Safe Motherhood

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Determinants of timely access to care for prenatal and postnatal services in Malawi by Liness Kataika
(Kamuzu University of Health Sciencies, 11-08-21) Kataika, Liness
EXECUTIVE SUMMARY Type of study This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi,” 2018-May 2020 Background Problem Timely access to prenatal and postnatal services is a key to maternal health services that can significantly help reduce maternal mortality. However, timely access to maternal and neonatal care services has always been a challenge in Malawi due to several factors. Understanding the factors that hinder timely access to service utilization helps to design appropriate strategies and policies towards improvement of services utilization and thereby reduce maternal mortality. Objective The objective of this study is to determine factors that affect timely access to prenatal and postnatal services in Malawi. Methodology This is the cross sectional qualitative study that will use secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). Data will be taken from the primary owner and will be analyzed thematically. Measures to ensure confidentiality will be followed throughout the period and there after Ethical approval will be sought from ethics committee COMREC Dissemination of expected find. Study design This is the cross sectional qualitative study that will utilize secondary data from a study titled “Integrating a neonatal Health care package for Malawi”2018-May 2020). The qualitative study was employed to fully gather the information from parents and guardians of neonates who are receiving care using the interventions under observation. Study Place This was a qualitative study conducted in 3 public Health facilities (Mulanje, Chikwawa and one central hospital in Blantyre Urban (Queen Elizabeth Central Hospital) and one private health facility (Mission hospital) Holy family hospital in Phalombe in Malawi from May 2018- May 2020. Study Population, Study Period, Sample Size, Data collection and management The study targeted Health Care workers, Mothers of Neonates, Fathers of Neonates, and Elderly Women or grandmothers in the southern rejoin of Malawi. The study from Nov 2020- June 2021. Participants were sampled purposively using maximum variation. Data will be taken from primary owner and permission already granted. Data will be managed manually Data analysis Data will be analyzed thematically. The extraction of data from primary data will be done guided by the coding guide which has been developed guided by the conceptual framework of the study [32]. Both inductive and deductive approach to the analysis will be employed.
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Prevalence and Factors Associated With Puerperal Sepsis among Postnatal Women at Queen Elizabeth Central Hospital, Blantyre by Priscabell Ndasauka Kalumbi
(Kamuzu University of Health Sciencies, 15-07-21) Kalumbi, Ndasauka
Executive Summary Study Type: An analytical cross-sectional study of hospital records. The problem: Globally 6 million women developed puerperal sepsis and around 77,000 mothers died from it in 2017(Atlaw et al,2017). Puerperal sepsis is the fifth common cause of maternal mortality worldwide. In Malawi a confidential inquiry into maternal deaths indicated that puerperal sepsis is the leading cause of maternal death (MOH, 2019) and it contributes to 9.3 % of all maternal deaths in the country. Anecdotal statistics from Queen Elizabeth Central Hospital(QECH) in 2019 showed there are 12.2 % puerperal sepsis cases out of 30 % caesarean section deliveries performed (QECH, HMIS ,2019). Despite its great impact on maternal mortality and morbidity, there is not enough literature on the prevalence and associated factors of puerperal sepsis among postnatal mothers in Malawi. With this backdrop, the aim of this study is to estimate prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital - a tertiary referral hospital in Malawi. Objectives Main Objective To determine prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital. Specific Objectives 1. To describe the demographic and clinical characteristics of women with puerperal sepsis during the postpartum period at Queen Elizabeth Central Hospital. 2. To determine factors associated with puerperal sepsis in postpartum women at Queen Elizabeth Central Hospital. 3. To assess relationship between puerperal risk factors and poor maternal outcomes at Queen Elizabeth Central Hospital. Methodology This study will deploy an analytical cross-sectional design with a non-predetermined sample size of postnatal women records in Chatinkha postnatal ward. Purposive total sampling technique will be used to select the study participants into the study. Data will be extracted from files of patients admitted from January 2020 to June 2020 and analysed using SPSS version 20. The data will be presented in form of percentages, frequencies through tables, graphs and charts. Logistic regression will be used to establish relationship between maternal factors and poor outcomes. Possible Constraints The major constraint in the study is missing data from the use of medical records. Multiple imputation will be done where data is missing. Expected Findings This will study will describe the burden of puerperal sepsis in postpartum women in QECH and Identify factors associated with it. The generated data will help health care providers and policy makers to develop interventions that focus on the primary causes of sepsis and prioritise the factors that will be associated with Sepsis. . It will also enable policy-makers and managers to consider integrating puerperal sepsis education with emphasis on factors that have shown to have poor maternal outcomes. Expected findings and dissemination: The results will be presented in tables showing summary statistics and odds ratios. A final master’s dissertation will be written and presented to the post graduate committee at the Kamuzu College of Nursing. The final dissertation will be shared with the Kamuzu College of Nursing library and The College of Medicine Research and Ethics Committee. Results from this research will be published in an open access peer reviewed journal and presented at research dissemination conferences. Background information and introduction Introduction Puerperal Sepsis has been defined by the World Health Organization as the infection of the genital tract occurring at any time between the onset of labour, rupture of membranes and the 42nd day postpartum. The Puerperal sepsis presents commonly with fever (oral temperature of 38.5 degrees Celsius or higher on any given occasion) and other symptoms such as pelvic pain, abnormal vaginal discharge, abnormal smell/foul odour discharge or delay in uterine involution (less than 2cm/day) during the first eight days (WHO, 2015). Puerperal sepsis accounts for a substantial contribution to the Maternal Mortality Rate (MMR). Global estimates suggest that direct (obstetric) infections are the third most common cause of maternal mortality, representing about 10.7% of deaths, a majority of which occur in Low- and Middle-Income Countries (LMIC) (WHO, 2020). The toll is higher in LMICs compared to high income countries (HICs) (Say et.al., 2014). In sub-Saharan Africa, maternal sepsis is one of the leading causes of over 70% of maternal deaths, others include: haemorrhage, hypertension disorders, unsafe abortion, and obstructed labour (Dillen et.al., 2010). Maternal sepsis, specifically, contributes 10.3% of all cause maternal deaths in SSA (Bonnet et.al., 2018). The Global Burden of Diseases Study reported a 30 % prevalence of maternal sepsis (James et al., 2018). A WHO maternal sepsis cohort study conducted in 713 health facilities found that 70.4 out of 1000 live births reported to health facilities with an infection (puerperal sepsis) (Group, 2020). Recent estimates suggest that in sub–Saharan Africa (SSA) the burden is highest compared to other regions with sepsis accounting for up to 45% (Rudd et.al., 2020). However, reliable estimates of the incidence and mortality of maternal sepsis in sub-Saharan Africa are incomplete (Otu et.al., 2020). In Malawi, a confidential inquiry showed that puerperal sepsis is the leading cause of maternal mortality accounting for 9.3 % of maternal deaths (MOH, 2019). Nevertheless, there is no programmatic interventions focused on prevention of puerperal sepsis. Malawi participated in the WHO-led Global Maternal Sepsis Study (GLOSS) and Awareness Campaign umbrella of the “Global Maternal and Neonatal Sepsis Initiative” the aims of which were to assess the burden of maternal sepsis, validate the identification criteria and raise awareness of maternal sepsis among health care workers. However, there is no evidence of Malawi’s implementation of this study following the campaign (GLOSS, 2017). According to Brizuela et.al., (2020), evaluation of countries that implemented the campaign shows improvements in service provision, reduced overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries. The Malawi Emergency Obstetric and New-born Care Needs Assessment results showed that puerperal sepsis contributes to 18.9% of direct maternal deaths (MOH,2015). Nevertheless, there is paucity of evidence with regards to the epidemiology (when, where, who, what and why) of sepsis in maternal mortality and morbidity burden. As in many developing countries many cases of puerperal infections can go undiagnosed and underreported (Panelope et al., 2013). Hospital-based anecdotal evidence suggests that puerperal sepsis potentially carries the biggest morbidity burden at Queen Elizabeth Central Hospital, a tertiary hospital in southern Malawi. According to 2019 hospital records, there were over 2911 caesarean section deliveries performed at Queen Elizabeth Central Hospital (QECH), comprising 38 % of the total deliveries; 12.2% of these deliveries developed puerperal sepsis within 42 days of post-delivery (QECH HMIS, 2019). Given that puerperal sepsis significantly contributes to preventable maternal morbidity and mortality, combating sepsis is an integral part of realizing the Sustainable Development Goals (SDGs) targets 3.1 and 3.2 relating to maternal wellbeing, as well as target 3.3 on infectious diseases (WHO, 2020). Indirectly, sepsis is relevant to other targets in SDG 3 such as 3.8 on quality of care for all, and its prevention and management is inherently linked with vaccination, efforts to combat antimicrobial resistance (UN, 2020). For Malawi to achieve this lofty goal, reduction of maternal mortality rate must set targets that need urgent achievement. Consequently, identifying potential contributors or determinants to maternal mortality would assist in having focused interventions that respond to the specific causes of the problem. Sepsis is an ever-changing problem. The patterns of sepsis have been shown to differ in time. One of the factors related to the changes in patterns has been the increasing antimicrobial resistance. While several attempts have made to quantify the burden of sepsis by estimating the prevalence, not many have studied the factors associated with it at the individual level in Malawi. Hence the need for this study to bring evidence for developing of policies and guidelines to address the problem. Background Puerperal sepsis is a preventable postpartum complication, and has the potential to quickly progress to septic shock, which can eventually result into death (GLOSS, 2017). The global incidence of puerperal sepsis is 4.4 per 100 live births (Taskin et. al., 2016) and case fatality as high as 30-50 % has been reported in Low- and Middle-Income Countries (UNFPA, 2012). Regional disparities in the prevalence of puerperal sepsis exist. According
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Survival of low birth weight babies admitted at Chiradzulu District Hospital (public) and St. Joseph Mission Hospital (private) in Malawi
(Kamuzu University of Health Sciences, 2020-05-13) Zgambo, Austin Chibisa
The type of research study This will be a hospital based retrospective cohort study collecting quantitative data from Nursery ward registers on Low birth weight babies. Low birth weight is defined as a birth weight of less than 2,500 g regardless of gestational age. This practical cut-off for international comparison is based on epidemiological observations that babies weighing less than 2,500 g are approximately 20 times more likely to die than those born with a weight of over 2, 500 g. Globally, it is estimated that 12 to 17% of all births are Low birth weights. However, the great majority (91%) of Low birth weight babies occur in low and middle-income countries. Malawi, being part of low-income countries, has nearly 12% of babies born with Low birth weight. Both the public and private sectors are responsible for the provision of healthcare services in the country. The problem Losing a baby is a devastating experience and every parent experiences grief in his/her own way. The World Health Assembly endorsed targets to reduce Low birth weight prevalence by 30% by 2025. Despite the availability of interventions to improve survival of Low birth weight babies, it still remains a challenge in low resource settings. People have a perception that quality of care is better in private hospitals than public hospitals partly due to differences in resource base. Consequently, better patient outcomes are expected in private than in public healthcare facilities. However, research analysis revealed that private sector health facilities had poorer patient outcomes compared to public sector health facilities. But this general analysis may not apply to all specific areas of health outcomes, for example, survival of low birth weight babies in these private and public health care facilities. Furthermore, few studies on neonatal survival have been conducted in Malawi but none of them has compared survival rates of low birth weight babies in public and private hospitals. Therefore, this study is intended to fill knowledge gap concerning survival rates of Low birth weight babies from admission to hospital discharge and the comparison of it between a public and private hospital. The Objectives The aim of the study is to compare the survival rates of Low birth weight babies admitted at Chiradzulu public hospital and St. Joseph’s private mission hospital; and to determine factors associated with mortality in these hospitals. Methodology It will be done in Chiradzulu district, specifically at Chiradzulu district hospital and St. Joseph’s Mission hospital’s nursery wards. The study will assess records of Low birth weight babies admitted in nursery wards at two hospitals between 1 January 2018 and 31 December 2019. Systematic random sampling will be used to achieve a calculated sample size. A pretested data extraction tool will be used for data abstraction. There could be a possibility of missing records but use of recent period (2018 – 2019) coupled with use of both case files and ward admission registers will ease the problem of missing data. Data will be entered in a Microsoft Excel application and later exported to STATA version 14 for analysis. Results will be presented in tables and graphs’ format. Ethical clearance will be obtained from the University of Malawi’s College of Medicine Research and Ethics Committee (COMREC). A written permission letter will be obtained from Chiradzulu District Council through the Director of Health and Social Services. Expected findings and their dissemination We are anticipating knowing the survival rates of Low birth weight babies between a public and private hospital; and common contributing factors to mortality among these babies. Knowledge of neonatal survival rates and mortality factors will help hospital managers to implement and/or scaleup appropriate interventions in nursery wards. The results will be shared with COMREC; Chiradzulu and St. Joseph’s hospitals; Malawi Ministry of Health, through the Reproductive Health Unit and published in Malawi Medical Journal for publicity at local as well as global level.
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Developing a rapid understanding of the impact of Covid-19 on maternity services and pregnant women’s health in rural and urban Malawi
(Kamuzu University of Health Sciences, 2020-06-05) Crampin, Amelia
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.
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Assessment of the effect of malnutrition on adverse pregnancy outcomes on adolescent pregnant women in Mchinji District: A cross sectional study Version 2.0
(Kamuzu University of Health Sciences, 2020-06-10) Zinyemba Chingoli, Manes
Malawi’s teenage pregnancy rate is at 29%[1] and Mchinji district ranks third in the country with teenage pregnancy rate of 37.5% only superseded by Machinga ( 41.1%) and Nsanje (38.8%) [1]. Adolescent pregnancies comprise 25% of all births and 20% of maternal deaths[2]. On the other hand, 7.2% of women of child bearing age (15-49) in Malawi are thin for their height (Body Mass Index (BMI) <18.5), and the situation is worse for adolescent girls aged between 15-19years amongst whom 13% are thin for their height[1]. Problem Studies have shown that in Malawi adolescent pregnancies comprise 25% of all births and contributes 20% of maternal deaths[2]. The country has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100,000 live births[2]. Furthermore, Adolescent pregnancy is associated with higher risks of adverse pregnancy outcomes including neonatal complications such as prematurity, low or very low birth weight, and perinatal mortality[6]. It is also associated with major maternal complications such as hypertensive pregnancy disorders, abortion, urinary infections, and premature rupture of the fetal membranes[6]. Some other studies have further shown that failure to achieve normal delivery is directly related to the height of the mother which is influenced by nutritional status in childhood and adolescence[10]. This could imply that in Malawi, where stunting in under five children is estimated at 37% [1], a substantial percentage of women do not reach their potential height hence difficult to achieve normal delivery. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low‐ and middle‐income countries[7]. Objectives Broad Objectives To determine the effect of malnutrition (wasting- MUAC (Mid Upper Arm Circumference) <22 cm) on pregnancy outcome in adolescent women in Mchinji. Specific Objectives Specifically, the study will address the following objectives:  To describe the prevalence of wasting in adolescent pregnant women receiving antenatal services at Mchinji district hospital from December 2018 to December 2019.  To describe the prevalence of adverse pregnancy outcomes among adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019.  To compare the proportion of adverse pregnancy outcomes (Miscarriage, preterm birth, stillbirth and low birth weight) among wasted and well-nourished adolescent girls receiving maternity services at Mchinji district hospital from December 2018 to December 2019. This will be a cross sectional study based on routinely collected facility data that is recorded in the antenatal, supplementary feeding and maternity registers. Type of Study and Methodology A cross sectional study design will be used. The routinely collected facility data for antenatal, supplementary feeding and maternity services will be collected then analysed. Data will be collected from service registers focusing on data from December 2018 to December 2019. Data will be collected using a case report forms (CRF). Data will be analysed using Stata version 14.0. Categorical response variables will be presented using proportions and will be analysed using Chi- square. For objective three, Chisquare test will be done to check whether there is association between nutrition status and proportions of adverse pregnancy outcome. Logistic regression will be run to adjust for confounders affecting the relationship between nutrition status and proportion of adverse pregnancy outcome. Expected results It is expected that there will be significant differences in proportion of adverse pregnancy outcome between malnourished and well-nourished adolescent mothers. Dissemination The results from this study will be shared with COMREC, Mchinji district hospital and College of Medicine through the Research Dissemination Meeting.
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Factors affecting quality of antenatal care services at health centres in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Juan, Cosmas; Phiri, Mphatso; Maunde, Mwayi
Introduction Health care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. Maternal and newborn health, are priorities for the Government of Malawi, as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011- 2016 Health Sector Strategic Plan (HSSP). AIM The research is a cross sectional study that looks at the quality of ANC as a factor which is reducing the recommended number of times women are supposed to visit the ANC to have a fair consensus about as to why women are not attending the recommended 4 ANC visit. METHODOLOGY The study is a qualitative cross-sectional study to be conducted at health centres around Blantyre. This will involve women attending the ANC and also health workers at the health centre. The study will be conducted in 6 weeks mainly collecting data on the type of ANC services received and women’s perceptions on utilization of the ANC, data analysis and interpretation and dissemination. The inclusion criteria will be; women with gestation age 32 weeks and above, aged 18-40, attending the ANC being chosen at random. A written consent will be attained for each woman who participates in the data collection. Conclusion The expected results will show the setbacks in ANCs that are attributing to lower ANC attendance and so create a room of improvement in which can be tackled in the future resource appointment. Justification According WHO IDSR Guidelines in 2013/14 and as highlighted in the 2012 Ministry of Health Road Map for Accelerating Reduction of Maternal and Neonatal Morbidity and Mortality and the 2011-2016 Health Sector Strategic Plan (HSSP), Maternal and newborn health are priorities for the Government of Malawi (1). In Malawi, the proportion of women that received the recommended four or more ANC visits generally declined from 1992 (62%) to 2010 (46%) before rising modestly in 2015-16 to 51% (3). 95% of women who gave birth in the 5 years preceding 2016, received antenatal care from a skilled provider at least once for their last birth and 51% of women had 4 or more ANC visits (1). Our research aims at finding out why there is a high proportion of women who are not adhering to the recommended 4 ANC visits. The study is to be conducted in Health centres around Blantyre.
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The influence of client demand on care practices during ANC, labour and postnatal care
(Kamuzu University of Health Sciences, 2020-09-16) Mauluka, Chancy
Type of Study: Quasi-experimental study (implementation science research). Background: Quality of care is affected by a wide spectrum of bottlenecks that range from human resource deficiency, inadequate drugs/equipment, and suboptimal clinical practice. On the demand side, clients are not aware of their right to demand care practices and they do not have knowledge about the care that has to be provided to them during ANC, labour and postnatal care. In addition, mothers lack selfesteem, self-efficacy and skills to demand care from service providers. In the absence of such, service providers continue to skip clinical guidelines even in cases where necessary supplies are available. This study aims to explore the extent to which care practices can change if clients are empowered to demand services in the continuum of care from ANC to postnatal. Objectives: The specific objectives of this study are to: i) identify care practices that can be demanded by the mother in the continuum of care from ANC to PNC, ii) develop an intervention package (tools) to improve mothers’ knowledge of care practices and promote demand the practices from service providers, iii) assess improvement in terms of mothers’ knowledge of care practices offered during ANC, labour and PNC after being exposed of the tools, iv) assess improvement in terms of mothers’ demand for care practices during ANC, labour and PNC after being exposed to the tools, and v) measure effectiveness of the intervention in terms of actual provision of the care practices by health workers during ANC, labour and PNC. Methodology: The research will combine qualitative and quantitative methods for data collection. The study will be conducted in Kasungu district where intervention and control sites will be selected. The target population for the study includes a) pregnant mothers b) mothers with children not more than three months c) service providers at health centre level d) health specialists (RHD, NGOs) and e) psychologists. A two-staged approach will be used in sampling, whereby health centres will be systematically selected based on their service readiness and finally selected randomly to arrive at the final research sites. Willing mothers will be randomly selected to achieve sample size. The research undertakes to study a minimum of 326 women in antenatal, post-partum and postnatal care to establish with confidence if client demand for services can increase adherence to recommended practices by at least 15%. Quantitative data will be collected using structured questionnaires for the mother while a checklist for vignettes will be used to observe adherence to standards during contacts. Qualitative data will be collected using FGD guides and guides for vignettes which will be used in simulations to explore demandable services at the point of care. Qualitative data will be analysed using Atlas software to code emerging themes while quantitative data will be analysed using Stata to generate percentiles and correlation between outcomes of interest and independent variables. Expected findings and their dissemination: This work hypothesises that when individuals are empowered with knowledge and skills to demand, they can influence care practices in the continuum of care from ANC to postnatal care. Findings of the study will be disseminated through national and international conferences, as well as publications.
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Behavioral design for antenatal and postnatal care in Malawi
(Kamuzu University of Health Sciences, 2020-09-16) Mbilizi, Yamikani
Type of study: Behavioral formative research ii. Problem: According to USAID’s 2019 statistics, Malawi has one of the highest maternal mortality rates in Africa and globally, with 439 maternal deaths per 100,000 live births. Recently, the government adopted the new WHO guidelines that recommend 8 antenatal contacts during pregnancy. The 2015- 2016 Demographic and Health Survey (DHS) found that 95% of women accessed ANC. Yet, only 51% of women completed (the previously recommended) 4 visits. Only 24% of women seek ANC during the first trimester. At a global level, UNICEF’s 2019 data reports that at least 85% of women access antenatal care with up to 65% receiving 4 antenatal visits. In comparison, only 46% of Malawian mothers meet the previously recommended 4 ANC sessions. In Malawi, women often attend ANC late. JHPIEGO will conduct implementation research (IR) for antenatal and postnatal service delivery models and tools in Malawi (and Ethiopia and Mali). This IR will generate evidence on how best to strengthen antenatal and postnatal platforms—not only to deliver equitable, high quality services, but also robust and resilient enough to test interventions and transition to scale. JHPIEGO’s study design will employ human-centered design to explicitly reflect actual conditions and incorporate considerations necessary to understand and inform scale up and sustainability. The project will use human-centered and behavioral design (HCD) to develop context-specific program implementation strategies, approaches, and models of antenatal and postnatal care for pregnant and postpartum women in Malawi. In the first phase (empathy) of the HCD approach that will be used end users are engaged to better understand the barriers and drivers to antenatal and postnatal care, and to solicit their suggestions for interventions that better meet the needs of the population. For this activity, interviews and group discussions will be conducted with women, aged 18-49 who live in Blantyre (Malawi) to understand their realities and how they facilitate or hinder access to and use of antenatal and postnatal care services. In addition, interviews will be conducted with related individuals and community groups identified by the women, to understand their perspectives and the way in which they influence women’s decisions. All of these participants shall advise and subsequently validate ideas generated through the inquiry period. The ideas generated through this workshop will then be narrowed down and prioritized for further testing after approval from local authorities. The intent of this study is to work with women, related individuals, and community groups using the HCD methodology to gather information in order to design, develop and implement an intervention. The results are not designed to be generalizable. They would be applicable to women in Malawi only. Ideas will be generated during the design workshop but after prioritization and selection of the ideas, separate studies that will be designed from these activities will examine the feasibility and acceptability for the intervention(s) designed as a result of HCD. These protocols will be developed and submitted in the future since they will be human subjects research.
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Prevalence of early and late neonatal sepsis at chatinkha nursery – Queen Elizabeth Central Hospital, Blantyre, Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Nyanga, Wilson; Nyongani, Mertha
Important measures and progresses have been made and put in place over the past three decades to combat and reduce global under 5 mortality from 91 deaths per 1000 live births in 1990 to 43 deaths per 1000 live births in 2015. However, mortality in neonates (under 28 days of age) remains disproportionately high, representing about two thirds of under 5 deaths. Of these deaths a huge percentage occur in Sub Saharan Africa thus inclusive Malawi. The prevalence of early and late neonatal sepsis at Chatinkha Nursery at Queen Elizabeth Central Hospital is the problem that this study will deal with. The broad objective is to investigate the prevalence of early and late neonatal sepsis at Chatinkha Nursery: Queen Elizabeth Central Hospital in Blantyre. This will be a cross sectional quantitative study on the prevalence of early and late neonatal sepsis. This study will analyze secondary data of all files of neonates who had met the criteria of sepsis from January to March 2019 or data from the Health Management Information System (HMIS) this will include: patient files, Nurses report book and the Death registration book. Therefore, this research will be centered on the following specific objectives: to ascertain the prevalence in HIV exposed and non-HIV exposed at Chatinkha Nursery, to compare the prevalence of neonatal sepsis in neonates who were born before arrival (BBA) at the hospital and those who were born at the hospital, to determine the prevalence of neonatal sepsis in neonates born via caesarian section and those born via spontaneous vaginal delivery and to estimate other predisposing factors to sepsis. It is expected that at the end of this research, prevalence of early and late neonatal sepsis will be evaluated in line with our specific objectives. The results of this study will aide clinical personnel with decisions regarding the management of early and late onset neonatal sepsis with the aim being to reduce morbidity and mortality. This research will be presented at College of Medicine research dissemination presentations for the undergraduates, a final copy will be given to COMREC and COM library. BACKGROUND AND INTRODUCTION The third Sustainable Development Goal (SDG) for child health aims to end preventable deaths of newborns and children less than 5 years of age by 2030. It cannot be met without substantial reduction of infection-specific neonatal mortality in the developing world. [1] Neonatal infections are a major cause of death worldwide. It is estimated that approximately 4 million deaths occur annually in developing countries in the neonatal period, attributable mostly to infections, birth asphyxia and consequences of premature birth and low birth weight.[2] Sub Saharan Africa bears a disproportionate burden of neonatal mortality, contributing an estimated 49.6% of under-5 deaths with mortality rates highest in sub Saharan Africa. Neonatal sepsis is a condition defined as bacteremia within the first month of life accompanied by signs of systemic infection. RATIONALE OF THE STUDY The prevalence of early and late neonatal sepsis despite being generally high in Sub Saharan Africa, differs within the same region at different times and depends on conditions predisposing to infection. However, we have limited data for Malawi about the topic, so Chatinkha being one of the major neonatal care unit in Malawi this calls for a study that will determine the prevalence of early and late neonatal sepsis, having known the prevalence, the burden of neonatal sepsis will be reduced. STUDY OBJECTIVES GENERAL OBJECTIVE To investigate the prevalence of early and late neonatal sepsis at Chatinkha nursery at Queen Elizabeth Central Hospital. SPECIFIC OBJECTIVES  To ascertain the prevalence of early and late neonatal sepsis in HIV exposed and non HIV exposed neonates  To compare the prevalence of neonatal sepsis in neonates born before arrival(BBA) at the hospital and those who were born at the hospital  To determine the prevalence of neonatal sepsis in neonates born via Caesarian section and those born via spontaneous vaginal delivery  To estimate other predisposing factors for sepsis.
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Determinants of long acting reversible contraceptives (LARC) use among 10 to 24 year old youths in Lilongwe
(Kamuzu University of Health Sciences, 2020-11-17) Maruwo, George
Type of research study This is a cross sectional study using secondary data analysis from a youth FP/RH outreach clinics program Problem Statement Despite limited resources, Malawi continues to register substantial progress on key family planning indicators. Demographic Health Survey reports an unmet need for Family Planning of 18.7% with 10.8% unmet need for spacing and 7.9% unmet need for limiting. However, unmet need is highest (22%) among women aged 15-19. Nonetheless, Teenage pregnancy remains a significant public health issue in Malawi. Tailoring LARC services for the youth may assist in attainment of health for all.(1) Objectives The study aims to identify the determinants of Long Acting and Reversible contraceptive uses among youth in Lilongwe. Methodology This is a cross-sectional study using secondary data of clients aged 10-24 years accessing SARC and LARC services from the 64 youth outreach sites within Lilongwe. Factors to be examined will include level of education, marital status, age, number of living children, occupation, and area of residence. Expected findings and their dissemination The study expects to identify key trends of contraceptive use among youth in Lilongwe. Furthermore, the findings from the study will uncover key determinants of LARC and SARC use that might assist Lilongwe district health office, and Banja La Mtsogolo in formulation of new strategies in reaching youth with services. In addition, the report of this study will be submitted to College of Medicine in fulfillment of the completion of Master of Public Health and College of Medicine Research Ethics Committee (COMREC). Furthermore, the results 17-Nov-2020Page 6 of 31 will be shared with the Ministry of Health and Population, in particular, The Reproductive Health Directorate to inform policy in FP/RH programming on youth interventions.
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Quality of basic maternal and neonate care signal function and clients perceived care in health facilities in Malawi:
(Kamuzu University of Health Sciences, 2021-08-11) Manda, Eddie
Study type: This is a secondary data analysis of national health facility surveys using Malawi 2013-2014 Service Provision Assessment Survey data for 960 health facilities in Malawi. Background: Global campaign for facility delivery has been an idea supported by many countries. However, an increase in volume of health-care facility deliveries might not reduce maternal or newborn mortality if quality of care is insufficient. There is little systematic evidence for the quality at health facilities caring for women and newborn babies in low-income countries like Malawi. This study is going to analyze the quality of basic maternal and neonatal care functions and its association with patients perceived quality of care received during antenatal care services in health-care facilities in Malawi. Objective: The main objective of this study is to determine quality of basic maternal and neonatal care, during routine delivery, emergency obstetric care, emergency neonatal care and client perceived quality of care during antenatal care services using the SPA data collected in 2013-2014 in 960 health facilities in Malawi. Setting: This is a secondary data analysis that will include data from 632 health facilities across Malawi that Malawi SPA survey of 2013-2014 captured its data on maternal delivery and newborn care and antenatal care services. Method: This is a secondary data analysis study which is going to use data from the Malawi Service Provision Assessment (SPA) survey of 2013-2014 done regularly by Demographic Health Survey to collect data on resource availability. The DHS and SPA are cross-sectional, nationally-representative surveys. Detailed reports on each national DHS and SPA, describing details of sampling, fieldwork, and characteristics of respondents can be obtained from the DHS website (measuredhs.com). In this study, we are going to explore whether facilities have the necessary signal functions for providing emergency and basic maternal and newborn care, and antenatal care (ANC) using descriptive and multivariate regression. We are also going to explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we are going to explore patient’s satisfaction and its association with quality of services received. Expected findings and their dissemination: The quality of basic maternal and neonatal care signal function in both government and private owned health facilities (primary, secondary and tertiary) in Malawi will be determined. In this analysis, the association between women’s reports of their care and observed indicators of care during labor and delivery will also be determined. The results of the study will be presented to the College of Medicine Research Committee through submitted dissertation and will also be submitted to the Malawi Medical Journal for possible publication. The results will also be presented to the Ministry of Health through National Research Council. The results will also be releases as a thesis and will be stored and displayed at the college of medicine library.
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Assessing factors that affects uptake of family planning among adolescents at Mulanje district hospital
(Kamuzu University of Health Sciences, 2021-08-11) Banda, Limbani, Martin, Caroline Nyirenda, Tchete
Young women in Malawi have high unmet needs for modern contraceptives. Child marriages and early pregnancies continue to be high. Youth-friendly contraceptive services use were defined as “a variety of possible approaches attempted by clinics to increase a young person’s access to services (e.g., clinic hours to suit schedules of young people) and improve quality of care (e.g., providers with specialized training in young young women and men health).However, access to health and social services for young young women and men in rural areas continue to be sparse. Our study focuses on young young women and men individual, community and institutional factors that inform young people’s family planning/contraceptive needs, use and experiences. Most young young women and men are affected by sexually transmitted infections and unwanted pregnancies because they do not effectively access and use of contraceptive methods. This study will assess the factors that affect service uptake and utilization for young young women and men aged 15-24 years at Mulanje District Hospital. The study will look at individual, social and cultural factors, access to youth friendly health services (YFHS) that encourage or discourage uptake of family planning for young young women and men living in Mulanje. The study is a mixed methods design. The qualitative part will use focus group discussion and in-depth interviews to understand multiple factors that influence uptake of contraceptives. The quantitative component will review hospital records in registers and a questionnaire will be used to understand and young young women and men’s uptake of contraception, proportion of young young women and men accessing abortion and YFH services. Analysis of qualitative data will use thematic approach. Descriptive statistics using tables and graphs will be used to analyze quantitative data. The study population will include young young women and men aged 15 -24 years. The study will use random sampling to select young young women and men presenting themselves at the YFHS clinic. We propose to use self-care approaches as the conceptual framework to understand and address individual, places of access and environmental factors related to family planning or contraceptive use. The study period will take seven months to complete according to the school of health sciences and management schedule. Ethical clearance will be requested from the College of Medicine Research Ethics Committee and the Mulanje District Hospital Management committee. Participants will be requested to consent before getting involved in this study. Participant’s names and identity will be replaced by codes to maintain privacy and confidentiality. The strength of the study is that it will use mixed methods to review of hospital records in registers and in-depth interviews to understand and young young women and men’s uptake of family planning/contraceptive use. The potential limitations to the study are not getting the targeted number of participants due to Covid 19 restrictions, young young women and men refusing to talk about their experiences when accessing health and social services at the hospitals including financial constraints. The results will be presented to the Department of Health Systems Management and Policy as an examination. The hard copies will be shared through the library at College of Medicine and presentation will be shared through conferences under the College of Medicine.
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Acceptability of Self injected contraception (DMPA-SC) among adolescent girls and young women in Lilongwe district
(Kamuzu University of Health Sciences, 2021-09-15) Chipeta, Taonga
Study Type This study will employ a cross sectional mixed methods approach to collect data. Quantitative data will be collected from secondary sources (family planning registers) while interviews will be used to collect qualitative data. The problem to be studied Approximately 1 in every 2 women (49.85) in Malawi uses an injectable contraceptive (Depo- Provera) and is required to travel to a health facility every 3 months to get their next dose [1]. This is according to the 2015 – 16 Malawi Demographic and Health survey (DHS). In the same DHS, distance to a facility was one of the reported problems in accessing health care by 56% of the women aged 15-49 interviewed. Subcutaneous depot medroxyprogesterone acetate or DMPA-SC, a lower dose of Depo-Provera emerged in 2011 as a new option that could increase access to contraception, especially at the community level in low-income countries as women would be able to inject themselves in the home without visiting the health facility [3]. While Malawi reached a milestone and rolled out DMPA-SC in facilities across the country, published literature is unclear on the extent to which women are self-injecting at home or in the presence of a provider. This study builds upon randomized control studies that have been done by Burke et al to explore the practices around self-injected DMPA-SC in a real world setting as Malawi is scaling up distribution in the public sector. Objectives The main objective of this study is to assess the acceptability of self –injection of DMPA SC among adolescent girls and young women. The specific objectives of the study are to assess the attitudes and perceptions of adolescent girls and young women towards self-injected contraceptive, to explore the interest for self-injection of DMPA-SC and to get the perceived self-efficacy in using self-injected DMPA-SC. The study will also establish a profile of current users of DMPA-SC and the proportion of those self-injecting to help guide implementation. Methodology The study is a cross sectional study that will use both qualitative and quantitative means of data collection. Two facilities, one from a rural area (Ngoni Health Centre) and one from an urban area (Area 25 Health Centre) have been identified as the study sites for this research. The study will use the theoretical framework of acceptability according to Sekhon – 2017 where the 7 components of the theoretical framework will be used. These are Affective attitude, Perceived effectiveness, Burden, Ethicality, Coherence, Self-efficacy and opportunity cost. The study will collect data from family planning registers to establish a profile of current users of DMPASC while qualitative data which responds to the theoretical framework will be collected from service providers and clients sampled through a client exit recruitment process. The quantitative data will be managed and analyzed in Stata while the Qualitative data will be analyzed following the themes aligned with Sekhon’s theoretical framework. The qualitative data will managed in Nvivo. Appendix 8.6 provides details of the theoretical framework to be used. Expected findings and dissemination It is expected that most users of DMPA SC chose to be injected by the provider and are women under the age of 24. Insights into the reasons for Clients opting to be injected by the provider despite undergoing counselling will show a need to build client competency in using DMPASC to ensure more client self-inject compared to provider administration. The study findings will help provide a baseline for identifying an implementation gap before scaling up. The findings will be presented before the College of Medicine Research Ethics Board, Lilongwe District Health Office and the Research dissemination conference.
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Prevalence and determinants of puerperal sepsis following caesarean section delivery at Mangochi District Hospital, Malawi: A case control study
(Kamuzu University of Health Sciences, 2021-10-18) Banda, Felix
Type of study: This is a case control study that aims to estimate the prevalence and assess determinants of puerperal sepsis following Ceasarian section delivery. Problem Caesarean section delivery is the most common surgical procedure performed in Malawian hospitals on women with obstetric complication to aid in delivery of babies[1]. This procedure however has its own complications on women including post-surgery infection (puerperal sepsis) among others[1–4]. Puerperal sepsis among other complications is responsible in causing high maternal and morbidity rates. Despite improvement in knowledge, health care personnel and health care delivery, puerperal sepsis continues to occur in different hospitals in Malawi including Mangochi DHO. Mangochi DHO does refer some complicated puerperal sepsis patients to Zomba Central Hospital for further Management. Most of these patients are those who delivers through C. section. Objectives The primary objective of the study is to determine the magnitude and determinants for puerperal sepsis following caesarean section delivery at Mangochi DHO. Secondary objectives include assessing the prevalence rate of puerperal sepsis and to assess factors associated with puerperal sepsis following C. section delivery at MDH. Methodology This is a case control study whereby data will be extracted from case notes of postnatal mothers who were admitted with puerperal sepsis at the facility and had their C. section also done at the facility and these will be cases. Additionally, data will also be extracted from theatre, labour ward and postnatal registers. Data for controls for each case will be extracted from case notes of those post C. section mothers who had their procedure done at the facility. From all the participants files, data to be extracted include demographic data, antenatal information, labour and delivery data, and postnatal management including medication and discharge. Data will be collected using a standardized paper based questionnaire. Analysis will be done using Stata version 15. Expected findings We will determine the prevalence of puerperal sepsis among postpartum women following C. section delivery at the facility. We will also describe factors that are associated with puerperal sepsis following C. section procedure at the facility. Dissemination We will share final copy of findings with Kamuzu University of Health Sciences, COMREC, Mangochi District Health Office, District Health Management Team, and District Commissioner. This copy will also be presented National and International conferences and will be published in peer review journal.
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Implementation of intravenous iron for anaemic women during pregnancy in Malawi
(Kamuzu University of Health Sciences, 2021-11-11) Manda-Taylor, Lucinda
Type of study: This research program will employ a mixed-methods research design, involving three studies. Problem statement: Antenatal iron supplementation has been shown to be critical to maternal and newborn health; however, in many low-income countries, access and adherence to oral iron is limited. Randomised controlled trials of the Effect of intraVenous iron on Anaemia in Malawian Pregnant women in second-trimester (REVAMP) and third-trimester (REVAMP-TT) will determine whether intravenous (IV) iron is better than oral iron in improving anaemia and benefiting critical maternal and child outcomes. Very little is known about the acceptability and feasibility of implementing IV iron for anaemic women during pregnancy to improve maternal and child health outcomes in low-middle income countries (LMICs) like Malawi. This study aims to address this gap in research and published literature. Objectives of the study: The overall objective will be to inform the acceptability and feasibility of the implementation of IV iron for anaemic women during pregnancy in the Malawian healthcare system. Specifically, the study will a) identify health system barriers and facilitators to implementing IV iron in the healthcare system of Malawi; b) identify touchpoints and co-develop strategies for the successful implementation of REVAMP-TT; and c) identify barriers and facilitators to delivering and upscaling of REVAMP-TT. Methodology: The research program will be implemented in eight health centres in the Zomba district, namely Likangala, Bimbi, Lambulira, Domasi, Naisi, Matawale, City clinic and Sadzi Health Centre. Interviews and focus groups will be conducted with policy makers, health system managers, health centre staff, community members and pregnant women enrolled in REVAMP-TT. Health services data and clinical audits data will be collected across the health centres. The research program will involve three studies: 1) Health system analysis. The aim is to understand the health system barriers and facilitators to implementing IV iron in the Malawian healthcare system. 2) Co-design of implementation interventions. This will help us understand the ‘touchpoints’ and strategies for the successful implementation of REVAMP-TT. 3) Development evaluation of implementation interventions. The purpose is to understand the barriers and facilitators to delivering and upscaling of REVAMP-TT at the individual, health centre and health system level. Ethics: This research will adhere to local and international guidelines for ethical and scientific conduct of research that involves human participants. Written informed consent will be obtained from all participants before the conduct of each interview and focus group discussion. Expected findings: We aim to understand the barriers and facilitators (i.e., health systems/health services supply-side and health-users demand-side) to implementing and accessing IV iron for anaemic women during pregnancy to improve maternal and child health outcomes. The research findings will lead to the development of intervention strategies by identifying key modifiable factors along the healthcare continuum. Dissemination of findings: Results from this research program will be disseminated at the CoM Research Dissemination Conference and to specific interest groups, both in meetings / workshops and through conferences, nationally and internationally; and through journal article[s]. Final publications will be shared with COMREC.
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Sustainable scale-up of “Best Practice” for the diagnostic evaluation and clinical management maternal infections and sepsis in Malawi
(Kamuzu University of Health Sciences, 2021-11-19) Twabi, Hussein Hassan
The type of research study We will conduct a cross-sectional survey using retrospective and prospective routine data on maternal infections and sepsis from the Kamuzu University of Health Sciences Microbiology laboratory and the Queen Elizabeth Central Hospital (QECH). 2.2 The problem to be studied Most of the maternal deaths in the world occur in sub-Saharan Africa and are predominantly caused by maternal infections and sepsis. However, there is a paucity of data to inform the organismspecific therapy of maternal infections. Coupled with the narrow range of available antimicrobials, there is an imminent threat of an outbreak of drug-resistant bugs in our maternal units. This study aims to describe the aetiological landscape of maternal infections and sepsis in secondary and tertiary care facilities in the Southern Region of Malawi, while profiling the antimicrobial resistance patterns in this setting. 2.3 The Research objectives 2.3.1 Broad objective • To describe the aetiological landscape of maternal infections and sepsis in secondary and tertiary care facilities. in the Southern Region of Malawi. 2.3.2 Specific objectives • To determine the prevalence of maternal infections and sepsis in secondary and tertiary care facilities in the Southern Region. • To describe the factors associated with maternal sepsis • To describe the antimicrobial resistance profile of maternal infections • To determine the immediate maternal and foetal outcomes of maternal sepsis • To describe the factors associated with poor maternal and foetal outcomes due to maternal infections and sepsis 2.4 Methodology We conduct a survey of the existing data storage and management systems at QECH OBGYN department, which will involve an electronic self-administered questionnaire that are to be filled by facility staff to investigate the existing record keeping facilities at the department. We will then conduct a retrospective review of case files from records at QECH OBGYN department as well as a review of microbiological reports of samples analysed by the microbiology lab at the Kamuzu University of Health Sciences Microbiology lab with a case file analysis of positive microbiology samples for outcome data. 2.5 Expected findings and their dissemination. We hypothesize that there is increasing prevalence of maternal infections and sepsis in Blantyre, especially with the more inclusive definition of maternal infection and sepsis that the WHO has recommended. The results of this study will be submitted to College of Medicine Research and Ethics Committee (COMREC) and to journals for peer-reviewed publication. The results of the trial will also be shared with policy makers at the Ministry of Health in Malawi and the World Health Organization (WHO).
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Knowledge and perceptions of postnatal mothers on quality of services provided at Limbe Health Center in Blantyre
(Kamuzu University of Health Sciences, 2021-12-10) Chitimbe, Joe; Sallamu, Annie; Nfungwe, Maria
The study will be a facility based cross section qualitative study. intending to assess knowledge and perceptions of postnatal mothers on quality of services provided at Limbe health Centre in Blantyre, Malawi. Problem There is overwhelming evidence that postnatal mothers lack knowledge of quality services rendered to them and also how they perceive the postnatal care services. Due to poor perception and lack of knowledge, it has contributed to increase in maternal death more especially in postnatal period where 60% of maternal death occurs. Objectives The main objective is to assess the knowledge and perceptions of postnatal mothers on quality of postnatal care services they receive during the postpartum period, with the aim of addressing the knowledge gap in women who are receiving postnatal care. The specific objectives is also to assess satisfaction of postnatal mothers with the quality of services provided Methodology Purposive sampling specifically homogenous sampling will be used to select participantsparticipants, in this case postnatal mothers after getting full consent ranging from ages between 15 to 30years. The collected data will be analysed , transcribed, typed in word and analysed for content, it is characterized by a deliberate effort to gain samples by including groups or typical areas in a sample, this was done in order to obtain knowledge from key informants and consumers who the researchers perceived to be knowledgeable on the subject matter. A range of 24-33 is good number for sample saturation point in qualitative research. Saturation point occurs when adding more participants to the study does not result in obtaining additional perspectives or information. In this study we will use 30 postnatal mothers as our sample size Findings and dissemination 10-Dec-202114 Expected findings of this study will help to improve the postnatal care services at limbe health centre as well as the country The results of the study will be disseminated to COMREC, Limbe Health centre as well as Blantyre District Health Office, and management teams as well as to local dissemination conference.
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Knowledge and perceptions of postnatal mothers on quality of services provided at Limbe health center in Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-12-10) Chitimbe, Joe; Sallamu, Annie; Nfungwe, Maria
The study will be a facility based cross section qualitative study.There is evidence that postnatal mothers lack knowledge of quality services rendered to them and also how they perceive the postnatal care services. Due to poor perception and lack of knowledge, it has contributed to increase in maternal death more especially in postnatal period where 60% of maternal death occurs. Objectives The main objective is to assess the knowledge and perceptions of postnatal mothers on quality of postnatal care services they receive during the postpartum period, with the aim of addressing the knowledge gap in women who are receiving postnatal care. The specific objectives is also to assess satisfaction of postnatal mothers with the quality of services provided. Methodology Purposive sampling specifically homogenous sampling will be used to select articipants, in this case postnatal mothers after getting full consent ranging from ages between 15 to 30years. The collected data will be analysed , transcribed, typed in word and analysed for content.Findings and dissemination Expected findings of this study will help to improve the postnatal care services at limbe health centre as well as the country The results of the study will be disseminated to COMREC, Limbe Health centre as well as Blantyre District Health Office, and management teams as well as to local dissemination conference.
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Challenges in implementing the revision of 4 focused antenatal care visits to 8 antenatal care visits in Lilongwe District
(Kamuzu University of Health Sciences, 2021-12-10) Matsuka, Pililani
Executive Summary Type of research study The study will use a cross-sectional descriptive study design, that will employ a phenomenological qualitative approach. The problem to be studied Maternal and neonatal mortality are issues of public health concern globally especially in developing countries, and Malawi is not an exception. Malawi, has high maternal mortality ratio (MMR) and high neonatal mortality rate (NMR) which are currently at 439 per 100,000 live births and 27 per 10000 live births respectively. For that reason, globally and nationally,several interventions have been introduced to Some of these interventions include advocating for health facility birth by a skilled attendant and utilization of antenatal care services that includes starting antenatal care within the first trimester and attaining at least 4 antenatal care visits. Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality through early detection and management of women with and those at risk of pregnancy related complications during labor and delivery. Different models of the antenatal care services have been implemented in Malawi over the past years as recommended by the World Health Organization (WHO). In 2016, WHO recommended that every pregnant woman should have eight ANC visits four scheduled focused antenatal care visits (FANC). The aim of the adjustment is to increase contacts of a pregnant woman with a health care worker to reduce perinatal mortality and improve women’s experience of care. In 2019, Malawi government, through the Ministry of Health and Reproductive Health Directorate, adopted and started implementing thise WHO recommendations in 2019. In 2020, however, out of the 93,801 women who attended antenatal care in Lilongwe District government health facilities, only 6736 (7.2%) attended 5+ visits. Additionally, there is insufficient data to show the impact of this ANC model has had on health care workers and ANC users as well as the challenges encountered with the model. This study, therefore, seeks to unveil/assess the challenges affecting the implementation of 8 ANC visits in public health facilities with a focus on Lilongwe District government health facilities. The results of the study will be instrumental in the efforts of increasing the number of women who attend 5+ ANC visits. The objectives • Broad objective To explore the challenges the 8 ANC visits model in health facilities of Lilongwe district. • Specific objectives To identify health system challenges that impact ANC provision in health facilities of Lilongwe district. 2. To explore sociodemographic factors that influence the timing of ANC start and number of ANC visits amongst childbearing women in Lilongwe district. 3. To explore knowledge, attitudes, beliefs and perceptions of childbearing women towards ANC start and number of ANC visits amongst childbearing women in Lilongwe district. 4. To explore social cultural factors that influence ANC initiation and number of visits amongst childbearing women in Lilongwe district Methodology The study will be conducted in government health facilities of Lilongwe district. Health facilities will be first stratified into urban and rural health facilities. Thereafter, there will be a random selection of health facilities proportionate to their population. The study population will be health care workers (Nurses and/or Clinicians) working at ANC departments and pregnant women found at antenatal care clinics accessing services Purposive sampling method will be used to recruit pregnant women and convenience sampling method will be used to recruit health care workers. Data will be collected through in-depth interviews for health care workers and focus group discussions (FGD) for pregnant women. During data collection, digital voice recorders will be used and all digital recordings will be transcribed and translated into English and coded using NVIVO qualitative software. Themes generated from the data will be analyzed using thematic content analysis. Expected findings and their dissemination The researcher is expecting to provide rigorous local evidence documenting the challenges affecting effective implementation of the new ANC guidelines and their impact towards the delivery of improved maternal and neonatal health care services in the hospitals. Dissemination of the study findings and possible recommendations will be made to College of Medicine Research and Ethics Committee (COMREC), College of Medicine research dissemination seminars, Lilongwe District Health Office and all study sites. A report of the findings will also be published as a journal article
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Exploring factors that influence uptake of ferrous sulphate among pregnant women attending antenatal care services at Queen Elizabeth Central Hospital (QECH) in Malawi
(Kamuzu University of Health Sciences, 2021-12-16) Nyika, Lyness
The type of research study This will be a qualitative study which will use phenomenological approach involving in-depth interviews with the health workers and pregnant women attending antenatal care services at Queen Elizabeth Central Hospital in Blantyre, Malawi. The problem to be studied Poor adherence to ferrous sulphate supplementation among pregnant women which contributes to iron deficiency anaemia during pregnancy and eventually leads to maternal and neonatal deaths. The objectives Broad objective:  To explore factors that influence uptake of ferrous sulphate supplementation in Antenatal women at Queen Elizabeth Central Hospital. Specific objectives: 1. To identify the individual and community factors that influence uptake of ferrous sulphate uptake among pregnant women. 2. To explore the health system factors that affect uptake of ferrous sulphate uptake among pregnant women. Methodology Study design: It will be a qualitative study which will use a phenomenological design involving in-depth interviews with the pregnant women and health workers. Study Setting: The study will be done in Blantyre southern part of Malawi. Blantyre is an urban District with an estimated population of 661,256 with 325,022 females. The participants will be recruited from the Antenatal Clinic at Queen Elizabeth Central Hospital. Study population: All health workers and pregnant women attending Antenatal care services at Queen Elizabeth central hospital in their second and third trimester since ferrous sulphate is given in these trimesters. All women who are in first trimester and health workers not working at antenatal care clinic will not be included. Sample size: In-depth interviews with pregnant women. Phenomenological studies recommend 5-25 participants [6]. This study will comprise of 20 participants (15 pregnant women and 5 nurses). but ultimately the number of participants will depend on when saturation is reached. Data collection process: An authorization letter from QECH will be obtained, followed by sensitization of antenatal clinic staff and potential participants on the study in order to gain consent. Thereafter, participants will be recruited into the study. Data management and analysis: Analysis will be thematic in which data collection and analysis will be done concurrently to determine if saturation has been reached. For the protection of participants, all names will be masked during consenting to avoid inclusion of identifiable information in the analysis files. Data collected will be organized into digital files and create a file naming system to ensure materials can be easily located in large databases of text for analysis. Expected findings and their dissemination: The study is expected to find out about facilitators and barriers to ferrous sulphate uptake among pregnant women which will inform policy makers to enhance uptake. The report is going to be submitted to Kamuzu University of Health Sciences Library (formerly College of Medicine), The University Research and Publication Committee (URPC) (through the KUHES Secretariat) and QECH Research committee. The research findings will be disseminated through holding dissemination seminar/workshop and publication of a manuscript.