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- ItemOpen AccessPsychosocial care for road traffic injury patients: An exploration of service provision to patients attending Orthopaedic Clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi(Kamuzu University of Health Sciences, 2022-03-30) Chigalu Chingwalu, Maclean GraceEvery year the lives of approximately 1.35 million people globally, are cut short as a result of a road traffic crash. Road traffic accidents are responsible for different types of injuries and disabilities which affect the individual’s quality of life as they may suffer limitations in physical, social and mental well- being. However, the nursing practice at QECH does not focus much on psychosocial wellbeing of patients. This study therefore, explored the provision of psychosocial services to patients with road traffic injuries attending Orthopaedic clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi. Literature shows that psychosocial care in patients with orthopaedic injuries is important as it involves collaboration between health care professionals as well as multidisciplinary care. This was a qualitative study employing a phenomenological design which focused on nurses, caregivers and patients. A purposively selected sample of 20 adult patients, who were attending adult orthopaedic clinic at QECH were interviewed. The sample was selected from orthopaedic patients attending clinic at QECH. Data analysis was done manually by following principles of thematic content analysis. Psychosocial issues are not recognized and nurses focus their care on Bio-physiological issues. Over 75% of the participants felt that delay to go to theatre lengthened their stay in hospital which further affected the patients psychosocially since their financial resources became depleted more and more. Holistic approach to patients’ care is necessary to provide psychosocial care to orthopaedic trauma patients. There should be development of standardized guidelines which will include psychosocial care in dealing with orthopaedic trauma patients.
- ItemOpen AccessAssessing the capacity of district hospitals in mobilizing and allocating resources after health care decentralization at Kasungu and Nkhotakota district hospitals(Kamuzu University of Health Sciences, 2021-01-01) Lifa-Udedi, Evelyn ZioneDelivery of efficient health services requires adequate and consistent availability of the right resources, be it human, financial, equipment or material resources. Decentralization has been considered a strategy to aid in resource mobilization for the health sector. The study aimed to assess the capacity of district hospitals in mobilizing and allocating resources after health care decentralization in Kasungu and Nkhotakota District. This was a cross sectional qualitative study which focused on DHMT members. A purposively selected sample of 14 participants from DHO and DC. Data was collected through in-depth interviews. Data analysis was done by on excel and Atlas Ti. All content with similarities were then grouped in different code groups that reflected the theme to which they presented and analysis was done based on the themes. A majority of participants were male at 79%, while 64% of the participants were within the young and productive age. 57%, had more than 10 years of experience working in government at senior level management while 71% of the participants had graduate level training. The results indicate that: there is lack of power and authority vested on DHMT as decision makers; inadequate and at times unclear decision-making powers (for recruitment, approvals); expectation that public institutions cannot be innovative (ability to think beyond the government funding), and lack of political will (inability of those in power to be ethical and just in making decisions affecting the health system). DHMT capacity in resource mobilization is limited. It is recommended that DHMT should receive skills and competency strengthening training particularly in regards to resources mobilization.
- ItemOpen AccessCatch them young: Assessment of implementation of sexuality education for very young adolescents aged between 10 and 14 years in Lilongwe, Malawi(Kamuzu University of Health Sciences, 2020-10-01) Banda Latif, EstherDespite the introduction of sexuality education (SE) in primary schools in Malawi, a significant number of very young adolescents still experience early marriages, high teenage pregnancies and high school drop-outs. The extent to which SE is being provided is not known. This study aimed at assessing implementation of SE in rural primary schools in Lilongwe District. This was a qualitative case study, which purposively selected three schools with registered high school drop-out numbers due to teenage pregnancies in Chowo Education Zone. We conducted 12 Focus Group Discussions with very young adolescents aged between 10-14 years, 20 parents and 8 religious/traditional leaders. We also conducted in-depth interviews with 12 teachers, to explore their perception towards sexuality education. In addition, we reviewed Education and Curriculum documents and conducted classroom observations. We used thematic content approach to analyze all the collected data. Most very young adolescents knew sexuality as boy/girl sexual relationships, and described the importance of SE in prevention of early pregnancy and sexually transmitted infections. However, some out of school Very Young Adolescents (VYAs) expressed lack of knowledge about sexuality issues. There were mixed reactions on how study participants perceived SE provided in primary schools; Some participants supported the teaching of SE in schools while others, mostly traditional and religious leaders felt SE in schools is not culturally and age appropriate. During classes, most teachers were observed to be uncomfortable in teaching SE; they lamented the lack of skills and resources, culture, religion as barriers to effective implementation of SE. Comprehensive sexuality education in Chowo education zone is not implemented according to the International Technical Guidance for Sexuality Education, 2018. Comprehensive sexuality education curriculum available in the country is a good opportunity for improvement.
- ItemOpen AccessPerceptions of heterosexual men on HIV-related stigma in HIV testing and ART services in Blantyre district(Kamuzu University of Health Sciences, 2020-12-01) Kazuma, ThokozaniAcross the world, the global pandemic of HIV/AIDS has shown its capability of triggering responses of compassion, solidarity and support bringing out the best in people, their families and communities. However, the disease is also associated with stigma. Stigma comprises negative attitudes and beliefs about people living with HIV; it is the prejudice that comes with labelling an individual as part of a group that is believed to be socially unacceptable. Stigma against those infected with HIV profoundly shapes the lives of people living with the disease. It leads to discrediting and discrimination against individuals who are HIV infected. HIV-related stigma remains one of the greatest barriers to the health and well -being of people living with HIV (PLHIV). While literature portrays women as mainly vulnerable to HIV infection, contrary heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. This thesis explores the perceptions of heterosexual men on HIV related stigma in HIV testing and ART services. This was an exploratory qualitative study employing a secondary data analysis which was done from the study titled ―Strategies for Early Access to HIV Services by Heterosexual Men in Blantyre, Malawi Version 5.0, dated 8th April 2019.‖ COMREC number P/06/18/2430. The main study aimed at assessing strategies for early access to HIV services among heterosexual men in Blantyre, Malawi. This study established that HIV-related stigma may come in form of name-calling, sidelining, gossiping, and is displayed in the delivery of services. The factors that facilitate the occurrence of stigma include the agent who can be the individual who may self-stigmatize, family members, work colleagues and community members, health care system and the environment. HIV related stigma exists and hinders heterosexual men from accessing HIV testing and ART services which may lead to poor HIV testing and ART services. A complete integration of HIV services into the health systems without designated spaces and days, respect to privacy and no labelling of HIV testing and ART rooms are integral mitigation factors that can minimize HIV-related stigma.
- ItemOpen AccessDelivery and promotion strategies for optimising uptake of contraceptives among adolescents aged 15-19 years in Nsanje district, Malawi(Kamuzu University of Health Sciences, 2020-09-01) Makwinja, Andrew KondaineDespite documented benefits of contraceptives, uptake among adolescents aged 20-24 years is high compared to age group 15-19 years in Malawi. As the world’s population of 15-19 year olds continues to grow the need to meet increasing demand for contraceptive services and information that address adolescent specific needs cannot be underestimated. To inform Sexual and Reproductive health services for the youth, we explored strategies that may optimize uptake of contraceptives among this age group. The objective of this study explored strategies for optimizing uptake of contraceptives among adolescents aged 15-19 years old. An exploratory qualitative cross-sectional study guided by Social Ecological Framework to understand strategies that may optimize uptake of contraceptives among adolescents age 15-19 years was conducted from September to October 2019 at Nsanje District Hospital and Nyamadzere Community Day Secondary School in Nsanje district, Malawi. Nsanje district was purposively selected based on the reason that it is second district in Malawi with highest rate of adolescent childbearing of girls aged 15-19 years. We conducted a Focus Group Discussion (FGD) with 9 traditional leaders, 11 Key Informant Interviews (KIIs) with health workers, 20 In-depth Interviews (IDIs) with 12 adolescents and 4 teachers and 4 parents. All data were digitally recorded, transcribed verbatim into English. The data was analyzed and managed using deductive thematic analysis guided by Social Ecological Framework. Individual, community and interpersonal level strategies with subcategories Physical spaces and Promotional strategies as well as organizational level strategies were identified. Individual level strategies: Physical spaces (local drug store, peers, and community health workers), Promotional strategies (Leaflets, flyers, Short Message Service, Placards, mass media). Community and interpersonal level strategies: Physical spaces (Youth Centred Services: youth corners, clubs and centers); Community promotion strategies (Use of community leaders, Counselling and guidance in schools and homes, Information, Education and Communication, Awareness campaigns and peer education). Organizational strategies include aspects of design and service delivery, society laws and policies (resource availability, introduction of bylaws and penalties by traditional leaders, provide adolescent health services separate from adults, mandatory teaching of contraceptive topics in schools, contraceptive health education by school health nurses in schools). This study suggests that enabling environment to deliver and promote use of contraceptives among adolescents aged 15-19 years need to have various people and places as deliverers of contraceptives such as local private drug stores, adolescent centered units in hospitals, community health workers and peers enforced by policies such as mandatory teaching of contraceptives in schools by school health nurses and bylaws and penalties for teen pregnancy by traditional leaders. This provides a strong argument for collaboration and involvement of different people and institutions at community, organization and policy level to strengthen strategies for optimizing delivery and promotion of contraceptives among adolescents aged 15-19 years. Leveraging of available structures, resources and services that target adolescents within and out of school will accelerate uptake of contraceptives among adolescents