Thesis & Dissertations

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    Open Access
    Determinants of cervical cancer screening uptake among women of childbearing age in Mangochi District Malawi
    (2021-04-01) Mpachika, Felistas Sungeni
    Cervical cancer (CC), a deadly disease, has a high burden and mortality at global and local level. Despite the burden, Malawi registers low uptake of cervical cancer screening (CCS). This study examined the determinants of uptake of cervical cancer screening among women of child bearing age in Mangochi district. A quantitative cross-sectional study was conducted in five health facilities offering visual inspection using acetic acid (VIA). A total of 482 women between the ages of 18-49 were selected using a multi-stage sampling method. Data that were collected through a structured questionnaire were coded and analysed using SPSS version 22. Logistic regression model was used to identify factors associated with CCS. Few respondents (13.1%) had ever been screened for CC. Those between 18-24 years were less likely to undergo CCS compared to those in 25-35 years category (AOR=0.38, 95% CI 0.19-0.77, P = 0.007). Respondents who had not received health education on CC were less likely to undergo CCS than those who had received (AOR=0.20, 95% CI 0.10-0.41, P=0.000). HIV positive respondents were more likely to screen than their HIV negative counterparts (AOR= 2.41, 95% CI 1.22-4.78, P=0.012). Respondents with high-level of knowledge on signs and symptoms of CC were more likely to undergo CCS than those with low-knowledge (AOR=2.91, 95% CI 1.51-5.63, P=0.002). Cervical cancer is preventable and one strategy to prevent it is through timely screening. This study has established that age, religion, ethnicity, residence, HIV status and health education are among the determinants of CCS uptake. We therefore recommend that CCS should be offered to all WCBA in this era of HIV infection, that community based screening services should be encouraged to reach out to more women residing in rural areas, that health education should be offered in all strategic areas in health facilities to give out information to clients accessing other health services and that the integration of antiretroviral therapy (ART) and CCS clinics should be rolled out to most health facilities to offer CCS to HIV positive women.
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    Open Access
    Psychosocial experiences of early childbearing among teenagers in Zomba district, Malawi
    (2021-04-01) Dzuwalatsoka, Lumwira Henry
    Teenage childbearing in Malawi is very high (29%), and socioeconomically burdensome, with Zomba having a higher rate than the national average (34.9%). A review of literature for Malawi revealed that little was yet known about the psychosocial experiences of teenage childbearing, yet most of the teen marriages and pregnancies are occurring in this region and Zomba in particular. This study explored psychosocial experiences of early childbearing. This was an explorative descriptive qualitative study. The target population was 13-19-year-olds living in Zomba District. A purposive sample of 16 teenagers (pregnant and parenting), was recruited comprising of 8 males and 8 females. Data were collected through audio-recorded face to face in-depth interviews using an interview guide. Data were analysed using content analysis. Results revealed that teenagers’ experience emotional trauma that included embarrassment, regrets, fear of parental reprimand, depression, emotional shock, and parental verbal abuse. They suffer social injustices like stigma, discrimination and rejection from parents; peers and community members. Corporal punishment and support withdrawal was part of the social problems. The study recommends that teenagers be equipped with sexual and reproductive health life skills so they can delay pregnancy; SRH policies should address gaps to ensure reproductive health services respond adequately to teenagers’ psychosocial needs. Extensive research is required to focus on both couples & single teen parents; parents of teens that are experiencing or experienced childbearing and on psychosocial experiences of health workers as they manage teen parents. These findings highlight psychosocial challenges experienced by childbearing teenagers. Childbearing teenagers require quality comprehensive psychosocial services.
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    Open Access
    A qualitative exploration on use of long acting reversible contraceptives among married women at Mzimba South District Hospital
    (2021-04-01) Phethi, Chisomo
    Long acting reversible contraceptives (LARC) are safe, cost-effective, and highly effective in the prevention of unplanned pregnancies for almost all women in the reproductive age group. Nationally, most married women 30% (4839) use Depo Provera with a high discontinuation rate of 41%, while 12% (1936) use Implants and 1 % (161) IUD, with a discontinuation rate of 8% for both. Records at Mzimba South District Hospital for the 2016-2017 fiscal year on the use of Implants and IUD among married women remains very low. Literature on quantitative studies indicates lack of knowledge, dependence on a provider for information, partner disapproval, myths, and misconceptions as some of the underlying factors to low uptake of Implants and IUD and yet did not capture detailed reasons as to why married women do not use Implants and IUD. The aim was to explore factors influencing the use of LARC among married women at Mzimba South District Hospital and a descriptive exploratory qualitative design was used. A purposive sample of 10 married couples was used. Data were analysed manually using thematic content analysis. The study findings generated 5 themes: inadequate knowledge of married women and their partners on Implants and IUD, source of information about Implants and IUD, reasons for partner approval/disapproval to use of Implants and IUD, reasons why married women do not use Implants and IUD for family planning, myths, and misconceptions among couples on use of Implants and IUD, perceptions of couples on use of Implants and IUD. Several factors influenced the use of Implants and IUD such as inadequate knowledge, myths and misconceptions, men’s approval, cultural beliefs, provider bias, health problems and side effects. Comprehensive contraceptive counselling on LARC is essential in knowledge acquisition hence promote LARC uptake among couples at the facility level.
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    Open Access
    Quality of health Information, education and counselling services for effective secondary prevention of sexually transmitted infections at Bwaila STI Clinic
    (2016-11-01) Kanyama Njinga, Salome
    Sexually Transmitted Infections (STIs) are preventable, though the public continue to be infected and increase reproductive health morbidity and mortality in Malawi. The purpose of this study was to explore and describe the quality of Information, Education and Counselling (IEC) services provided to STI patients at Bwaila hospital in Lilongwe District. A descriptive quantitative design was utilised. The participants were recruited using systematic random sampling method and a total of 384 STI participants were recruited to participate in the study. Data were collected using semi structured questionnaire and observational checklists and analysed using Statistical Package for Social Science (SPSS) version 20.Relationship between variables was established using cross tabulations and Chi-square tests (χ2). The quality of IEC services provided to clients attending the STI clinic was sub-standard. This was attributed to inadequate structures and provider practices during provision of IEC. On average, the facility scored 59% on IEC services rendered which is far below the recommended 80% to be regarded as providing quality IEC services. Many participants (65.4% n=251) were not informed about the type of STI they are infected with and acquired limited knowledge on STI signs, symptoms, transmission, complications, prevention, partner notification and return visit. The attendance of group IEC was significantly associated with acquisition of knowledge on STI transmission (χ2=273.347, df=3, p value=0.000) and time adequacy opinion (χ2= 271.806, df=1, p value=0.000). Infrastructure renovations, increasing staff, development of protocols, refresher courses emphasising on IEC messages and interpersonal communication skills are some of the strategies which could improve provision of IEC.
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    Open Access
    Health seeking behaviour of women with cervical cancer at Gynaecological Ward- Zomba and Queen Elizabeth Central Hospitals, Malawi
    (2012-08-01) Chadza, Eleanor Thoko
    Worldwide cervical cancer is the second most common form of cancer in women and the leading female cancer in sub-Saharan Africa, South America and South East Asia. It causes an estimated 275,000 deaths in the world annually with the highest prevalence being in the developing countries. In Malawi, between 2001 and 2002, cervical cancer accounted for approximately 28% of all female cancers nationally. Cervical cancer is preventable and Malawi is one of the African countries that has had the greatest success in introducing cervical cancer prevention and treatment. Despite the effort by the Malawi government to increase sites for cervical cancer screening, women still report late for cervical cancer services. The study was conducted at Zomba and Queen Elizabeth Central Hospital gynaecological wards since these are tertiary health institutions which are also referral centres. It was done to explore health seeking behaviour of women with cervical cancer. The target population for this study was all women diagnosed with cervical cancer that had been admitted at the hospital at any stage but not terminally ill patients. The planned sample size was thirty but it reached saturation at twenty-four participants. Data collection was done using semi-structured interview guide and face to face in-depth interviews which were conducted in Chichewa. The data was analysed using content analysis. The study revealed that women have knowledge of symptoms and risk factors of cervical cancer. However, they lacked knowledge of the causes of cervical cancer as such they thought the symptoms would stop or that they had been bewitched and first visited the traditional healer. The women also encountered a lot of challenges to access health care services. They reported challenges in terms of distance, transport, economic factors, family support and health care providers. The women need to have information about cervical cancer by increasing awareness of the disease through using locally understood messages. Women should be empowered to make decisions about their health as well as financially. More nurses and clinicians should be trained on cervical cancer screening so that all districts and some selected health centres should be able to provide the service to women in order to prevent them from walking long distances. Ministry of Health should prioritize cervical cancer as a national problem and allocate substantial resources for national awareness. There is also need to address the challenges for the women to access the services in an operable state.