Health Systems & Policy

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Open Access
Social interactions among research stakeholders and ethical issues in the context of community engagement in Malawi
(2018-01-01) Nyirenda, Deborah
This 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.
Open Access
Effects of working conditions on healthcare providers’ provision of quality maternal healthcare services at Kamuzu Central hospital and Bwaila district hospital in Lilongwe district, Malawi
(2020-03-01) Mawanga, Jacqueline Zambezi
In developing countries, health workforce is one of the predominant challenges affecting the health care systems’ function of providing quality services including maternal care. The challenge relates to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve maternal healthcare services in hospitals. The research study was assessing the effects of working conditions on healthcare provider’s ability to provide quality maternal healthcare services in two major hospitals; Kamuzu Central hospital and Bwaila district hospital of Lilongwe district. Methods: The research study was a qualitative descriptive approach applying in-depth interviews and focus group discussions using interview and discussion guides respectively. Participants were selected using purposive sampling. Data was digitally collected using audio recorders. The data was manually analyzed using thematic analysis. The study has reviewed many working conditions that surround health workers at maternity departments of these two major public hospitals in Lilongwe district. The status of these identified working conditions received mixed reactions as majority of study participants expressed them as poor and pathetic, and that hugely affects their ability to provide quality maternal healthcare services. Health system and health managers have major role to play in supporting health workers available on the ground in order to improve maternal healthcare services that have higher potential to reduce maternal mortality rates in this country.Both health workers and managers explained their perceptions on existing working conditions and how they are related to work motivation and overall performance.
Open Access
Enablers and barriers to condom use and uptake among young people living with HIV in Mchinji district, Malawi
(2020-03-01) Chirambo, Paul Bingo
Young 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
Open Access
Impact of media training and journalist support on the development of health research reporting in Malaw
(2020-03-01) Phumisa, Josephine Semu
n 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.
Open Access
Factors affecting antiretroviral therapy (art) adherence in adolescent girls and young women (AGYW) at Umodzi family clinic, Blantyre
(2020-03-01) Lakudzala, Suzgika
Adherence 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
Open Access
Measuring the value of an employee assistance program intervention using the workplace outcome suite well-being scales in Malawi
(2020-03-01) Vokhiwa, Maclean
The lack of local evidence on the effectiveness of Employee Assistance Programs (EAP) has restricted the scope of Malawi workplace well-being programs, as well as hindering training for local EAP professionals. Such evidence is relevant to support the spread of EAP into African countries. Global statistics indicate that EAPs significantly improve workplace outcomes (p<0.05) with equal effectiveness across demographic factors. However, the effectiveness of EAP within localised African settings has received little attention in academic research. This study sought to establish the effectiveness of an EAP intervention on work-related outcomes among Malawian employees.It adopts a mixed method, quantitative correlational ‘pre-post’ design to examine improvement over time in employees after EAP intervention, during 2018/2019. The target population was 335 employees working in a local organisation receiving EAP services. Dependent on chance and employee consent, 318 participants enrolled at pre-test and 226 (71%) completed assessments after EAP. The Chestnut Global Partners’ Workplace Outcomes Suit (CGP-WOS) and a basic demographic questionnaire were used. Descriptively, there was no characteristic difference among participants between the two time-points, as well as between post-test responders and non-responders, p>0.05. Paired mean comparison tests indicated statistically significant improvement after EAP in four of five outcome scores. In addition, regression analysis indicated that participant characteristics do not predict this improvement. Furthermore, analysis of themes indicated that the intervention met participant expectations. The study established that EAP locally reduced absenteeism, presenteeism, and workplace distress, and increased employee life satisfaction, p<0.05. It also recommends adoption of EAP policies across Malawian organisations, training of local professionals, as well as the need for rigorous research among local workplace well-being programs
Open Access
Factors affecting the use of mobile technology in patient-provider communication in hypertensive care in Malawi
(2020-03-01) Chilongo, Allan
Evidence suggests that Malawi and other developing countries have benefited a lot through increased adoption of mHealth approaches in service delivery. While the benefits of mHealth are widely published, there lacks a holistic approach in identifying factors that can deter or improve patient-provider communication when using SMS mobile technology in hypertensive care. Objective: Examining factors affecting the use of SMS mobile technology in patient-provider communication in hypertensive care in Malawi. A survey was conducted at Kamuzu Central Hospital and Bwaila Hospital, in the capital of Malawi, Lilongwe. A quantitative approach applying a structured questionnaire was used in this study. A systematic random sampling method was used to obtain its sample of 133 hypertensive patients. A total of 129 participants were interviewed, 89 female (69 %), and with a mean age of 53.2 (SD=8.3). The study has revealed that perception that SMS is a useful tool in communication between the patient and provider (AOR=3.26, 95% CI 1.66 to 6.39), perception that SMS improves quality of care (AOR=5.12, 95% CI 1.57 to 16.71), perception that SMS is easy to use (AOR=4.28, 95% CI 1.35 to 13.50) and perception that the hospital supports the use SMS (AOR=4.11, 95% CI 1.22 to 13.86) were significantly associated with the use of SMS mobile technology. No barrier to the use of SMS among patients in hypertensive care was found. The study has shown that SMS has the potential of improving management of chronic diseases if several factors such as perceived usefulness, perceived ease of use of SMS and social influences are considered when implementing the technology
Open Access
Exploring socio-economic factors affecting utilization of health care among patients with hypertension in Zambia
(2022-03-01) Mwale, Flata
Non-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.

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