Midwifery

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Open Access
Factors associated with alcohol and drug abuse among secondary school students in Lilongwe urban1917
(Kamuzu College of Nursing, 1997) Nkhope, Saukira Louisa
Open Access
Factors That Influence Nurses Utilisation of Knowledge Gained from In-Service Education at Lilongwe Central Hospital
(2000-04-14) Janet H. Botha
In-service education for nurses often results in improved quality of patient care as well as personal and professional growth pf the participants. These outcomes are not achieved if nurses encounter barriers in attempt to implement the knowledge gained from in-service education into practice. This quantitative study aimed at determining factors that inhibit or encourage the use of knowledge gained from ISE. The study was conducted at Lilongwe Central Hospital in December in 1999. A sample of 35 participants; 15 Registered nurses, 7 senior enrolled nurses and 13 enrolled nurses completed an anonymous semi-structured questionnaire developed by the researcher. The force field theory provided framework of the study. Data was analysed using the computer through the Statistical Package of Social Sciences (SPSS) windows release 8.0. The findings indicated that participants had attended in-service education as important. However, 40% of the participants had attended in-service education only once despite having been practicing in the nursing profession form one year to 14 years. Data suggests that 74% of the nurses lack adequate resources and supplies to enable them to put into practice what they had learnt from in-service education. Support from fellow staff members was singled out by 60% of the participants as a major encouraging factor. Other determining factors to use knowledge were follow-up by facilitators, reduced workload and proper ward allocation. However, almost all the nurses indicated that they were able to implement whatever knowledge they get from in-service education. The study has implications to nursing practices, education, research and management. The findings suggest the need for participant involvement from the planning phase of in-service education to implementation since nurses cannot make use of knowledge if they encounter any barriers in the process of implementing the knowledge.
Open Access
Knowledge of hypertension among female clients with hypertension at Kamuzu Central Hospital
(Kamuzu College of Nursing, 2006-12-11) Nyirongo Ndindase Tiwonge
Open Access
Experiences of antenatal mothers staying in a maternity waiting home at Malamulo Mission Hospital in Thyolo
(2011-03-01) Sundu, Susan
In many areas of the world, and especially in Sub – Sahara Africa, utilization of maternal services is low. In low-resource settings, cost, distance, and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; one of these strategies is the maternity waiting homes (MWHs), but few studies have reported or evaluated the impact of the wide scale implementation of the strategy. This study was conducted to explore antenatal mothers’ experiences of staying in MWHs in Thyolo District. A qualitative, phenomenological study was conducted utilizing on audio-taped, semi-structured in-depth interviews (IDIs). A purposive sample selection of 15 antenatal mothers staying in MWHs was recruited. The lived experiences of these 15 mothers were revealed through IDIs. The findings on antenatal mothers’ experiences of staying in MWHs revealed several things including motivating factors, benefits, and challenges of staying in MWHs. Some of the motivating factors were proximity to the hospital, birth by skilled attendance, and availability of specialized care. The benefit of staying in MWHs was that the antenatal mothers had adequate time to rest, a thing which was rare at home. They enjoyed peace of mind because they did not have to worry about how they would get to the hospital if labour started, and they made new friends while in MWHs. Challenges that the antenatal mothers reported during their stay in MWHs were lack of privacy, poor sanitation, pests, congestion, poor attitude of midwives, and adverse cultural practices. Antenatal mothers who reside long distances from the hospital need to be encouraged to wait in MWHs for two to three weeks before the expected time of delivery where they can receive adequate medical care should complications arise. Health workers need education and training on interpersonal skills, ethics, and attitudes to address the issue of poor attitude of midwives. This could portray a better midwifery image to the community. However, further studies should be conducted on client – provider interaction to address the poor attitude of midwives. Additionally, the hospital management needs to improve the infrastructure in MWHs, and spray the buildings regularly with pesticides to eliminate mosquitoes, ants, and fleas. The findings indicate the need to address the challenges which will increase the utilization of MWHs. When the challenges are addressed, the number of antenatal mothers utilizing MWHs will increase leading to improved pregnancy outcome.
Open Access
Early hospital discharge following childbirth: Mothers' experiences during the first week of the postpartum period at home in Mzuzu City, Malawi
(2011-03-01) Kalale Chirembo, Judith
There has been a dramatic decrease in the length of time mothers remain in hospital following childbirth, which may affect the health outcome of the mother and neonate in the immediate postpartum period. This is because mothers may have health needs and concerns during the immediate postpartum period related to physical recovery from childbirth, neonatal care, and family relations that may need the midwife’s attention. Hence, a descriptive phenomenological qualitative study was conducted to explore mothers’ experiences during the first week of the postpartum period following early hospital discharge after childbirth in Mzuzu City, Malawi. In-depth interviews were conducted with 26 participants. All participants had given birth within six weeks prior to interviews and were discharged from the hospital within 24 hours after delivery. Data was tape-recorded and field notes were taken to complement the recorded data. Narratives were analysed following Collaizz’s technique. The results indicated that the majority of participants and their neonates experienced health problems during the first week of the postpartum period. Maternal problems included abdominal pains, excessive bleeding, breast problems and general medical health problems. Neonates experienced neonatal infections such as eye, skin, gastro-intestinal, and general health problems. Very few participants in this study sought medical care for the health problems they or their neonates experienced. However, almost all the participants attended the one-week scheduled postpartum check-up visit. Furthermore, the study revealed that the majority of participants received support from family members, specifically from their mothers, mothers-in-law, husbands, and neighbours during the first week of the postpartum period. The study further revealed that mothers were either satisfied or dissatisfied with early hospital discharge depending upon the extent of family support they received, the hospital environment, the amount of information they received and health assessment that was conducted in preparation for early hospital discharge, and their personal health status. The results further indicated suggestions for improving the practice of early hospital discharge. Suggestions included follow-up through home visits, telephone calls, scheduled postpartum check-up visits at the hospital and self-report to the hospital if any problem arises. The study adds insights into health problems that mothers experience during the first week of the postpartum period following early hospital discharge. Therefore, preparation for early hospital discharge should include a thorough health assessment of both mother and neonate to ensure that they are healthy before discharge. Midwives should also educate mothers on normal physiological changes during the postpartum period and that certain signs and symptoms indicate serious health problems. This information will help them to differentiate normal experiences from abnormal ones. There is a need for further research to explore the prevalence and types of maternal and neonatal health problems following early postpartum hospital discharge. Furthermore, exploration of the factors that contribute to postpartum health problems in the home during the early postpartum period is necessary. This knowledge will assist in guiding the care and education of mothers following childbirth.
Open Access
Factors that are associated with adolescents health seeking practices during pregnancy in Blantyre rural
(2011-03-01) Mbiza, Christina Ruth
Strategies to improve the pregnant adolescent‘s health need clear understanding of the patterns and determinants of the adolescent‘s health seeking practices. This research study, guided by Kroeger Model, explored factors that are associated with adolescent health-seeking practices during pregnancy in Blantyre rural. The study objectives were to assess individual factors that are associated with adolescent‘s health-seeking practices during pregnancy, determine psychological factors that are associated with adolescent‘s health-seeking practices during pregnancy, and to identify health service factors that are associated with adolescent‘s health-seeking practices during pregnancy. A descriptive quantitative design was used. A total of 240 pregnant adolescents and adolescents who delivered within the previous 6 months, aged between 13 and 19 years were selected using Purposive sampling. Data was collected using a structured interview guide and analyzed using SPSS version 16.0. The results identified individual, psychological and health service factors that hinder adolescent‘s health-seeking practices during pregnancy. The individual factors were low level of education 72.5%, inability to make decisions as regards to care 73.8%, inadequate knowledge 44.16 % related to health seeking practices, under age 40.8%, and marital status 30 %. The psychological factors were shyness 85.8%, fear 84.2%, reluctance to open up 50.8 %, denial and concealed pregnancy 49.6%, and stigma, 34.2%. The health service factors were transport 80.4%, distance 79.2%, a lack of provision of adolescent friendly services 72.5%, and inaccessible roads 62.9%. The factors found to promote health seeking practices were provider‘s sensitivity on adolescent‘s issues 44.6%, free services 19.2%, skilled care 6.3%, and trust 6.3%. The factors identified can provide a basis for improving the services there by promoting adolescent health seeking practices during pregnancy. The study recommends that health education and counseling of pregnant adolescents should be strengthened. Efforts to increase the adolescent's status and decision-making power should be made through community mobilization by empowering adolescents, parents, and the community with knowledge about adolescent‘s pregnancy. There is need to establish and/or make existing health facilities more youth friendly and ensure that policies regarding pregnant adolescents are being implemented. Every effort should be made to facilitate accessibility of pregnant adolescent services.
Open Access
Factors influencing utilization of prevention of mother to child transmission of HIV services in young adults in Balaka District
(2011-03-01) Muheriwa, Rose Sadandaula
One of the most tragic consequences of Human Immunodeficiency Virus (HIV) infection in women is the transmission of the virus to their children. It is estimated that, during the year 2005, 17.5 million women and 2.3 million children worldwide were infected with HIV (UNAIDS, 2006). Ninety percent of these children acquired HIV through Mother to Child Transmission (UNAIDS, 2008). Transmission of HIV from mother to child can be reduced with Prevention of Mother to Child Transmission (PMTCT) of HIV services. The purpose of this study was to explore factors that might have influenced utilization of PMTCT services in young female adults aged 15 to 24 years in Balaka district. The specific objectives were to: (i) identify the knowledge of the young adults that might have influenced utilization of PMTCT services, (ii) identify the beliefs of the young adults that might have influenced utilization of PMTCT services, (iii) describe the relationship between knowledge and utilization of PMTCT services in young adults, (iv) describe the relationship between attitude of young adults and utilization of PMTCT services, and (v) describe other contextual factors that might have influenced decisions on utilization of PMTCT services in young adults. This study used quantitative and qualitative methods. The sample size for quantitative component was 184 women, who had delivered in the past 18 months and had utilized PMTCT services. For the qualitative component, 12 participants from the quantitative sample were selected by purposive sampling where every 10th participant was picked. A structured questionnaire was used to collect quantitative data and a semi structured interview guide was used to guide an in-depth interview. Descriptive statistics were computed using Statistical Package for Social Sciences (SPSS) version 16. Content analysis was used to analyze the qualitative data. The results revealed that, overall the participants had general knowledge about PMTCT services. However, they lacked comprehensive knowledge about the services hence actual utilization of the services was poor. Statistically significant difference was found between knowledge and utilization of PMTCT services. The participants had positive beliefs and attitude towards PMTCT services, however not all positive attitudes translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. It is recommended that community mobilization on prevention of mother to child transmission of HIV should be conducted in the district to promote awareness, reduce stigma and discrimination, and improve utilization of PMTCT services. Monitoring and evaluation activities and in-service education for health workers should be emphasized in order to enhance provision of comprehensive care to HIV positive pregnant women.
Open Access
Assessing quality of focused antenatal care provided to pregnant women at Bwaila Antenatal Clinic in Lilongwe District
(2011-03-01) Lungu, Florence Tamanda
Although antenatal care coverage is high in Malawi (93%), worrying gaps exist in terms of its quality and ability to prevent, diagnose, or treat complications. According to Multiple-Indicator Cluster Survey (MICS, 2006), there is limited content of focused antenatal care services (FANC), indicating that pregnant women are not getting the quality care that would assist in the identification and management of complications. This contributes to the risk of maternal and neonatal mortality in Malawi which is currently 675 per 100, 000 live births and 33 per 1, 000 live births respectively (Malawi EmNOC Needs Assessment Report, 2010). The purpose of this study was to assess the quality of FANC services provided to pregnant women at Bwaila Antenatal Clinic in Lilongwe District. Specifically, the study identified the availability and functioning of the basic infrastructure and material resources necessary for offering quality FANC services. It also aimed at exploring the process of delivery of quality FANC services provided during antenatal consultation. Additionally, the study determined if provision of FANC services at Bwaila Antenatal Clinic met the required reproductive health standards as stipulated by Ministry of Health (MoH) in Malawi. A descriptive quantitative study was conducted on a convenience sample of 369 antenatal mothers. Following informed consent, these mothers were interviewed using a structured questionnaire to assess the perceived quality and content of FANC services provided during consultation. A checklist was used to assess structural quality and to determine if FANC services at Bwaila Antenatal Clinic met the required standards, as stipulated by Ministry of Health in Malawi. Descriptive statistics were computed using SPSS version 10.0. Study findings indicated proper structure for providing FANC services. Consultation rooms had basic equipment and essential drugs for providing FANC services. However there were inconsistencies in taking comprehensive history, incomplete physical examination, inadequate laboratory investigations and poor health education. There was lack of reagents for investigating Heamoglobin (Hb), and Syphylis. Only reagents for HIV test were readily available. Based on the national reproductive health standards; Bwaila Antenatal Clinic scored above standard on structural quality (87%) and below standard in performance (60%). It is recommended that community mobilization and training of health care providers be conducted in the district to promote awareness of the new approach in order to provide evidence based practice. The necessary material resources for providing FANC should be consistently supplied to provide an enabling environment for providing FANC services.
Open Access
Factors associated with home deliveries in Thekerani Area in Thyolo District
(2011-03-01) Kamoto Chanza, Dorothy
The study aimed at exploring factors associated with home delivery in Thekerani Area in Thyolo District. In order to achieve the objective, a quantitative descriptive design was utilized for the study. The target population consisted of women attending under-five, postnatal, and family planning clinics at Thekerani Health Centre in Thyolo district, located in the southern region of Malawi. A convenient sampling technique was used to select a sample of 253 mothers. Data was collected through face-to-face interviews using a structured questionnaire. Statistical Package for Social Sciences (SPSS) version 16 was used to analyze the data. Descriptive statistics such as range, means, frequencies, and percentages were utilized to analyze the data. The results indicated that 80% of the mothers were in the age group of 20-35 years with an age range of 13-44 and mean age of 29 years. Sixty-two percent of the mothers had some primary education while 32% had no education. The study revealed four main factors influencing women to have a home delivery. Seventy-eight percent of the mothers indicated long-walking distance to a health facility compounded by lack of transport; 31% of the mothers mentioned traditional beliefs such as trusting in the experience of elderly women, and 31% reported deep rooted beliefs in herbs; 52% indicated lack of financial support while in hospital and poor attitudes of health workers whereby 40% of the women indicated hostile behavior of health personnel towards patients in labor and 38% of the women indicated that women are left to deliver on their own without supervision. Based on the findings, it is recommended that the government and non-government organizations should provide bicycle ambulances to each group village headman for easy transportation to health facilities; Awareness campaigns on birth preparedness and complication readiness should be conducted. Efforts should be made to reduce the distance to EMOnC services by providing infrastructure for delivery services with skilled attendance. Government through Thyolo District Hospital should consider upgrading existing primary health care centres such as Nkhata-ombere and Nsabwe Health Centres to provide EMOnC services. Improving financial status of women in the rural areas is also recommended. Thyolo District Assembly should influence local Non Government Organizations (NGOs) to provide capital funds (in form of loans) to the women in the area to engage in Income Generating Activities (IGAs) in order to strengthen their economic/bargaining power to influence place and timing of delivery. The community should be educated on combating harmful practices. Supportive supervision is also recommended in order to improve health workers poor attitudes towards laboring women.
Open Access
Factors associated with HIV positive pregnant women's participation in prevention of mother to child transmission of HIV programme at Thyolo District Hospital, Malawi
(2011-05-01) Chanachi, Serra
The Prevention of Mother to Child Transmission (PMTCT) of HIV program aims at reducing transmission of HIV infection from mother to child. The problem worldwide is that very few HIV positive (HIV+) pregnant women utilize PMTCT of HIV services. The purpose of this study was to identify factors that influence HIV+ pregnant women’s participation in PMTCT of HIV program at Thyolo District Hospital, Malawi. This was a quantitative descriptive research study conducted at Thyolo District Hospital. A total of 106 HIV+ pregnant women, attending antenatal care services participated in this study. A convenient purposive sampling was used to select the study respondents and a structured questionnaire with 46 questions was used to collect data from the respondents. The data was analyzed by the computer package called Statistical Package for Social Science, (SPSS) version 16.0 windows. Results of this study showed that knowledge on Mother to Child Transmission (MTCT) and PMTCT of HIV among HIV+ pregnant women was very high and this significantly influenced utilization of PMTCT services. Among the respondents, 99.1% (n = 105) heard about MTCT and were able to mention the period of time when the virus can be transmitted from an infected mother to the baby. The most frequently mentioned period was during delivery (83 %, n = 88) followed by during breastfeeding (77.4%, n = 82) and during pregnancy (54.7%, n = 58). However, 1.9 %, n = 2 of the respondents did not know any way of how an HIV + pregnant woman can transmit the virus to her baby to her baby. In addition, 87.7 % (n = 93) of the respondents heard about PMTCT of HIV. All the study respondents (100%) were able to identify at least one way of PMTCT of HIV. Most frequently mentioned way was through practicing exclusive breast feeding (46.2%, n = 49) followed by having safe delivery at hospital (44.3%, n = 47). However, 9.4 %, n = 10 of the respondents did not know any way of PMTCT. Other significant factors noted to influence the utilization of PMTCT services were educational level and knowledge of own HIV status before pregnancy. Most of the study respondents (78.3%, n = 83) had some education and (57.5 %, n = 61) had knowledge of their HIV status before they became pregnant and starting antenatal care. Some of the factors noted to hinder participation included distance to the PMTCT of HIV clinic and stigma and discrimination on HIV in the community. Most of the respondents (73.9%, n = 78), reported taking one to four hours to get to the clinic. This study found that stigma and discrimination against HIV and AIDS exists in Thyolo district because 1.1 % (n = 1) of the respondents were abandoned after disclosure of HIV + results to their spouses. The study recommends that MOH should embark on IEC campaigns to improve knowledge on MTCT and PMTCT in the community and men should actively be involved. Additionally, there should be community based education and sensitization regarding HIV and AIDS, and specific education against stigma and discrimination. Furthermore, this study recommends that MOH should increase access to HTC services to all women of reproductive age so that they should know their status before they become pregnant. Additionally, referral from HTCT clinics to family planning, and PMTCT of HIV program should be strengthened. This study also recommends that MOH should also ensure an adequate number of health workers including support staff who are also trained in PMTCT of HIV in all PMTCT sites. All PMTCT staff should be supportive, and should take great care to ensure confidentiality and privacy. The study recommends that individual and couple counseling should be stressed in all PMTCT of HIV clinics. All clients should be treated as individuals and more time should be set aside for counseling each client for them to make informed decisions. All PMTCT staff should have good attitude, be supportive and should take great care to ensure confidentiality and privacy. This will also ensure that adequate information is passed to all clients. Evidence by several researchers has shown that HIV+ pregnant women fail to participate in PMTCT services because of bad attitudes of health workers (Varga, 2008), fear of their status being disclosed to other people, and fear of being discriminated by health workers, family and community members Kasenga, Hurtig, and Emmelin (2008); andNjunga (2008). This study recommends that PMTCT of HIV should be incorporated in pre-service education curriculum and should also be part of topics taught during in-service education. This will ensure that all nurse/midwives are knowledgeable on PMTCT and able to offer the service at all levels. Furthermore, this study recommends that more studies should be conducted in the area of PMTCT of HIV. These studies may be such as adherent to PMTCT program and experiences of HIV + pregnant women who go through PMTCT program. All participants in this study were participating in PMTCT program but we don’t know if they were able to adhere to the program protocols.
Open Access
Quality of care offered to HIV positive pregnant women during routine opt out HIV testing and counselling in Dedza, Malawi
(2012-08-01) Khonje Mtumbuka, Ellasy
Following a joint policy statement by the WHO/UNAIDS in 2004 and also a policy statement in the National HIV/AIDs policy of 2003, HIV Counselling and Testing is offered routinely in antenatal clinics in Malawi, known as opt out HIV testing and counselling. The aim of this study was to describe the quality of the care offered to HIV positive pregnant women during routine HIV testing and counselling at the antenatal clinic. The study utilized a descriptive exploratory design using qualitative phenomenological method and was guided by Donabedian quality conceptual framework. The study was conducted at the antenatal clinic of Dedza District hospital in the Central Region of Malawi. Twelve HIV positive antenatal women between the ages of 15-49 were purposively sampled and interviewed through in depth interviews using semi structured interview guide. In addition, a check list was also utilized to observe and examine the structure elements in HIV testing and counselling and health workers present at the time were also interviewed to verify the findings on structure attribute. Observation was also utilized to supplement the findings from the in depth interviews. Data was analyzed through thematic content analysis. The findings revealed inadequate infrastructure, lack of some necessary resources and lack of adherence to guidelines as structural issues affecting the quality of HIV testing and counselling. Women made the decision about HIV testing at home prior to visiting the antenatal clinic and were well aware of HIV and its related issues. Women were primarily motivated to get tested in order to know their status so they could protect their baby and get access to treatment and care. The findings also revealed that the right to opt out of the test was not mentioned by the providers before administering the test and there were some women who were not aware of that possibility. In addition the findings revealed some gaps in the counselling process, more especially during the pre test counselling. However the data revealed that the participants were satisfied with the care and the services provided, and emotional needs and well being of participants was well taken care of by the counselors. As a result, a majority of the participants had disclosed their status to someone especially the partner even though some of the partners had not yet gone for testing. The results of this study indicate that there are still some gaps during HIV testing and counselling especially on the structure and process attributes. Therefore there is a need to ensure quality in HIV testing and counselling services if clients are to benefit from HIV services available. Supportive supervision is necessary to ensure adherence to the guidelines by the service providers so that women receive appropriate and adequate information before and after the test to make informed decisions. In addition there is need for continued community awareness campaigns to ensure that the women have the right information on HIV and PMTCT. Availability of resources is necessary more especially test kits to ensure timely diagnosis of HIV. This is a critical issue considering the damage that the virus causes to the immunity of the person who is infected who does not begin treatment, so that the woman can benefit from timely interventions. Finally there is a need to encourage couple counselling as this will ensure that more men are tested together with their partners and provide support in preventing mother to child transmission to their partners. This will in turn contribute towards the achievement of the goals of the prevention of mother to child transmission programs and hence assist in the reduction of the maternal and neonatal mortality rates.
Open Access
Intention and decision making regarding contraception acceptance among tertiary school adolescents in Blantyre District, Malawi
(2012-08-01) Kapito, Esnath Mwayiwawo
There is low contraceptive use reported in most of sub-Saharan Africa including Malawi despite adolescents indulging themselves in risky sexual and reproductive health behaviours such as unprotected sexual activities. This study explored intentions and decision making regarding contraceptive acceptance among tertiary school sexually active adolescents in Blantyre district in the southern region of Malawi. A qualitative basic interpretive design was used for the study involving 18-19 year old male and female adolescents. A purposive sampling was used and a total of 23 (13 female and 10 male) adolescents participated in the study. Data was collected through in-depth interviews using a semi-structured interview guide. Descriptive statistics were computed for demographic data while the qualitative data was analysed by manifest content analysis using verbatim transcription from which categorises and themes were created. Five themes emerged from the data, which included contraceptives information; contraceptive knowledge; attitude towards contraceptive use; consistency in contraceptive use and motivating factors for contraceptive use. Some respondents had positive attitudes towards contraceptive use which were developed from knowledge on the benefits of contraceptives hence avert the negative consequences of sex. Adolescents reported that they had self efficacy to use condoms. They also admitted to have perceived behaviour control in terms of time, opportunity and resources to use condoms. While most adolescents in this study were using less effective contraceptive methods, other respondents were not using any contraceptive at all. Use of condoms, withdrawal and calendar methods were well-accepted as compared to the other methods such as the pill, Norplant and injectable contraceptives. Contraceptives that require a health facility consultation were unpopular to the adolescents. Lack of adequate and accurate information was found to be a major hindrance to contraceptive use among the respondents. Information gaps were identified in other contraceptive methods except the condom which was found to be the most widely discussed and used among the adolescents. Religious, cultural and societal beliefs of the respondents held negative attitudes on premarital sex and consequently the use of contraceptives among adolescents. Despite adolescents adopting this negative attitude towards sex, they still indulged in sexual relationships. Rampant misinformation jeopardised the knowledge respondents had consequently hindered contraceptive use as respondents developed negative attitudes towards contraceptives. Respondents lacked details on contraceptives as well as how they are properly used. There is need for the health educators, teachers, parents and others to reach out to the adolescents with accurate information about sex and contraceptives. Civic education should emphasise the positive aspects of contraceptives to the public in general and particularly adolescents in order to increase their awareness, which can affect the intention to use, and the actual use of contraceptives. Adolescents need to be assisted to have goals in life which can help them focus on their future hence delay pregnancy beyond adolescence.
Open Access
Factors leading to postnatal mother's delay to access basic emergency obstetric care at Khombedza Health Centre in Salima District
(2012-08-01) Kupatsa Botha, Alliet
The majority of maternal deaths occur during labour, delivery, and within 24 hours postpartum. Apart from medical causes, there are numerous inter-related socio-cultural factors which delay care-seeking and contribute to these deaths. Delay in problem recognition or deciding to seek care outside the home is delay number one on the causes of maternal deaths. Birth preparedness and complication readiness are interventions designed to address delays by encouraging pregnant women, their families and communities to effectively plan for birth and prepare for emergency if they occur. Therefore the study explored factors that lead to postnatal mother’s delay to access basic emergency obstetric care at Khombedza Health Centre in Salima District, Central Region of Malawi. The study design was cross sectional and utilized qualitative data collection and analysis methods. The target population consisted of postnatal mothers who delay in arriving at Khombedza Health Centre for basic emergency obstetric care in Salima District of the Central Region in Malawi. Purposive sampling technique was used to select a sample of 15 mothers. Data was collected through in-depth interview using a semi-structured questionnaire. Content analysis was used to analyse the data and the emerging themes and sub themes are reported as results of the study. The majority of the mothers were in the age group of 20-35 years with the age range of 18-40 and the mean age of 25 years. The majority of the mothers had some primary school education and they were all married. All the postnatal mothers attended antenatal care. The emerging themes from the participants’ narrations were: decision to seek care, access to care, distance and cost. Most of the participants lacked knowledge on birth preparedness and recognition of obstetric danger signs. The finding further indicated that the midwives did not provide quality ANC, and information content was very low. Generally participants were satisfied with the care they received from the facility. The study identified poor comprehension of knowledge and practices about preparation for birth and its complication by mothers in the area. Client education about preparation for birth and its complication and empowerment of women through expansion of educational opportunities are important steps in improving birth preparedness and complication readiness among women. Antenatal care clinics should give due emphasis to preparation for birth and its complication and provide information and education to all pregnant women to prevent delay in accessing obstetric care.
Open Access
An exploration of midwives and clients experiences of emergency caesarian section at Bwaila Maternity Unit
(2012-08-01) Mwale, Ruth Cynthia
Worldwide 35.7 % of women suffer from major complications post caesarian section (Mukherjee, 2006). These include but are not limited to pelvic infection, generalized sepsis, deep vein thrombosis, and minor complications such as fever, urinary tract infections, and wound sepsis. Major complications are almost double in emergency caesarian sections compared to those in elective caesarian section. There is evidence that preoperative care rendered to mothers before emergency caesarean section helps to reduce complications postoperatively. A study was conducted at Bwaila maternity unit to determine midwives’ and clients’ experiences of preoperative care before emergency caesarean section. The objectives of the study were: to establish midwives’ perception of the components of standard preoperative care of clients undergoing emergency caesarian section; to assess midwives’ actions on components of standard preoperative care for emergency caesarian section; to determine clients’ perception of the preoperative teaching rendered to them prior to undergoing emergency caesarian section; to determine clients’ reaction to preoperative care they received prior to undergoing emergency caesarian section. to determine if there was an association between preoperative emergency care rendered and the incidence of postoperative complications. The study used a combination of retrospective and prospective designs using quantitative methodologies. A sample size of 87 clients and 28 midwives was obtained through convenient sampling. Data was collected using structured questionnaires and structured interview guides and a checklist was used to collect data from client chart review. The data obtained was analyzed using the statistical package for social science (SPSS Version 16.0). Data has been summarized using frequency tables, and bar charts and tables have been used to present the results. The Chi-Square test was used to determine the significant statistical association between the preoperative care rendered to the clients and the incidence of postoperative complications. Independent-samples t-test was used to examine statistically significant differences between the complications expressed by clients and those documented in the clients’ charts. Imogene King’s middle range theory of Goal Attainment guided this study. Chi-Square test showed a statistically significant association between preoperative teaching offered to the clients on deep breathing and coughing exercises, and the incidence of postoperative complications (P<0.05). Complications expressed by the clients (mean = 0.84, S.D. = 1.7) scored statistically significantly higher (p<0.05) than those documented in the clients’ charts. Although results showed that midwives were able to mention most of the components of basic preoperative care for clients undergoing emergency caesarean section, only 25% mentioned that they would check vital signs prior to emergency caesarean section, 28.6% mentioned that they would allow the client to ask questions, and 25% mentioned that they would answer client’s questions. Gaps were also noted between the mentioned components of care and those documented in the clients’ charts the least documented being vital signs (19.5%), psychological reassurance of the client (3.4%) and preoperative teaching of the client (1.1%). The main contributing factors were poor deployment of midwives to this hospital; lack of preoperative care guidelines; and lack of in-service training for the midwives in perioperative care.
Open Access
Women’s awareness and preferences for birthing positions: a comparison with midwifery practices, a study conducted in Chikhwawa district
(2015-10-01) Nyirongo, Tiwonge Ndindase
This study aimed at determining women’s awareness of birthing positions as well as their preferences for any particular position. Studies have shown that the supine birthing position during labour and delivery has many disadvantages to the mother, the foetus and on the progress of labour. In health facilities, women mostly use the supine position for delivery. This forces some women to deliver in their homes. This cross-sectional, descriptive quantitative study was conducted at Chikhwawa District Hospital, St Montfort Hospital and Mfera Health Centre in Chikhwawa District. A total of 267 women aged 18 to 50, having at least a second pregnancy or second birth attending antenatal and postnatal services and17 midwives working in the labour wards of the three facilities were recruited in the study. The data for the women was collected using an interview schedule and an observational checklist was used for the midwives. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 20. Ninety eight percent (n=261) of the women were aware of the supine position and the sitting position was known by only 21% (n=56) of the women. Thirty two percent of the women had in-depth knowledge of the benefits of the upright positions and only12% (n=31) of the women preferred to use upright position. The women’s location had an influence on their knowledge of the benefits of upright positions (χ2=24.05; P value=0.001) and the women’s age had an influence on their preference for upright positions (χ2=21.14; p-value=0.002). There were no information, education and communication (IEC) materials and equipment for positioning the women in upright position and all the midwives used the dorsal position when conducting the deliveries. Overall, there was some knowledge gap on upright positions among the women as well as the midwives. Midwives should therefore be empowered with knowledge and skills for the upright positions and the women should be equipped with knowledge of the various positions so that they should make informed choices.
Open Access
Midwives’ perception of postnatal care provided in Ntcheu District
(2015-12-01) Nyirenda, Lucy Florence
Postnatal care is one important aspect of maternal and new born health services. The physiological changes which occur in the postnatal period put the mother and neonate at risk of complications that, if comprehensive postnatal care is not given, may result in disability including death. Providing postnatal care therefore, reduces the risk of postpartum complications which cause 60% of all maternal and neonatal deaths. The study aimed at exploring midwives' perception of postnatal care provided in Ntcheu district health facilities. The study used a cross sectional qualitative design. Data was collected from purposive sampling of 24 participants through focus group discussions and in-depth interviews using semi-structured interview guides. The qualitative data were analysed using thematic content analysis which generated the following themes: knowledge of postnatal care, availability and use of postnatal care protocols, factors perceived to promote delivery of postnatal care and hindrances to effective provision of postnatal care. Descriptive statistics were computed for the demographic variables. The study findings indicate that midwives in Ntcheu regard postnatal care as important because it helps in identification of complications, which if managed appropriately, lead to health outcomes. Midwives also viewed postnatal period as the time to promote health behaviour through health education and counselling thereby promote health outcomes. Findings revealed that although midwives considered postnatal care as important, midwives failed to provide some of the crucial elements of PNC due to lack of human and material resources, inadequate space to provide PNC, negative attitude of providers and lack of supervision.
Open Access
Pregnancy related stigma experienced by adolescent mothers in Blantyre District
(2016-09-01) Chirwa Msuku, Jessie Achsah
Adolescent pregnancy in Malawi is high with 26% of all births to girls aged between 15 to 19 (Malawi national Statistical Office and ICF Macro, 2011). This early childbearing for adolescents brings challenges such as stigma. This qualitative descriptive study was done using a phenomenological approach to investigate adolescent mothers’ lived experiences of stigma related to adolescent pregnancy in Blantyre district. The objectives of the study were to identify the sources of pregnancy related stigma experienced by adolescents; to determine how the experience of pregnancy related stigma affect adolescent mothers’ socially, academically and when utilising health services, and to determine the strategies pregnant adolescents use to cope with stigma. The study was conducted in Blantyre between September and December 2016. Convenience sampling technique was used to select 18 pregnant adolescents attending antenatal clinic at Ndirande health centre in Blantyre. A semi-structured interview guide was used to collect data from participants on one to one in-depth interview. Nvivo 10 was used to code the data. Data was analysed using thematic content analysis guided by Colaizzi’s (1978) method. Four main themes emerged from the data which were; sources of stigma; stigma to parents; effects of stigma on adolescents’ life and the coping strategies used to deal with stigma. The findings showed that the sources of stigma pregnant adolescents experienced was from within themselves (self-stigma), family members, friends and other community members. On the effects of pregnancy related stigma, pregnant adolescents face rejection, social isolation, mockery, have feelings of shame and fear, thoughts of abortion and often drop out of school because of pregnancy. Accepting their situation, praying, isolation, use of media and social support are the strategies pregnant adolescent used to cope with the experiences of stigma. Recommendations include that adolescent or youth health programs should be intensified in schools, and support groups for pregnant adolescents should be created to assist pregnant adolescents and avoid experiences of stigma.
Open Access
Assessing partograph recordings and perinatal outcomes at Queen Elizabeth Central Hospital, Malawi
(2016-12-01) Chisuse, Isabella Chikondi
The development of the partograph provides health professionals with a pictorial overview of labour progress, maternal and foetal condition and aids in early identification and management of complications such as poor progress of labour, prolonged labour, foetal distress, and, in the worst cases, obstructed labour and ruptured uterus. The aim of this study was to assess the documentation of the partograph recordings and perinatal outcomes during intrapartum period at Queen Elizabeth Central Hospital which is situated in the southern region of Malawi. A descriptive cross sectional study was conducted using a simple random sampling of 246 partographs. Using a checklist, recordings of observations on foetal, progress of labour and maternal parameters were assessed and given a grade as completely documented, adequately documented, inadequately documented and grossly inadequately documented. Results indicated that only 1.2% of the partographs were completely documented with observations on foetal, maternal and labour progress. Foetal heart rate monitoring was documented according to standard in only 2.4% of partographs and not recorded at all in 11.8% of the partographs. There was no association between recordings of foetal parameters (foetal heart rate, status of membranes and degree of moulding) and neonatal birth outcome (p = 0.713). The reviewed records showed 4 fresh still births and 21 newborns who were admitted to neonatal intensive care unit with Apgar score of less than 7 at 5 minutes within a period of one month. On labour progress, cervical dilatation was the only parameter that was more documented according to standard in 33.7% (n = 83) of the partographs as compared to the documentation of uterine contractions which was 4.5% (n = 11) and of descent of presenting part which was 5.9% (n = 14) of the partographs. On maternal parameters, blood pressure was not documented in 65.4% of the partographs reviewed and respirations were documented in only 3.3% of the partographs. On the maternal condition, the findings did not show a significant association between partograph recordings and immediate maternal outcomes. Though not statistically significant but very important, women experienced adverse outcomes such as pre-eclampsia (n = 4), uterine tears (n = 4) and postpartum haemorrhage (n = 13) were experienced by the women. There is need to investigate on possible explanations as to why the partographs were not documented according to World Health Organisation’s recommended guidelines.
Open Access
Assessment of quality of antenatal care that pregnant women receive during the initial visit at Kawale Health Centre in Lilongwe District
(2017-02-01) Bandawe, Violet Love
Antenatal care is one of the strategies for the improvement of maternal health and the he reduction of maternal and neonatal morbidity and mortality. The initial antenatal care visit is the entry point for antenatal care and is the most significant visit since this is the visit where women are categorised into standard care or special care in accordance with the World Health Organization (WHO) guidelines. This study aimed at assessing the quality of antenatal care that pregnant women receive during the initial antenatal visit at Kawale Health Centre in Lilongwe District. Specifically, the study assessed the availability of resources necessary for the provision of quality antenatal care, nurse midwives’ knowledge and actual practice, and pregnant women’s knowledge of antenatal care and their satisfaction with the care that they receive during the initial visit. The study design was descriptive which used quantitative approach. Systematic random sampling was used to recruit 384 pregnant women who participated in the study. Data was collected using observation checklists and structured questionnaires for both pregnant women and nurse midwives. The study was guided by Donabedien’s Quality of Care Framework. Data collection was done in May and June 2015. Data analysis was done using SPSS version 16.0. Results of the study showed that the structure for providing antenatal care scored below the WHO standard at 46% and the process also scored below standard at 65%. Pregnant women lacked knowledge of antenatal care but showed satisfaction with the care received. Uninterrupted supply of material resources necessary for the provision of quality antenatal care, the use of stipulated guidelines, including health education and counselling to pregnant women is recommended for the improvement of quality antenatal care during the initial visit at Kawale Health Centre
Open Access
Knowledge, attitudes and practices of pregnant women on preconception care in Blantyre Urban, Malawi
(2017-02-01) Chisoni Khonje, Violet Talinda
Preconception care (PCC) is the care given to adolescents, women and couples prior to pregnancy. PCC has shown to improve the health of the mother and of the expected baby. Lack of PCC has resulted in continued occurrence of preterm birth, small for gestation babies, abortions, stillbirths and other pregnancy related complications despite prenatal care. In Malawi, studies on knowledge, attitude and practices of pregnant women were not traced. A descriptive quantitative study was conducted to explore knowledge, attitudes and practices of pregnant women on preconception care in Blantyre Urban. The main objective of the study was to explore knowledge, attitudes and practices of pregnant women on preconception care. The specific objectives were to; assess the knowledge of pregnant mothers on preconception care, describe the preconception practices that pregnant women were involved in, assess attitudes and beliefs of pregnant women on preconception care and describing factors that influence preconception care practices among pregnant women. The study setting was Limbe and Ndirande Health Centres. A total of 767 pregnant women; 384 from Limbe and 383 from Ndirande Health Centres were interviewed using a semi structured questionnaire. Consecutive sampling was used to recruit respondents for the study. Statistical Package for Social Sciences (SPSS) version 20 was used to analyse data. The study findings have shown lack of knowledge on PCC. Majority of women (70%; n=537) do not practice PCC while few (22.3%; n=171) have HIV testing to prevent mother to child transmission (PMTCT) of HIV. Most respondents (97.3%; n=746 ) demonstrated positive attitude towards PCC. Close to half of the respondents (49.2%; n=377) felt that health workers would influence them to attend PCC services seconded by respondents’ spouses (31.7%; n=243). Further, knowledge on PCC was mentioned as the major factor that would influence PCC attendance of most respondents (72.5%; n=556). There is need to educate women of childbearing age on the importance of PCC. PCC needs to be provided both at hospital and community level in order to reach majority of people.