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- ItemRestrictedIdentifying priorities for guidelines on newborn and child health in Malawi: a protocol for a priority setting exercise, version 1.0(2022-08-17) Mbeye, NyanyiweType of Research: A cross sectional study design will be applied to set the priority topics related to Poverty Related Diseases in the field of new born and child health for guideline development or adaptation in Malawi. Problem Statement: Despite progress in the health of young children globally, most countries in sub-Saharan Africa (SSA) fall below the average gains and do not meet maternal and child health targets set by Sustainable Development Goal number 3 to ‘ensure healthy lives and promote wellbeing’. Poverty related diseases (PRD) remain amongst the leading causes of death in children under-5 years, including pneumonia, diarrhoea and malaria. Guidelines based on the best available evidence are key to informing care and funding decisions. The guideline development process can be complex and resource-intensive, and there is scope for improvement in the process in sub Saharan Africa (SSA). Objectives: The GELA project is where the impact of research on poverty-related diseases will be maximised through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant Clinical Practice Guidelines (CPGs) for poverty-related diseases (PRDs) in the field of new born and child health. The first step of this project will be a priority setting process. This will ensure that stakeholders shape the project by advising us about the important issues and conditions to be addressed in clinical guidelines. Methods: Mixed methods will be employed following good practice methods for priority setting. These will include stakeholder mapping, and stakeholder engagement and document review to identify an initial long list of potential priority topics, in the pre-prioritisation stage; and an online survey with a broad range of stakeholders followed by a consensus meeting with a guideline steering group to identify the final priority topics in the prioritisation stage. The stakeholders will be asked to rank the proposed topics in order of importance according to pre-specified criteria. Expected findings and their dissemination: The priority setting process will identify top three priority topics. These will be shared with the Steering Committee in the Ministry of Health, the College of Medicine Research and Ethics Committee (COMREC) and the wider team of stakeholders. The topics will further be taken forward to the next steps in the GELA project, i.e. to develop or update guidance on these topics.
- ItemRestrictedFeasibility, 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 ConnisType 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.
- ItemRestrictedProtocol for development of a meta-core outcome set for stillbirth prevention and bereavement care following stillbirth, version 1.0(2022-07-11) Kikham, 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. Broad Objective The broad objective of this study is to develop standard sets of outcomes for stillbirth prevention and bereavement care in LMiC settings. Specific Objectives The specific objectives are 1. to identify outcomes used in current stillbirth research in LMiC settings relevant to stillbirth; 2. to solicit the importance of stillbirth outcomes from health care professionals, researchers and parents’ perspectives; and 3. to determine 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 Formatted: Font: Bold Formatted: Font: Bold11-Jul-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 2 16/06/2022 8 virtual consensus meeting with representation from all stakeholder groups. In Malawi, the study will be conducted at Bwaila, Ethel Mutharika and Mitundu Hospitals. 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 [16]. We will register the COS with CROWN (Core Outcomes in Women’s & Newborn Health) [17] and share our findings across the GHRU Network, College of Medicine Research Ethics committee (COMREC), the LAMRN (Lugina Africa Midwives Research Network) [18] and other relevant international societies and organisations for wider dissemination.11-Jul-2022 Protocol for development of a meta-core outcome sets for stillbirth prevention and bereavement care following stillbirth Version 2 16/06/2022
- ItemRestrictedChild 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, JohnThis 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.
- ItemRestrictedFactors 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, PatrickType 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