Thesis & Dissertations
Permanent URI for this collection
Browse
Recent Submissions
- ItemOpen AccessExploring socio-economic factors affecting utilization of health care among patients with hypertension in Zambia(2022-03-01) Mwale, FlataNon-communicable diseases have emerged as a major health concern in Developing Countries. This study investigated the effect of socioeconomic status on utilization of hypertensive care/services in Zambia. A probit model was used to establish the probability of 1) having hypertension, 2) having BP checked, 3) having a diagnosis, and 4) use of hypertension medication. The study analysis is based on the Zambia STEP survey conducted in 2017. The STEP is a population level cross-sectional survey of 4302 adults aged 18-69 sampled from all ten (10) provinces of Zambia. The results of the analysis showed that the prevalence of hypertension in Zambia was 18.70%. Of those that had hypertension, of the total number found to have raised blood pressure during the survey, only 22.3% had been diagnosed by a doctor or health worker and only 26.0% used medication. Based on the probit results, compared with the poorest respondents, being in the middle, rich and richest income groups was associated with an increase in the probability of being hypertensive by 6.9%, 5.5%. and 9.8% respectively. On use of healthcare, compared to the poorest, being poor was associated with a 7.6% increase in the probability of having a BP check while being in the middle income group was associated with a 7.2% decrease in the probability of having diagnosis. There was no statistically significant effect of income groups on use of medication. The results also showed that primary education was associated with a lower probability of hypertension of 4.2% while having secondary and post-secondary education was associated with an increase in the probability of having a BP check by14% and 22% respectively. Urban residence was associated with an increase in probability of having a BP check and having a diagnosis by 10.8% and 5.8% respectively. With regards to occupation, Non-Governmental Organization employees were associated with an increased probability of having a diagnosis of 10.5%. The study findings suggest that, while prevalence of hypertension is pro-rich, the use of hypertension treatment services is equitable. These results are important as they suggest a fairly equitable service delivery arrangement that ensures use of hypertensive services among Zambians regardless of socioeconomic status and location. However, the under diagnosis and under medication found in this study warrants deliberate population based awareness programs to raise more awareness on hypertension, importance of its detection, management and control.
- ItemOpen AccessSocial interactions among research stakeholders and ethical issues in the context of community engagement in Malawi(2018-01-01) Nyirenda, DeborahThis thesis examines community engagement practices and consequent effects on ethical research, knowledge re-production and study acceptability. Community engagement is promoted in international ethical guidelines for health research to engage communities in research design. Limited evidence exists on practical translation of these international ethical guidelines to improve ethical research. This study was undertaken to address this knowledge gap by using three ethnographic case studies in Malawi. A qualitative research design was used to understand community engagement practices in light of a theoretical framework of neo-colonial research relations. Three research projects were purposively selected as ethnographic case studies focusing on an urban, rural and hospital setting. I used participant observation to understand unarticulated aspects of community engagement. Field notes from participant observation were triangulated with 43 in-depth interviews and 17 FGDs with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret findings by applying theories of neo-colonial research relations. Although international ethical guidelines promoted active involvement of communities in research design, neither researchers nor community members wished to engage in fully collaborative partnerships. Community engagement processes were shaped by historical experiences with service providers, political context, power dynamics between research stakeholders as well as social norms of interacting with outsiders. In addition, the broader socio-economic context and local power structures raised issues of structural coercion. Rather than improving ethical research practice, community engagement often influenced research participation and did not yield mutual benefits. Lack of community awareness of ethical guidelines or activism for collaborative partnerships affected successful translation of collaborative partnerships. These results raise important questions on how community engagement in low resource settings ought to balance between bridging research stakeholders’ contradictory expectations.
- ItemOpen AccessEnablers and barriers to condom use and uptake among young people living with HIV in Mchinji district, Malawi(2020-03-01) Chirambo, Paul BingoYoung people aged 15 to 24 years account for 25% of new HIV infections among adults. Those living with HIV are at risk of passing on the virus to their sexual partners and children. As such consistent condom use is regarded as a comprehensive and sustainable approach to HIV prevention. The aim of this study was to explore factors enabling and hindering the uptake and consistent use of condoms among young people living with HIV in Malawi. This was a cross-sectional study utilizing both quantitative and qualitative research methods. It involved young people living with HIV (YPLHIV) aged 15 to 24 years in four antiretroviral therapy (ART) facilities in Mchinji District, Malawi with a sample size of 308. Quantitative data was collected using a structured questionnaire while qualitative data used in-depth interviews and focus group discussion (FGD) guides. Data was analysed using STATA (quantitative data) and N Vivo (qualitative data). 77% (237) of young people reported ever had sexual intercourse. The prevalence of condom use at last sexual intercourse was 73 % (P
- ItemOpen AccessFactors affecting antiretroviral therapy (art) adherence in adolescent girls and young women (AGYW) at Umodzi family clinic, Blantyre(2020-03-01) Lakudzala, SuzgikaAdherence to treatment and retention in care is essential in the management of HIV among people living with HIV. In 2015, Adolescent Girls and Young Women (AGYW) population in Sub-Saharan Africa accounted for 25% of new HIV infections, which is 6 times their male peers. AGYW are characterized by high risk sexual behavior and lack of engagement with health care providers that can affect adherence to Antiretroviral Therapy (ART). This study aimed at determining the level of and factors associated with ART adherence among AGYW at Umodzi Family Clinic in Blantyre. This was a cross sectional quantitative study which used structured questionnaires for data collection. The study recruited 189 HIV positive AGYW who had been on ART for 6 months and above at Umodzi Clinic in Blantyre Malawi. Adherence was measured using 4 cut-off points. 1. Pill count ≥95% and Viral load 1000 3.Pill count > 80%, 4. Pill count ≥95%. Data analysis was done using Stata. Chi-square tests were performed to check association. Results: A total of 63.1% of participants were AGYW aged 15-19 while 36.9% were young women aged 20-24. The study found a high proportion (91.0%) of ART adherence at cut-off point of >80 % pill count but a moderate (63.15%) ART adherence at cut-off point of >95% pill count which is recommended. ART adherence was significantly associated with reduced waiting time to see a doctor(X2 4.51; P80% pill count. No factors were found to be significantly associated with ART adherence at cut-off point of >95% pill count. Reduced waiting time and perceived health workers attitude were found to be associated with ART adherence. Hence improving on these factors could hold keys in improving AGYW ART adherence
- ItemOpen AccessImpact of media training and journalist support on the development of health research reporting in Malaw(2020-03-01) Phumisa, Josephine Semun 2012, the Science Communication Department at Malawi-Liverpool Wellcome Trust established the Journalist in Residence programme. It was established to train journalists and give them support when reporting health research stories from Malawi-Liverpool Wellcome Trust. However, the programme has not been evaluated since its inception. Objective: To assess the impact of media training and support through the Journalist in Residence programme on the development of health research reporting in Malawi. Qualitative approaches were used to conduct in-depth interviews with 5 journalists, 2 editors, 2 consultants, 5 researchers, and 3 Ministry of Health Officials. Two Focus Group Discussions were also conducted with Community Advisory Group members selected in Blantyre and Chikwawa. All interviews and focus group discussions were recorded and transcribed verbatim. Data were analysed using Nvivo11. The findings show that most stakeholders recognize that JIR programme has a positive impact on the development of health research reporting in Malawi. The quantity and quality of health research stories are reported to have increased after introducing the programme. Additionally, journalists are motivated to write health research stories as they get training as well as support in the programme. The health research work of Malawi-Liverpool Wellcome Trust is now being recognized by policy makers and the public at large through stories published by journalists in the programme.The evaluation found that JIR programme is a powerful tool to achieving the development of health research reporting in Malawi through all its aspects.