Developing a rapid understanding of the impact of Covid-19 on maternity services and pregnant women’s health in rural and urban Malawi
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Date
2020-06-05
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Kamuzu University of Health Sciences
Abstract
Type of study: This is a qualitative study exploring the early impact of Covid-19 preparatory work on the maternity services
and the experiences of women currently pregnant and women in postpartum periods.
Problem statement: There is a lack of knowledge of the effects of novel coronavirus (SARS-COV-2) in pregnancy. Emerging
case-reports and case-series have raised uncertainties about risk of pregnancy complications such as higher rates of
miscarriage, preterm birth, pre-eclampsia, caesarean delivery and perinatal death. The lack of available evidence has led
to advice to treat pregnant women as a vulnerable group. The potential consequences of Covid-19 disruption of maternity
services and women’s health in pregnancy in Malawi are devastating. In many countries Covid-19 has led to rapid
reshaping of health care services for pregnancy (e.g. reducing all but essential antenatal screening, reducing number of
antenatal checks) and for pregnant women (e.g. self-isolating in the third trimester). Much of this will almost certainly be
impossible to implement in Malawi. We aim to conduct a rapid evaluation of the situation in order to directly inform and
drive best practice.
Objectives
General objective: To understand the early impact of Covid-19 on maternity services in both rural and urban Malawi.
Specific objectives:
1. To acquire views from health care providers looking after pregnant women on the changes that have been made
in health service delivery and their working environment during the COVID-19 pandemic.
2. To gain views from women who are currently or recently pregnant about changes that have been made in their
antenatal care, birth plans and health seeking behaviours during the COVID-19 pandemic.
3. To find out whether pregnant women and service users have been reached with COVID-19 information, and
whether they are able to comply with government advice
4. To understand whether health needs of pregnant women are being met during the COVID-19 pandemic.
Methods
The study will take place in sites where the DIPLOMATIC partnership (established to evaluate interventions to prevent
stillbirth and complications of premature birth) is planning intervention trials. This includes the Malawi Epidemiology and
Intervention Research Unit (MEIRU) has well-established infrastructure – Chilumba in Karonga District and Area 25 in
Lilongwe and Chileka, Zingwangwa, Limbe and Bangwe in Blantyre District. We will train data collectors to administer
telephone questionnaires from their homes, with precautions in place to ensure confidentiality and data security.
Potential participants will be identified through our DIPLOMATIC network of participating maternity service providers.
We will recruit a sample size of 16 facility staff and 24 women split between the study sites.
Expected findings: The data collected will allow us to answer key questions including:
What is the availability of personal protective equipment and how has the Covid-19 pandemic impacted on routine
antenatal and delivery care?
What are women’s concerns about being pregnant during the Covid-19 pandemic and are these concerns influencing
their choices about their healthcare during pregnancy?
Dissemination: The study will be written up and submitted to appropriate peer-reviewed journals. The study results will
be presented to relevant conferences. Study results and publications will be shared with COMREC. Interim results will be
made available to the Government of Malawi, Ministry of Health to inform the public health response to the COVID-19
pandemic.