identifying facilitators and barriers of engaging FBOs in reaching men with HIV testing and treatment services would help to identify better implementation strategies which can make this evidence-based intervention reach more people. Objectives: The broad objective of this study is to evaluate the perceptions of stakeholders on the facilitators, barriers and effectiveness of engaging FBOs in reaching men with HIV testing and treatment services in Malawi. Specifically, the study aims to: • Identify factors that facilitate implementation of FBO led interventions in reaching men with HIV testing and treatment services • Identify factors that hinder implementation of FBO led interventions in reaching men with HIV testing and treatment services • Determine the perceived effectiveness of engaging FBOs in reaching men with HIV testing and treatment services in Malawi Methodology: The study will purposively sample stakeholders who were involved in implementing the FCI project including beneficiaries. Data will be collected through Semi- structured questionnaire from key informants and through focus group discussions from project beneficiaries. The semi-structured interview guide will be developed using the Consolidated Framework for Implementation Research (CFIR). Recorded data will be transcribed. Transcripts will be coded to come up with themes. Thematic data analysis will be employed using Nvivo 12 software.17-Aug-2022 VERSION 2.0 2022-08-03 4 Expected Findings and Dissemination: It is expected that stakeholders who have been implementing Faith-led HIV interventions will share their experiences on the difficulties they were facing during the implementation of their programs and the strategies they used to overcome such challenges. These experiences, guided by the CFIR constructs will form the facilitators and barriers of the programs. Study findings will be submitted to KUHeS, School of Global and Public Health, COMREC, KUHeS library for access by others and also published in a peer-reviewed scientific journal
- ItemRestrictedInvestigating The Role of Social Media in Sex Work in Urban Blantyre,Malawi(2022-09-09) Sakala, DoreenExecutive Summary Type of research study This is 1 year qualitative study among Female Sex Workers (FSW) in urban Blantyre, Malawi. The study will be managed by Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) and Liverpool School of Tropical Medicine (LSTM). The Problem Globally, female sex workers (FSWs) have the highest HIV prevalence with potential to drive HIV transmission due to a myriad of individual, societal and national level challenges. FSWs face and negotiate various risks due to the nature of their work including abuse, inconsistent condom use, alcoholism, legal constraints, and male-female power dynamics. Social capital has been found to mitigate some of these risks. There is little literature regarding social media effect in the context of sex work in Africa. I aim to understand how social media as a form of social capital is being used in the context of sex work engagements and transitions, to contribute to identifying social media-based health interventions. Objectives Broad Objective To investigate the role of social media in sex work engagements and transitions in order to identify potential mitigating interventions.To understand how social media is used in the Malawian context and as a form of social capital in sex work engagements and transitions, to contribute to identifying social media-based health interventions. Specific Objectives: • To explore how social media impacts contemporary lives of FSW in sub-Saharan Africa and Malawi • To identifyunderstand the nature and pathways through which social media as a form of social capital promotes engagement in sex work • To investigate the potential of social media and digital approaches in promoting safe health behaviors and transitioning of sex work in Malawi Methodology The study will use an ethnographic approach (traditional and digital ethnography) which involves a researcher immersing him/herself in a particular setting or community to observe their behaviour and interactions up close. Traditional ethnography will involve participant observations where I will visit the participants on a daily basis in their venues to observe and interact wit them. Observations will mainly be on social relationships, trust, reciprocity, social norms and social support as they are expressed and experienced through in person. The researcher will observe the social capital gained from these groups and how that informs the FSW decisions in sex work engagements and transitions. Digital ethnography will involve making online observations (on same components mentioned in traditional ethnography) in social media groups the FSW is part of. During these observations (traditional and digital ethnography), the researcher will take field notes of interactions observed in-person and online.09-Sep-2022 Page 11 of 33 SWEET Protocol _V21.0_10 August20 June 2022 In Depth Interviews (IDI) and Key Informant interviews (KI) will be conducted with an aim to seek in-depth explanations of some of the observations that were made for both traditional and digital ethnography. The interviews will be conducted depending on the emerging findings. Interviews will be conducted with study participants, bar men, gatekeepers (bar owners, group administrators, supervisors) and other FSW not using social media. Expected Findings and dissemination By the end of the project, there will be complete understanding of the role of social media and how it is being used in female sex work in Malawi and how social capital is being used for peer support. The study will also understand and identify the HIV risks and vulnerability that FSW face on social media and through peers. Such understanding may lead to identification of potential (social media based) interventions for impacting engagements and transitions in sex work. Results will be disseminated at Kamuzu University of Health Sciences (KUHeS) Annual Research Conference,Liverpool School of Tropical Medicine (LSTM) Postgraduate Research Conference and other national and international meetings and conferences. Publications will also be made in peer reviewed journals and a copy of the report will also be shared with College of Medicine Research Ethics Committee (COMREC),KUHES.
- ItemRestrictedBefore BREATHE: A baseline audit of hypoxemia in Malawi(2022-09-16) Rylance, JamieExecutive summary 4.1 Type of research study The study is a prospective audit. 4.2 Problem to be addressed Our team’s study at Queen Elizabeth Central Hospital (QECH) in 2012 showed tha one third of medical patients had a respiratory diagnosis, and hypoxia was not identified in 21% of these. Furthermore, only one third of those requiring oxygen by WHO guidelines were receiving it.1z Due to the COVID-19 pandemic, interest in improving outcomes for all hypoxemic patients in LICs has increased, with proposals including increases in oxygen supplies, improvements in systems for monitoring hypoxemia and titrating oxygen therapy, and testing of various oxygen delivery devices. This audit will provide updated information on the practices, and outcomes for oxygen monitoring and titration at QECH. The information collected for this audit will provide the necessary platform from which future quality improvement and research studies can be developed. Parallel data collection will occur in Rwanda and Kenya as part of the assessment of potential sites for a prospective trial of high flow oxygen. 4.3 Broad objective To understand oxygen supply and demand at Queen Elizabeth Central Hospital, Malawi. 4.4 Specific objectives 1. To describe the physical resources and current practices for oxygen therapy for hypoxemic adults at QECH. 2. To measure the baseline performance of key indicators for optimal oxygen monitoring, documentation, and titration. 3. To assess in-hospital outcomes of mortality and length of stay for all hypoxemic adults. 4.5 Methodology Prospective audit of data recorded in the patient medical notes and charts. The audit will continue for three months to give information on an estimated 300 patients (based on local patterns), which will allow confidence in the representativeness, and ability to detect low levels of non-compliance with hospital guidelines. To estimate mortality, this number gives a 5.7% precision around a prior estimate of 50%.16-Sep-2022 Before BREATHE: a baseline audit of hypoxaemia protocol (version 1.0)Before BREATHE: a baseline audit of hypoxaemia protocol (version 2.0) - 06/03/202201/09/2022 Page 6 of 16 4.6 Findings and dissemination Data collected by the audit team will be freely available to, and owned by, the hospital. We hope that this will allow an assessment of current practice, and inform repeated quality- improvement cycles. The audit data will be used to power a future randomised controlled trial of alternative (high flow) oxygen therapy. We will work with our team to present the findings to hospital grand rounds, and to publish, for example, in the Malawi Medical Journal. We will also feedback directly to COMREC.
- ItemRestrictedEffectiveness of heat stocking in attenuating Core and Muscle Temperatures Loss during half-time Break in Football in Blantyre, Malawi, version 1.0(2022-09-05) Nkhoma, ChimwemweExecutive Summary Title: Effectiveness of heat Stocking in attenuating core and muscle temperatures loss during half- time break in football in Blantyre, Malawi. Type of research: This is a randomized controlled trial research design. Background: Many team sports are played in two halves separated by a 10-20minute half-time break. This half-time break is essential to both the Players, coaches and sports medicine doctors, fitness and conditioning coaches and physiotherapists. Players use the half-time break to rest from cognitive and physical demands of the game, rehydrate and refuel, receive medical and kit attention. On the other hand, Coaches have to provide technical and tactical feedback to the players. Problem: However, half-time break is associated with a decline in core and muscle temperatures. Such a decline in temperature is associated with decreased levels of performance coupled with increased risk of injury during the initial 15-20 minutes of the second half. The drastic fall in levels of performance and increased risk of injury is attributed to decrease in core body and muscle temperatures that occur during the half-time break. Broad objective: This study intends to evaluate the effect of a heat stocking worn in the lower limbs during a 15-minute half-time break on core and muscle temperatures loss among football players. Specific Objectives: 1. To determine the amount of core and muscle temperature lost from using a heat stocking worn in the lower limbs during a 15-minute half-time break among football players. 2. To examine the effect of heat stocking on core and muscle temperatures loss during a 15- minute half-time break among football players. Study population: All players who are playing for Blantyre based Super League teams will comprise the study population. The research participants will be randomised into control group and intervention group. Methods: Study participants will be randomised into intervention groups and control groups. Athletes in the intervention group will wear the heat stocking during a 15-minute half-time break05-Sep-2022 VERSION 2.0 March 14, 2022 17 whilst those in control group will not wear the heat stocking. Skin temperatures and core temperatures will be measured before the game, at the start and at the end of 15-minute half-time break and at the end of the second half. Findings will be compared between the intervention and control groups to determine the effectiveness of the heat stocking in preserving core and muscle temperature among football athletes. Data analysis: Data will be analysed using the Statistical Package for Social Sciences Software (Version 21; SPSS, Inc. Chicago, IL). Descriptive statistics of mean, standard deviation and frequency will be used to summarise data on age, body weight, height, Body Mass Index (BMI), core and muscle temperatures. Changes in body core and muscle temperature before and after the half-time will be analysed using dependent student’s t-test for within group analysis and independent student’s t-test. The significance level for the study is set at P < 0.05. Expected Outcome: Core and body temperatures loss will be greatly attenuated in the intervention group than the control group. Thus, heat stocking will be effective in attenuating core and muscle temperatures loss during half-time break in football. Dissemination of study findings: Copies of the findings of the research will be submitted to College of medicine Research Ethics Committee (COMREC), University college hospital research ethics committee (UI/UCH REC) and Kamuzu University of Health Sciences Library. The findings of this study will also be presented in conferences and seminars. The researcher will publish the findings of the study in most reputable journals