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- ItemOpen AccessRegistered nurses lived experiences on family involvement in the care of hospitalised children at Queen Elizabeth Central Hospital, Malawi(2015-07-01) Phiri, Patrick GMCFamily involvement entails that care is planned around the family and the hospitalised child. Families need to be involved because they are custodians of valuable information for provision of care. QECH is the main referral hospital which provides specialised care to children across Malawi. Shortage of nurses is a chronic health problem at this hospital. The average nurse-patient ratio in paediatric unit is ratio is 1:84. This ratio is very high. However, nurses are expected to involve families in child care. Evidence shows that nurses’ experiences about family involvement are key factors in the way care is delivered. Little is known about nurses’ experiences on family involvement in the care of hospitalised children at QECH in Malawi. The objective of the study was to describe registered nurses experiences when involving families in the care of hospitalised children at Queen Elizabeth Central Hospital. A descriptive qualitative design using semi structured interview guide was used. Data was collected from 14 full time registered nurses at QECH and analysed using thematic content analysis. Six themes emerged from the data: Rationale for family involvement, nurses’ experiences on family involvement, power and control, factors influencing nurses’ efforts on family involvement, core concepts of family centred care, factors influencing nurses’ efforts on family involvement and nurses’ impression with family involvement. The findings of this study are consistent with those from western countries and show that registered nurses are knowledgeable on family involvement and their experiences are mixed but are constrained by socio-cultural and institutional factors. These factors should be subjected to further research because their implications may be greater than perceived. The findings support the notion implementation of family involvement is inconsistent. This status quo may continue unless authorities provide support in form of human and material resources and develop a policy.
- ItemOpen AccessKnowledge, beliefs and practices of mothers related to anaemia in under-five children at Kamuzu Central Hospital, Malawi(2015-10-01) Macheso, FelistasChildhood anaemia is a major health burden which contributes to underfive morbidity and mortality in Malawi. It is estimated that 63% of children in Malawi have anaemia, however, anaemia is preventable. The purpose of this study was to explore knowledge, beliefs and practices among mothers whose underfive children were admitted with anaemia at Kamuzu Central Hospital. The study was cross sectional descriptive and it used both quantitative and qualitative methods. The study recruited 198 participants for the structured quantitative interviews and 12 participants were recruited for the qualitative in-depth interviews. The quantitative data was analyzed using descriptive and Kruskal- Wallis H statistical tests using SPSS version 16.0. The qualitative data was analyzed following principles of qualitative content analysis. The findings revealed that majority of mothers were young mothers within the age group of 20-24 years (41.4%; n=82) and unemployed (44.4%; n=88). The findings also revealed that majority of mothers (59.1%; n=117) had average knowledge related to causes and symptoms of anaemia in under-five children. Anaemia in under-five children was positively related to the education status of mothers (p = 0.005) such that mothers with higher education level (college level) had adequate knowledge of anaemia than mothers who had primary or no formal education. The study also found that majority of children had inadequate consumption of food containing iron. In addition, the study revealed that mothers received information related to nutrition from under-five clinics however mothers were not given information related to anaemia. The challenges that participants encountered in accessing health care services for under-five children were long walking distances, lack of medicine and lack of comprehensive screening of children. There is need to educate mothers on early recognition of signs of anaemia in children to prevent complications; update health workers on nutrition counselling, anaemia checkups and follow up. Furthermore, there is need for multisectoral collaboration to improve the health and nutrition status of the children.
- ItemOpen AccessCaregivers’ perception regarding parental participation in care of hospitalised children at Queen Elizabeth Central Hospital, Malawi(2015-10-01) Phiri, LophinaParental participation is one of the cornerstones of pediatric practice. Evidence from literature has shown that effective parental participation depends on caregivers’ preparedness, adequate communication between caregivers and Health Care Workers (HCW) and the negotiation process. Queen Elizabeth Central Hospital (QECH) is the major referral hospital for the country and caregivers stay with their children in the hospital and participate in the care. However, little is known about the perception of these caregivers regarding their participation in the care of their hospitalised children. The study aimed to explore caregivers’ perception regarding parental participation in the care of their hospitalised children at QECH. A descriptive qualitative design using a semi-structured interview guide was used to collect data from 20 caregivers in the pediatric department and thematic analysis was done guided by the Colaizzi method. Seven main themes emerged from the data and these were lack of role negotiation by health care workers, inadequate role preparation for caregivers, care given by caregivers to their hospitalised children, poor HCWs- Caregivers communication, benefits of caregivers’ participation in the care of hospitalised children, needs of caregivers participating in the care of hospitalised children and overall impression of caregiver’s participation. The study findings showed that caregivers view their participation in hospitalised child care as appropriate, important and satisfying. However, gaps exist in the way caregivers participate in the care of their hospitalised children due to inadequate role negotiation, role preparation for caregivers and inadequate information for caregivers. Given this, it is recommended that management should develop protocols and guidelines for the implementation of parental participation in the care of hospitalised children to promote best practices.
- ItemOpen AccessParents' perceptions of available support following diagnosis of childhood cancer at Kamuzu Central Hospital, Lilongwe,Malawi(2015-10-01) Gundo, BeatriceThe purpose of this study was to explore parents' perception of available support following diagnosis of childhood cancer at Kamuzu Central Hospital, Lilongwe, Malawi. The study utilized descriptive design of quantitative research to achieve research objectives. Sixty participants participated in the study. Data were collected using a questionnaire developed by the researcher based on literature review. Statistical Package for the Social Science (SPSS) version 20 was used to analyze the data. Majority of the parents reported that there are nurses and doctors who care for their sick children. They also reported availability of information regarding children’s condition, treatment, food, spiritual support and accommodation if needed. The parents rated highly the availability of treatment (excellent, 68.4%, n=41). Majority of the parents reported that provision of accommodation was good (good, 85%, n=51) and that they are treated as an individual rather than a typical parent of cancer child (good, 100%, n=60). Parents also reported that children are not cared for holistically (e.g. mental, emotional and social needs) instead only their physical needs are met (81.7%, n=49) and all parents reported that there is poor provision of advice on how to get information or to contact other parents, organizations. In relation to treatment, parents reported poor explanation on treatment (70%, n=42), and on the types of cancer services available (80%, n=48). Majority of the parents reported that provision of spiritual support is good (76.7%, n=46) and there is adequate treatment at the facility (83.3%, n=50), however they are not provided with an opportunity to make decisions about treatment (71.7%, n=43).vi The study highlights areas of concern for practice, management, education and research relevant to paediatric oncology. Health professionals need to update themselves on peadiatric oncology through conducting research and attending research conferences on pediatric oncology. They also need to facilitate parents’ access to information and should be able to give timely, appropriate information.
- ItemOpen AccessQuality of care provided to hospitalized under-five children suffering from severe malaria at Kamuzu Central Hospital, Lilongwe, Malawi(2015-11-01) Nyirongo Chiluzi, Blessings ChimwemweBackground: Severe malaria, the number one cause of morbidity and mortality in Africa and Asia causes imminent death in an under-five child if left unattended to. As such provision of timely, quality care to this age-group helps save lives and it also results in 46% reduction of all neurological impairments. To explore and describe the quality of care that is provided to hospitalized underfive children suffering from severe malaria at Kamuzu Central Hospital, Children’s’ Special Care ward. This was a descriptive, study that utilized qualitative approach. Purposive sampling was used to recruit participants. A semi-structured interview guide was used to collect data. Data was collected through face to face in-depth interviews by the researcher from 24th June 2014 to 25th July 2014. A digital tape recorder was used to record interviews with permission of the participants. A total of 25 Health Care Workers (HCWs’) were interviewed. Thematic Content Analysis (TCA) was used to analyze data manually. Demographic data was collected using a questionnaire computed and analyzed using descriptive statistics. Despite the fact that triage was implemented and that very sick children were priotized for urgent care, findings generally indicated that the quality of care that majority of hospitalized under-five children suffering from severe malaria received was poor and below standard. Major attributable reasons for poor quality care were severe shortage of Health Care Workers, poor and unfriendly infrastructures and shortage of essential medical supplies required for resuscitation. Severe shortage of staff, poor infrastructures and shortage of essential medical supplies required for resuscitation resulted in delivery of poor quality care by Page health care workers. It is therefore, recommended that more Health Care Workers should be deployed, there is need for infrastructure renovations and increased hospital funding by government to improve resource mobilization and availability.
- ItemOpen AccessManagement of diabetes and self-care practices among older adolescents with type 1 diabetes at two central hospitals(2015-11-01) Chimbe, EttaThe study aimed at assessing knowledge levels and practices on management of type 1 diabetes among adolescents at Queen Elizabeth and Kamuzu Central Hospital. It was a quantitative research that used a descriptive cross sectional design. The participants were recruited using convenience sampling method, with a total of 46 adolescents. Data was collected using a structured questionnaire on various aspects of diabetes that included knowledge on management, self care practices, type of support and challenges faced in managing the condition. The data was analyzed using two statistical packages; IBM SPSS Statistics version 20, to enter and summarize data and R version 3.1 to analyze statistical relationships between variables of interest. Relationship between demographic variables and knowledge of diabetes was established using spearman correlation for continuous variables and for categorical variables, Chi-square test was used. A total of 63% (n=29) of the respondents knew the cause of type 1 diabetes and 58% (n=42) had inadequate knowledge on managing hyperglycemia. There was a significant association between age and number of admissions (P=0.022) and no link between knowledge and self care practices (P>0.05). Majority (64%, n=28) of the adolescents were injecting themselves with insulin. Sixty four percent (n=39) of the adolescents were inappropriately doing the self monitoring of blood glucose. Majority of the adolescents (70%, n=32) knew why changing insulin injection site is important and 78% (n=36) of them were not counseled on diet plan. Psychological support was the least provided by family (11%, n=13) and health care providers (9%, n=11). Lack of blood glucose monitoring equipment and erratic insulin supply were mentioned as some barriers affecting management and self care practices.vi Knowledge, ability to perform self care practices and support, affects diabetes management behaviors among adolescents. Findings from the study revealed inadequate knowledge amongst the adolescent’s on diabetes and diabetes self care practices. Therefore, there is need to train health care providers on diabetes and develop health education materials for adolescents with type 1 diabetes
- ItemOpen AccessExploring knowledge, attitudes and practice of parents/guardians on home management of diarrhoea in children less than five years in Ekwendeni(2015-12-01) Kasonda, Esau AbrahamThis is a descriptive cross sectional study done to explore knowledge, attitude and practice of parents or guardians on home management of childhood diarrhoea. A semi structured questionnaire was used to interview parents or guardians of children less than five years old who presented to Ekwendeni Mission Hospital for the treatment of childhood diarrhoea and those who visited the underfive’s clinic for growth monitoring and immunizations. The specific objectives for the study were to assess knowledge of parents/guardians on the four basic rules of home management of childhood diarrhoea, to determine the attitude of parents/guardians on modern management of childhood diarrhoea and to find out home care practices of parents/guardians in the treatment of childhood diarrhoea before taking the child to the health facility. The study was conducted at Ekwendeni Mission Hospital in Mzimba District and the sample was drawn from parents or guardians of children aged five years or less who presented to the hospital’s outpatient department with a complaint of diarhoea and those who came to under five’s clinic for growth monitoring and immunizations. The study topic was chosen because it is one of the major concerns of the WHO in the reduction of deaths among children under the age of 5 years since diarrhoea accounts to 16% of all childhood death worldwide (WHO, 2010). Children from developing countries (including Malawi) are the worst hit as diarrhoeal diseases account for an estimated 17.5-21% of causes of death in children less than five years of age (WHO, 2010). However, a few studies have explored issues related knowledge, attitude and practice on management of childhood diarrhoea in Malawi. In addition, the results from the demographic and health surveys in Malawi do not give adequate information on the four rules of managing diarrhoea in children at home. This means that these demographic survey reports do not provide clear evidence on people’s attitude towards modern treatment of diarrhoea. Information from the current study will enable health workers to determine whether information given to parents and guardians on home management of childhood diarrhoea is adequate and if the information given has any impact on the home care practices in the communities. Two sampling methods were used in the selection of participants in this study. A consecutive sampling technique was used in selection of parents or guardians of children with diarrhoea and a random sampling technique was used to select parents or guardians of children who attended the underfive’s clinic at Ekwendeni Mission Hospital. A total of 327 parents or guardians were interviewed using a carefully designed semi structured questionnaire. Among the 327 respondents, 100 (30.6%) were parents/guardians of children who presented with diarrhoea at the time of data collection. Two data collectors administered a questionnaire to respondents at the hospital’s outpatient department from 12th December 2013 to 14th February 2014. Data was coded manually and entered into the computer. Analysis was done using Epi info version 7, a statistical package recommended for health related research. Presentation of results was done using tables and figures. The results have indicated that parents or guardians had partial knowledge about the four rules in home management of childhood diarrhoea. Knowledge about giving more fluids including oral rehydration solution (ORS) was better than knowledge about continued feeding and zinc. Most of the respondents had a positive attitude towards modern management of childhood diarrhoea but lack of resources and lack of knowledge about diarrhoea were the main barriers that affected the recommended home care practices of diarrhoea. It is recommended that health workers should give full information about diarrhoea and its management in order to improve home care practices for childhood diarrhoea.
- ItemOpen AccessExperiences of caregivers of children receiving palliative care at Mzuzu Central Hospital, Malawi(2015-12-01) Chaputula, Bertha MwandidaThe number of children with life threatening and limiting illnesses requiring children palliative care is increasing each and every year. In response to the rising number of children requiring palliative care, family involvement in care giving has expanded. Caregivers play a major role in caring for children with life-limiting or threatening illnesses on palliative care at home as well as in hospital. However, for them to adequately provide the care, they require adequate support.This study reports on the caregivers’ experiences of caring for children receiving palliative care at Mzuzu Central Hospital Palliative Care Clinic. The study was aimed at exploring the caregivers’ experiences of caring for children receiving palliative care. A descriptive qualitative research method was used. The target group was caregivers of children with life threatening or limiting illnesses receiving palliative care at the clinic. A total of 30 caregivers were recruited for the study using purposive sampling technique. Qualitative data was collected using semi structured interview guide for in-depth interviews and a tape recorder while analysis was done using thematic analysis. Findings revealed that caregivers play a major role in caring for their children receiving palliative care. They provide assistance with activities of daily living and health care management in additional to their usual daily chores. The needs of the children receiving palliative care included transportation, finances, information, health care and daily needs. Family members and community members formed part of the caregivers’ support systems. Caregivers of children receiving palliative care reported facing financial, social, physical, and psychological and health service challenges. Proper assessment and availability of adequate support would positively influence the caregiver’s experiences of caregiving and the child’s quality of life. Hence, there is need to develop practical interventions that will lessen the caregivers’ challenges.
- ItemOpen AccessExperiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth Central Hospital(2016-03-01) Joshua Gondwe, MtisungeThe bubble Continuous Positive Airway Pressure (bCPAP) is a form of oxygen treatment given to children with severe respiratory distress. The bCPAP treatment might be stressful to caregivers caring for their sick infants. As such, caregivers may need continuous psychological support and adequate information for them to understand treatment better. This was a descriptive study that utilized qualitative method to explore experiences of caregivers of infants who have been on bCPAP at QECH. Data was collected from a purposive sample of twelve caregivers from Chatinkha and Paediatric nursery wards through in-depth interviews using a semi- structured interview guide. Qualitative data was analyzed using Colazzi’s framework which resulted in identifications of 3 themes; information about bCPAP, perception of caregivers and psychological support. The study found that information given about bCPAP was inadequate and not standardized for caregivers to understand bCPAP treatment. Most caregivers perceived bCPAP as a good treatment that saved lives of their infants. The caregivers were more stressed due to interrupted parent infant interaction and bCPAP machine as they prevented them to be in physical contact with their infants. The family members, friends and religious beliefs were among preferred source of psychological support rather than the healthcare workers. Therefore, the results have shown that there are gaps in providing support to caregivers of infants on bCPAP at QECH in terms of giving information and psychological care. As such, it is recommended that specific interventions be developed to minimize psychological distress and promote psychological health of caregivers with sick infants on bCPAP at QECH.
- ItemOpen AccessDeterminants of paediatric health services utilization at Daeyang Luke Hospital, Lilongwe - Malawi(2016-11-01) Khombe, Ida ApatsaHealth service utilization is crucial for the survival of under-five children. Underutilization of health services is associated with increased number of deaths among under-five children. There was a decline in paediatric health services utilization by under-five children from Daeyang Luke Hospital (DLH) catchment area between the years 2011 and 2013. Therefore, this study was conducted to explore the determinants of utilization of paediatric health services at the hospital. Andersen model of health service utilization was used to guide the study. The study used a cross-sectional descriptive quantitative design for data collection and analysis. A semistructured questionnaire was used to interview parents or guardians of under-five children. The results showed that 97 % (n=146) of parents and guardians had knowledge about the services that are offered at DLH, 98 % (n=147) had good health seeking behaviours in times of sickness of their under-five children, 70 % (n=105) were living within a distance of five kilometers from DLH and 80 percent of the respondents reported good waiting time at the hospital. However, the study also revealed inconsistence in utilization of paediatric services at DLH. Logistic regression analysis yielded significant results in marital status, religion, waiting time, distance, service delivery, bills and distance. Service delivery had almost five times likelihood of influencing service utilization (odds ratio 4.6). Just over half (53%) of parents or guardians could not afford to pay for the cost of care. Therefore, the results warrant the need to subsidize the cost of care to under-five children living within Daeyang catchment area, in order to enhance health service utilization.
- ItemOpen AccessExperiences of mothers separated from their children with pneumonia admitted in the paediatric high dependency unit at Kamuzu Central Hospital in Lilongwe, Malawi(2017-01-01) Chiundu, DianaMothers of children admitted in the paediatric general wards at Kamuzu Central Hospital are allowed to stay with their children in the ward and take part in caring for their children. When a child is very sick and requires high level of care, is transferred to paediatric high dependency unit where the mothers are not allowed to stay with their children all the time. Studies that have explored experiences of mothers separated from their children are limited in Malawi. The aim of this study was to explore experiences of mothers separated from their children with pneumonia admitted in the paediatric high dependency unit. The study utilized a descriptive research design using qualitative method to data collection and analysis. The study was conducted at Kamuzu Central Hospital in the paediatric high dependency unit in Lilongwe, Malawi. Twenty mothers separated from their children with pneumonia admitted in the paediatric high dependency unit were purposively sampled. Data was collected through in-depth interviews using semi structured interview guide. The data was analysed using thematic content analysis. On experiences, five themes emerged: being involved in the care of their children, receiving support and guidance from nurses when providing care to their sick children, negative experience regarding attitudes of nurses and other health workers while caring for their children, feelings of lack of trust on the nurses and other health workers and feelings of anxiety. On satisfaction with care, mothers’ reports were mixed. Some mothers were satisfied with care given while some were not satisfied. On parental needs, three needs were reported: the need to be with their sick child; information about condition of the child; and a good relationship with nurses and other health workers. Taking into account the findings of the study, mothers’ involvement in the care of the child should continue and be encouraged. Mothers should be given enough and continuous information, guidance and support throughout hospitalization. There should be good relationship and mutual trust between nurses and mothers to work hand in hand in caring for the sick children in order to meet their emotional needs. Health workers should avoid shouting at mothers but rather make them understand why some of the ward’s regulations should be followed and for their own benefit. The findings of the study could assist in making the nurses work in partnership with the mothers and support them during the stressful period of hospitalization in the high dependency unit. In addition, the results would also inform managers to develop policies that will address the needs of the mothers in Paediatric high dependency unit thereby improving patient care.
- ItemOpen AccessAssessment of quality of care offered to HIV exposed children under 24 months and their mothers during follow up visit at Mzimba North Health Centre- Malawi(2017-01-01) Chimbatata, Chikondi SharonLiterature in the Sub Saharan Africa indicates that, delivery of quality care during follow up period for HIV exposed children is poor leading to high rates of loss to follow up. According to national statistics of 2015 in Malawi, only 16% of HIV exposed children were retained in care at 24 months. Little is known in Malawi regarding the delivery of quality care to HIV exposed children during follow up period. A descriptive quantitative cross sectional study which was guided by Donabedian (SPO) framework was conducted to investigate the quality of care offered to HIV exposed children during follow up period. A sample size of 250 mother - baby pairs attending follow up visit at Mzimba North Health Centre was recruited. Data were collected using a structured questionnaire which was developed based on study objectives. The objectives were to; assess the availability of physical infrastructure, human and material resources for the delivery of quality care (Structure); to assess if children were provided with care according to national guidelines (Process) and to determine mothers’ satisfaction with the care they were provided during follow up visit (Outcome). Results on Structure found infrastructural deficiencies which included inadequate equipment, clients’ waiting area and counsultation rooms and there were also no counselling rooms while on Process, there was a higher uptake on Nevirapine (97.2%) and cotrimoxazole administration (100%), infant Deoxyribonucleic Acid test (89.2%) and exclusive breast feeding (95.6%) however, counselling and growth monitoring were inadequate. Under Outcome, all mothers were satisfied with the care provided. Overall, there were critical service delivery gaps on Structure and Process. It is critical that more efforts are invested on the improvement of these gaps.
- ItemOpen AccessReproductive health needs and sexual practices of female adolescents with perinatally acquired HIV(2017-01-01) Mkandawire, Beatrice MasoziThe advent of Anti-retrovirals (ARV), a life longing drug, has enabled more and more children with perinatally acquired Human Immunodeficiency Virus (HIV) to reach adolescence, a situation which was not anticipated. These adolescents are at a stage where they are making transition from childhood and are undergoing physical and emotional changes and begin sexual exploration hence are vulnerable to HIV re-infection and other sexual infections. However, to date, this group has received relatively less attention in the field of reproductive health care as most of such services are adult centered. The aim of the study was to explore reproductive health needs and sexual practices of female adolescents with perinatally acquired HIV. An exploratory study utilizing qualitative approach was conducted at Baylor College of Medicine-Lilongwe District, Malawi. A total of ten female adolescents with perinatally acquired HIV, aged between 18-19 years were purposively selected and interviewed using a semi structured interview guide. All the interviews were audio taped and transcribed verbatim. Thematic Analysis (TA) was used to analyze data manually. The study findings have shown that access to comprehensive health information and services remains a challenge. Participants expressed ignorance on other reproductive options available and how to use them. The study revealed that the desire to have children in future was common amongst participants. Participants showed understanding of contraception. However, there seemed to be a huge gap between their knowledge of different types of contraception and access to these services. The study demonstrated that the commonly used contraception was injectable form, due to the secrecy surrounding it. It was noted that participants were sexually active. However, they were not using dual protection methods of contraception despite their HIV sero status. ALHIV need more information, skills, and support to practice healthy behaviours. Tailored interventions are required for adolescents living with HIV to improve their sexual and reproductive health.
- ItemOpen AccessParental involvement in neonatal pain management at Queen Elizabeth Central Hospital, Malawi(2017-09-01) Chimenya Gowero, NetsayiParental involvement in neonatal pain management is an area that is receiving attention under neonatal pain care worldwide because parents can provide non-pharmacological pain management interventions (NPPMI) like therapeutic touch, kangaroo mother care, breast milk, containment or swaddling when their babies undergo painful procedures (Kyololo and Marete, 2014; Golianu et al., 2007). In Malawi, it was observed that involving parents in neonatal pain management is not practiced in most neonatal units as parents are routinely not involved during or after invasive procedures like lumbar puncture, therapeutic tapping, wound dressings, after a baby has undergone surgery and during collection of blood specimens. The involvement of parents in pain care can be of benefit in limited resource countries like Malawi (Molyneux, 2012) to promote pain management. Therefore, this study aimed at describing how parents are involved in neonatal pain management at Gogo Chatinkha neonatal Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi. A descriptive study that used qualitative data collection and analysis method was employed. Participants were parents/guardians of babies who had undergone invasive procedures in the neonatal unit. Data was collected using a voice recorder then it was transcribed word by word, then coding was done to categorise it. Based on the meaning of the coded data, themes and sub themes were developed. Data were analysed manually using thematic content analysis. Findings showed that parental involvement in neonatal pain care is poor. However, parents expressed willingness to take part in invasive procedures in order to provide NPPMI’s. This would in turn improve parental involvement in neonatal pain care and promote the use of NPPMI in Malawian neonatal units hence improve neonatal health. Therefore it was concluded parents should be involved in neonatal pain care with an emphasis on use of NPPM to improve neonatal health.
- ItemOpen AccessAssessing family involvement in chronically ill children health care at Queen Elizabeth Central Hospital, Malawi(2018-01-01) Kamwendo, AniziaFamily involvement has been recognized as the standard of care in caring for children with chronic illnesses. Studies have suggested that family involvement in child’s care increases family understanding of the child’s illness, management and sharing in decision-making between the family and the health care providers. In Malawi, though family members stay with their hospitalized children, they only played a role of providing food and supportive care due to cultural expectations and due to lack of available nursing care. Studies had revealed family members' desires to be involved in both the physical care of their children and in decisions regarding their care. However, there was no information regarding the perception of health providers on family involvement. The aim of this study was to assess the perception of healthcare providers on the practice of family involvement in chronically ill children’s health care at Queen Elizabeth Central Hospital. A descriptive qualitative study was done using semi structured interview guide to collect data from 16 health care providers working with children with cancer conditions. Thematic analysis was done guided by Collaizi’s framework. Five main themes identified from the data were: perception of health care providers on family involvement in the care of children, health care providers’ practice of family involvement in children’s care, inadequate involvement of other family members, lack of care giving role negotiation, factors that facilitate involvement of caregivers in children’s health care and challenges encountered by health care providers to involve families in children’s health care. From the study findings, it was found that there was a discrepancy between the health providers’ perception and practice in regards to most of the areas of family involvement in child’s care. For the few areas that the caregivers were involved, the health care providers only interacted with the caregiver who was available in the hospital with the child, the other family members were not involved. Furthermore, results have shown that health care providers were not aware of their role of negotiating the caregiver role in caring for their children. Health care providers need to have the appropriate theoretical knowledge and practical skills to negotiate roles with the families.
- ItemOpen AccessSexual and reproductive health needs of adolescents growing with perinatally acquired HIV at Mzuzu Central Hospital(2018-04-01) Ngwira, Thom GeorgeAdolescents with perinatally acquired HIV are growing up to adulthood. Data from the Rainbow Clinic in 2015 indicated that there were 94 adolescents growing up with perinatally acquired HIV accessing services at the hospital. Provision of the services at the Clinic is ill-equipped to address the specific age-appropriate sexual and reproductive health needs of adolescents growing up with HIV. This is complicated in adolescents with perinatally acquired HIV who have both psychological and physiological problems. This study sets up to explore the SRH needs for adolescents growing up with perinatally acquired HIV from the service providers and the adolescents themselves. This study was qualitative in nature that used an exploratory design to understand the SRH needs for adolescents growing up with perinatally acquired HIV. Qualitative data was collected from seventeen adolescents growing up with perinatally acquired HIV and five service providers using semi structured interview guides and focus group discussion for a period of approximately four weeks. The thematic content analysis was used to manage and analyse data manually. Study results revealed that a generalised lack of knowledge on sexual and reproductive needs among adolescents growing up with HIV accessing services at the clinic. The clinic also is not yet integrated to provide a full range of sexual and reproductive health services together with HIV services. Access to information on SRH is limited as adolescents are not adequately provided with this information. However adolescents suggest practical strategies to improve SRH service delivery. Adolescents growing up with HIV need age appropriate services that are comprehensive as to assist them with the challenges they face as they grow up with HIV in order to improve their quality of life. The need for adolescents to access services under one roof ensures that adolescents living with HIV can have an easy access to both HIV and SRH services rather than HIV treatment and care alone.
- ItemOpen AccessKnowledge, attitudes and practices of health care workers on management of severe acute malnutrition at Kamuzu Central Hospital, Lilongwe, Malawi(2018-04-01) Chitete Ngoma, Lucy LusekeroMalnutrition is responsible for 35% of deaths among children under five years of age globally (Black et al., 2008). In 2013, an estimated 2.9 million children under-five were admitted globally for treatment of severe acute malnutrition (UNICEF, 2015). The 2015 Malawi annual SAM burden was estimated at about 79, 301 under five children (Kouam, 2016). The need for health care workers to have knowledge in management of severe acute malnutrition has been emphasized in many studies. Evidence has shown that health care workers’ knowledge in management of severe acute malnutrition promote good practices and positive attitudes which result in quality care hence decrease in mortality. The aim of the study was to explore the knowledge, attitudes and practices of health care workers on management of severe acute malnourished children at Kamuzu Central Hospital. This was a cross sectional descriptive study. Participants were from the paediatric department. Simple random sampling was used to select 51participants for the study. A structured questionnaire and observation checklist were used to collect data. 9 observations were done on actual provision of care. Analysis was done using the Statistical Package for Social Sciences (SPSS) version 20. Findings on knowledge, attitudes and practices of health care workers were presented in descriptive form using tables, graphs, charts and percentages. Majority of the participants were females with a ratio of 4:1. High number of participants were in the age range of 25-34. Overall, 65% of health care workers had inadequate knowledge in management of severe acute malnutrition. 75% of health care workers had positive attitudes towards management of severe acute malnutrition. In practice, health care workers did not follow the recommended guidelines in management of severe acute malnutrition. Correlation between knowledge and practices as well as attitude and practices was not significant (p> 0.05). Shortage of staff, lack of resources, lack of adequate space and lack of in-service trainings in management of SAM were some of the challenges mentioned by most respondents. Health care workers did not have adequate knowledge in management of severe acute malnutrition which led to substandard care. The study recommended in-service trainings of health care workers in management of SAM. Training institutions should also strengthen the pre-service curriculum on managing children with severe acute malnutrition.
- ItemOpen AccessExperiences of caregivers of children with hydrocephalus at Queen Elizabeth Central Hospital(2018-04-01) Chidziwisano, CynthiaThe impairment of cortical connectivity involving the afferent and efferent pathways in hydrocephalus usually leads to cortical pathway dysfunction. Consequently, in most of the affected children the dysfunction is permanent causing both motor and cognitive deficits and behavioral difficulties. This causes the affected child to entirely depend on the caregiver for all daily functions. Therefore parents are responsible for helping the child in all the activities of daily living. Understanding parents’ experiences has the potential to improve parent–professional collaboration and the management of the child’s condition. To explore parents’ experiences of living with a child with hydrocephalus and their responsibility of having to care for a growing child who is entirely dependent on them. Design and methods: A descriptive qualitative method was undertaken, and twenty caregivers were interviewed using an in depth interview guide. Six themes were identified; strange illness, financial constraint, work overload, social stigmatization and support system. The identified themes were all from the parent’s verbalized experiences, the caregivers referred to hydrocephalus as a strange disease which they have never heard or seen. Financial constraint is a major challenge arising from their failure to work or do business and from frequent hospitalization. Social stigmatization was another major challenge which was deterring the caregivers form participating in important community events. Furthermore support system involved the support the caregivers received from their friends and relatives, health professionals and the organizations. Therefore, caregivers of children with such a condition must cope tremendous emotional, physical and economic burdens, although in the course of this, they gain a vast experience on care management approaches of the affected child. Therefore collaboration with parents requires health professionals to listen to parents’ concerns and value their experiences.
- ItemOpen AccessManagement of dehydration in under-five children with acute gastroenteritis by nurses and midwives in selected health centres in Lusaka, Zambia(2018-07-02) Benkele, Rodgers GiftDehydration is a major cause of child mortality in sub-Saharan Africa. In Zambia child mortality rate from diarrhoea is 68 deaths per 1,000 live births despite implementation of child survival interventions. A descriptive quantitative study with triangulation of data collection methods and guided by Donabedian’s Quality of Health Care Framework was conducted to assess management of dehydration in under-five children with Acute Gastroenteritis (AGE) in selected health centres in Zambia. The specific objectives were; to assess availability of resources (structure) in the management of dehydration in under-five children with Acute Gastroenteritis; to examine the process of management of dehydration in under-five children with Acute Gastroenteritis; to evaluate caretaker satisfaction (outcome) with care given during the management of dehydration due Acute Gastroenteritis; and to analyse associations between healthcare provider characteristics, caretaker satisfaction and case management. Simple random sampling method was used to recruit 155 nurses who answered a self-administered questionnaire and 58 who were observed; and 58 caretakers who participated in exit interviews. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 24.0. Chi-square tests were used to determine significant relationships between healthcare provider characteristics, caretaker satisfaction and case management. Quality of management of dehydration due to AGE in under-five children was inadequate. Structurally, nurses and midwives had inadequate knowledge on dehydration management. Only 25.8% had knowledge that age is used to determine duration of rehydration. On process measure, only approximately 40% of the cases were well managed. Significantly in-service training improved case management (CI 95%, p=0.000). Caretaker satisfaction was significantly associated with interaction with nurses and midwives (CI 95%, p=0.000).
- ItemOpen AccessExploring parent's participation in the care of their hospitalised children in a general paediatric ward at Zomba Central Hospital, Malawi(2018-10-01) Nsitu, George YotamuParental participation is regarded as an essential element of the quality of care for hospitalised children, and is the main element of Family Centered Care (FCC). Parental participation has been perceived significant in the reduction of adverse effects of hospitalisation and anxiety, and improvement of satisfaction. Parents in Malawi are allowed to stay with their sick children and participate in the provision of care in the ward. Their participation extends to the performance of almost all tasks related to care due to shortage of staff, which is critical in most public health facilities. The parents’ perspective of their participation in the care of the sick children in a paediatric context had not been explored in Malawi. This study therefore, aimed at exploring parents’ participation in the care of their hospitalised children. The study used a descriptive qualitative design, and it involved parents of children hospitalised for more than forty-eight (48) hours in a general paediatric ward at Zomba Central Hospital, Malawi. Purposive sampling method was used, and twenty three (23) parents who met the inclusion criteria and gave consent participated. Collection of data involved the use of an interview guide through face to face interviews and all responses were audio recorded. Findings showed that parents participate in care through roles which are not different from roles performed at home. The roles include mainly providing physical care and emotional care. There were various reasons also for the parents to participate in care that the study revealed. Parents’ participation is not without challenges. Challenges included limited support and guidance in care provision, and limited family support and needs. The study has highlighted other significant areas also that need the health worker’s attention if parental participation is to assist in improving the care outcomes of the hospitalised children. It was therefore recommended that policies and guidelines be formulated in the department, to guide parental participation in care.