Thesis & Dissertations

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    Exploring factors that affect uptake of water-based lubricants and male condoms among men who have sex with men in Salima District, Malawi
    (2022-03-01) Lumbe, Williot Joaquim
    Men who have sex with men (MSM) are at high risk of contracting HIV due to several factors, both biological and social. They form an underserved population in terms of getting support for both HIV prevention and treatment due to so many factors that make them vulnerable. Key to HIV prevention among MSM is the correct and consistent use of water-based lubricants and condoms. However, studies have shown MSM are still underserved and lack access to prevention commodities. As such, there is low uptake of lubricants and condoms among the population due to several factors that need contextualization for them to be addressed. The goal of this study was therefore, to explore factors that influence uptake of condoms and lubricants among MSM. Specially, the study aimed at classifying the identified factors into either facilitators or barrier of uptake. A phenomenological qualitative study was implemented to inquire the living experiences of MSM in relation to access and use of condoms and lubricants. Data was collected focus group discussions and in-depth interviews. Participants were sampled through snowballing and purposive sampling. The study found three main factors affecting uptake of condoms and lubricants; availability, accessibility, knowledge and perceptions on condom and lubricant use. These are largely influence by a contingent of other underlying factors that are categorized into five domains: structural, physical, cultural, socioeconomic, and legal. All these taken from a different angle can be either facilitators or barriers of uptake. Notable underlying factors affecting uptake of these commodities among MSM included poverty, relationship between MSM and health service providers, distance to selling or access points of the commodities, stigma and discrimination, cultural, traditional, and religious beliefs among others. The study concurred with other studies that the main factors are availability, accessibility, and knowledge on importance of using the commodities and appropriate use, which are affected by various underlying factors. Lubricants are not available in the mainstream health system and there is need to consider starting stocking at different levels to enhance and localize accessibility and use.
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    Open Access
    Exploring determinants of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district: An interpretive phenomenological analysis study
    (2022-03-01) Njolomole, Blessings
    Exclusive breastfeeding is the most widely known and effective intervention for preventing early childhood illnesses and deaths. Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. In Malawi despite having some improvements in early initiation of exclusive breast feeding (EIBF), in the last decade there has been a decline in EBF and EIBF rates. EBF and EIBF rates have declined from 72% and 95 % in 2010 to 61% and 76% in 2016 respectively. The study aimed to explore determinants of exclusive breastfeeding among women with children aged 0-6 weeks attending postnatal clinic services in Balaka district. Results for this study may help to inform evidence based planning and policy recommendations and interventions and may help managers and health workers in the district to come up with context specific interventions and strategies to promote EBF. This was a qualitative interpretive phenomenological analysis (IPA) study. Purposive sampling technique was used to select breast feeding women with children 0-6 weeks and key informants while snowballing technique was used to recruit significant others. The sample size was 40 involving 18 women, 6 Spouses, 6 grandparents and 6 siblings of the women and key informants involving 2 maternity nurses and 2 clinicians and data was collected using focus group discussions (FGD) and in-depth interviews. The data was analyzed using thematic content analysis. The study was conducted within a period of 12months. This period included proposal preparation, submission and approval, training of data collectors, pretesting of data collection tools, data collection, data analysis, report writing and dissemination of the findings. Most of the women, sisters, spouses and grandparents were aware of the importance of exclusive breastfeeding but few were not aware. The source of information on the importance of EBF was nurses/doctors, friends, radio and care group volunteers. Women who were intrinsically motivated and those that had a good breastfeeding support system along the continuum of care practiced EBF. Availability of BFHI and EBF policies acted as cues for health workers to re-enforce EBF among women through health education talks. Some HCWs assumed that the women already knew how to breast feed as such they did not discuss with them about EBF and possible problems that could arise from breastfeeding such as sore nipples, failing to latch the baby to the breast, breast engorgement and the perception of breast milk insufficiency. Yet some HCW provided information based on their own biased intuition and not scientific professional knowledge. Nonetheless some women described EBF as an empowering experience and the best thing any woman can do to her child. Findings of this study have shown that exclusive breastfeeding is not merely just an intuitive biological process based on the natural instinct of both the mother and her baby but rather that successful exclusive breastfeeding is dependent on a complex interplay of factors such as mothers agency, health care worker factors, socio-economic factors and support from significant others. Furthermore HCW should provide reliable information based on scientific professional knowledge and not based on their own biased intuition and should provide practical demonstrations of breastfeeding and involve significant others when counselling a woman on exclusive breastfeeding during discharge from the postnatal ward.