School of Global & Public Health

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Open Access
Assessing teachers and parent’s knowledge, attitudes, perceptions and awareness on type 1 diabetes in children presenting to the children’s diabetic clinic at Queen Elizabeth Central Hospital
(2017-10-17) Kasiya, Marrianne
Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from inadequate insulin production or reduced tissue sensitivity to insulin. Type 1 diabetes is an endocrine disorder characterized by the absolute deficiency of insulin caused by the autoimmune destruction of the β cells of the pancreas. DM is a lifelong condition which requires continuous self-management by patients. Early diagnosis and improved management will reduce the risk of complications of the disease. The majority of young people with diabetes spend many hours at school and/or in some type of child care program. Trained and knowledgeable staff are essential to provide a safe school and child care environment for children with diabetes. The child’s parents/guardians and health care provider(s) should work together to provide school systems and child care providers with the information necessary to enable children with diabetes to participate fully and safely in the school and child care setting experiences. This study assessed the knowledge, attitudes, perceptions and awareness of teachers and parents of children with Type 1 diabetes presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This study employed a mixed methods research design to data collection, analysis and interpretation integrating qualitative and quantitative approaches. Twenty-three parents attending QECH diabetic children’s clinic in the under-five department and 65 teachers from different primary and secondary schools around Blantyre Urban were interviewed. Majority of the respondents explained that diabetes mellitus was concerned with how overly increased or reduced sugar levels affected the way the body carried out its normal functions.Teachers were more general about the disease, while parents were more particular in defining the disease; 67% of the teachers were willing to host diabetic children in their class compared to 33% who were not willing. It was however clear that the teachers had no confidence in handling such conditions. Fifteen of the 25 parents reported that the school was limited in capacity and expressed concern over their children’s performance. The findings highlight the importance of diabetic education for both the teachers and the parents. The study has identified the need to take into account the major differences between children and their care givers in managing Type 1 Diabetes and also the need to invest considerable amount of efforts and resources aimed at supporting Type 1 diabetic children by establishing school clinics or ensuring the presence of school nurses in schools
Open Access
Social interactions among research stakeholders and ethical issues in the context of community engagement in Malawi
(2018-01-01) Nyirenda, Deborah
This thesis examines community engagement practices and consequent effects on ethical research, knowledge re-production and study acceptability. Community engagement is promoted in international ethical guidelines for health research to engage communities in research design. Limited evidence exists on practical translation of these international ethical guidelines to improve ethical research. This study was undertaken to address this knowledge gap by using three ethnographic case studies in Malawi. A qualitative research design was used to understand community engagement practices in light of a theoretical framework of neo-colonial research relations. Three research projects were purposively selected as ethnographic case studies focusing on an urban, rural and hospital setting. I used participant observation to understand unarticulated aspects of community engagement. Field notes from participant observation were triangulated with 43 in-depth interviews and 17 FGDs with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret findings by applying theories of neo-colonial research relations. Although international ethical guidelines promoted active involvement of communities in research design, neither researchers nor community members wished to engage in fully collaborative partnerships. Community engagement processes were shaped by historical experiences with service providers, political context, power dynamics between research stakeholders as well as social norms of interacting with outsiders. In addition, the broader socio-economic context and local power structures raised issues of structural coercion. Rather than improving ethical research practice, community engagement often influenced research participation and did not yield mutual benefits. Lack of community awareness of ethical guidelines or activism for collaborative partnerships affected successful translation of collaborative partnerships. These results raise important questions on how community engagement in low resource settings ought to balance between bridging research stakeholders’ contradictory expectations.
Open Access
Perceptions of HIV positive women on integrated health service delivery’s efficiency: A review of public health facilities of Lilongwe district, Malawi
(2019-05-15) Chauya, Ivy Violet
The study reviews perceptions of HIV positive women on Integrated Health Service Delivery (IHSD) efficiency focusing on HIV integration with other health services. HIV/AIDS has proved to be a global health concern impacting more on poor countries and vulnerable populations like women and children. The study aimed at exploring perceptions of HIV positive women aged 18 and above on IHSD’s efficiency in public health facilities of Lilongwe district, Malawi. Specifically describing the nature of IHSD, examining their knowledge and perceptions of IHSD. This study used a cross-sectional qualitative in-depth study design where 18 HIV positive clients and 6 KIs from 6 health facilities were purposively sampled: 2 from rural, 2 urban and other 2 from peri urban. Three clients and 1 KI were interviewed in each health facility. Data collected was analyzed using themes. Codes were developed bearing in mind the purpose of the study. The researcher identified the themes by isolating data that was significant and interesting in relation to the study objectives. The results focused on whether IHSD is effectively and efficiently being implemented, focusing on the 4 conceptual models of PATH that include patient centeredness, health operations, the health system as well as inter-sectoral initiatives. It was revealed that the public health facilities of Malawi are not fully implementing effective and efficient IHSD as perception of clients in the 4 conceptual models proved inadequate to deliver quality IHSD. The challenges of inadequate resources i.e. trained staff, equipment, drugs, poor infrastructure forcing the health workers to refer clients to other departments/health facilities to access a service does not please most clients as it entails a waste of time and money. HIV positive women also perceive IHSD as a good and helpful service, however, they expressed dissatisfaction with delays in the delivery services due to late commencement of work and continuous referrals done for them to access a service. This is also attributed to inadequate resources as few health workers fail to adequately support the increased number of clients. There is need for government to provide effective governance to mobilize resources and improve on resource availability, enforce laws that protect the scarce resources and strengthen collaborations within and between sectors to ensure effective and efficient implementation of IHSD in the public health facilities of Malawi
Open Access
Assessing uptake and utilization of modern contraceptive method amongst young people in tertiary institutions of Lilongwe University of Agriculture and Natural Resources and Kamuzu College of Nursing in Lilongwe
(Kamuzu University of Health Sciences, 2019-10-01) Kayira, Yewo
Modern contraceptive uptake and utilization still remains a significant global health issue among young people. Despite a number of interventions on modern contraceptive services targeting young people in primary and out of schools, evidence on Modern contraceptive use in tertiary institutions is limited. Hence, an assessment on uptake and utilisation of modern contraceptives among tertiary institutions of LUANAR and KCN was carried out in Lilongwe between 2017 and 2019. A cross sectional exploratory study which used a mixed methods approach to assess uptake and utilisation of modern contraceptive methods among young people in tertiary institutions of LUANAR and KCN in Lilongwe. 8 focus groups were conducted, 6 key informants were interviewed and 220 females and male students were interviewed using self-administered questionnaires from the two institutions which were purposively selected. The study found out that Modern contraceptives uptake was higher among young people of LUANAR and KCN while utilisation was lower. On comparative basis, utilisation and knowledge of modern contraceptives was higher among students at KCN than LUANAR. Male condoms and emergency contraceptive services were frequently accessed. Barriers to access modern contraceptives were noted and included: provider attitudes, privacy and confidentiality, shortage of some modern contraceptives and long waiting time at the clinics. Access to modern contraceptives among young people in tertiary institutions is influenced by individual, health system related and environmental factors. Tertiary institutions students need information on modern contraceptives to reduce sexual and reproductive health problems. Providing young people with access to modern contraceptives in tertiary institutions can reduce teenage pregnancies, abortions and maternal deaths.
Open Access
Burden and predictors of metabolic syndrome in adolescents and young adults in Blantyre district, Malawi.
(2020-02-07) Mwakhwawa, Queen
Metabolic syndrome (MetS) is a major public health concern as it is on the rise in developing countries. However, there is limited regional and national data specifically in adolescents to help drive interventions against MetS. To describe the burden and predictors of MetS in adolescents and young adults in Blantyre district. This was a cross-sectional study that used secondary data. MetS related risk factors from socio-demographic characteristics, anthropometric indices and body composition by deuterium dilution technique (DDT) were assessed. MetS was diagnosed using 1) the international diabetes federation (IDF) criteria by the presence of three or more of the following components: raised blood pressure (BP), raised fasting blood glucose (FBG), reduced high density lipoprotein (HDL), raised triglycerides and larger waist circumference (WC), 2) Metabolic syndrome severity score (MSSS) using these inputs: age, gender, race, weight, height, FBG, BP and HDL on an online calculator. Multivariate logistic regressions were applied to identify MetS -associated risk factors. The study enrolled 371 adolescents and young adults aged 10-28 years The most prevalent MetS component was raised FBG at 31.3 % and reduced HDL at 30 % while the least common component was raised blood pressure BP at 3%. The overall prevalence of MetS was 3.1% by MSSS and 2.5% by IDF criteria and all participants had mild MetS. There was no difference in MetS prevalence by all socio-demographic characteristics and anthropometric indices including history of treatment for acute malnutrition except for waist to height ratio (WHtR). High WHtR and excess fat % were associated with MetS in unadjusted regression analysis with Odds Ratio (OR) 95% Confidence interval (CI)) of 5.18 (0.33,0.91) and 8.87 (1.91,41.08) respectively. After adjusting for sex, age, maternal occupation, WHtR and WHR, participants with excess fat % had 6 times more risk of MetS compared to those with no excess fat%, OR (CI) of 5.88, (1.37,35.4). Conclusions: MetS was relatively rare in this population at 3% prevalence. Abnormal body composition, especially presence of excess fat% increases the odds of presence of MetS.
Open Access
Assessing factors that hinder effective utilisation of family planning services by perinatally HIV infected adolescents in Chiradzulu district
(2020-03-01) Siyasiya, Gloria
Adolescents who have perinatal HIV are equally sexually active and a higher proportion of them is becoming pregnant and bears children. This is happening when family planning services are being provided at the teen clubs where they access HIV services. The study aimed at assessing reasons why these adolescents are not utilizing the family planning services that are being offered. The objectives of the study were to: establish perinatally HIV infected adolescents’ knowledge of the importance of family planning, identify sexual and reproductive health services available for perinatally HIV adolescents, determine the support system that is available for perinatally HIV infected adolescents and determine the challenges that the perinatally HIV infected adolescents face during care.This qualitative study was conducted at Chiradzulu District Hospital and Namitambo Health Centre from March to May 2019. The researcher recruited19 adolescents aged 15-19 years, who were perinatally infected with HIV and were aware of their HIV status. The results showed that most perinatally HIV infected adolescents are aware of the importance of family planning. Additionally, it was found that misconceptions about and side effects of some family planning methods are the main reason for non-contraceptive use.Parents/guardians are the main source of support but they do not have adequate knowledge about reproductive health issues relating to the adolescents, hence fail to provide the needed support. The study also showed that the majority of the adolescents who have a romantic relationship disclosed their HIV status to their partners. The findings also revealed that there is to involve parents and traditional leaders in issues of sexual and reproductive health so that they know the kind of support they could provide to their adolescent children. Additionally, improving the sexual and reproductive health information and services for adolescents will help create contraceptive demand by these adolescents.
Open Access
Barriers and facilitators to the uptake of HIV testing services among adolescents and young adults in Machinga district, Malawi
(2020-03-01) Sakala, Joseph Jasper
While studies generally indicate a low uptake of HIV testing Services (HTS) among young people, other reports also indicate a worrying HIV burden among the same group. For example, the United Nations Children’s Fund (UNICEF) recently reported that globally, new infections have been dropping in all demographic groups except amongst young people where they have largely remained constant. The low HTS uptake among young people, therefore, mean that many of these infections remain undiagnosed, limiting the ability to control transmission.The study’s objective was to explore the factors that motivate, as well as factors that hinder, the uptake of HIV Testing Services among adolescents and young adults in Machinga District of Malawi at the individual, interpersonal, community and health service system levels. 24 In-depth interviews and 4 key-informant interviews were used to collect data, and purposive sampling was used to identify respondents. Respondents were adolescents and young adults aged 15-24 years, as well as HTS and youth-friendly health service (YFHS) providers. Data from audio recordings were transcribed in Microsoft Word and analyzed for content to generate themes. Data coding and analysis was done using Atlas 7. The study found that perceived risk of infection, perceived benefits of knowing one’s status for couples, availability of community-level youth clubs and other interaction fora, and the provision of HTS through outreach clinics were key facilitators for HIV testing. The findings also established that fear of a positive result, poor communication in relationships and families, cultural norms as well as lack of youth-friendly HIV testing services were key barriers to HIV testing. The study establishes the critical role of mobile HIV testing through outreach clinics and other community-based avenues in encouraging access to HTS by young people. The findings also suggest that stigma and misconceptions associated with HIV/AIDS are still issues in Malawi as evidenced by the fear of a positive result also emerging as a critical barrier to HTS
Open Access
Maternal and fetal outcome of hypertension related pregnancy and their associated risk factors in Adigrat General Hospital, Northern Ethiopia, hospital based retrospective cohort study
(Kamuzu University of Health Sciences, 2020-03-01) Lijalem, Naomi
This was a quantitative retrospective cohort study and Presence of hypertensive (exposure) was assessed retrospectively from medical records of mothers who visited the obstetric ward in Adigrat General Hospital, Tigray regional state, northern Ethiopia from January 1 2017- December 30 2019. Hypertensive disorders of pregnancy are the most common causes of adverse maternal & perinatal outcomes. Conducting such studies would support to have great design policies and strategies in preventing unfavorable outcome. The General objective of this study was to determine maternal and fetal outcome and risk factors associated with pregnancy related hypertensive disorder who receive obstetric care in Adigrat General Hospital, Eastern Tigray, and Northern Ethiopia from January 2017 to December 2019. The data were collected using data extraction sheet and entered in to Epi info and analyzed in SPSS version 25. Strength of association was measured using odds ratio and 95% confidence intervals. The p-value <0.05 was set for statistical significance. I have found huge burden of maternal and perinatal death and complications, which makes it a big priority for the health system. A total 314 records of pregnant women was included in the study, 164 had developed HDP, but due to incompleteness and twin gestation, 14 records of those with HDP were excluded from the analysis, this resulted in the HDP prevalence of 50% (150/300). The dominant type of HDP in pregnant women studied was Preeclampsia. Majority of the study participants (90.33%) tested negative for HIV and more than ninety percent of the participants (94.67%) had Anti natal follow up. Majority of pregnant women (62.67%) underwent Spontaneous Vaginal Delivery (SVD) of which (38.7%) had HDP. Prevalence of chronic medical illness in participants was as follows, Proteinuria (72.0 %), DM (22%), CHD (3.33%), Renal failure (2.7%). The proportion of the type of HDP chronic hypertension in pregnant women (preeclampsia, Eclampsia, super imposed preeclampsia, and gestational hypertension) were 42.00%, 25.3%, 7.30%, 12.0% and 13.30% respectively. The most frequent type of antihypertensive drug given to the mothers with HDP was hydralazine (87.3%) and mgso4 (59.3%). On a logistic regression analysis, several factors were found to be associated with HDP, these included age (OR 0.15; 95% CI, 0.09-0.25, P≤0.001), education (OR 0.43; 95% CI, 0.32-0.58; P≤0.01), occupation (OR 0.65; 95% CI, 0.51-0.84; P≤0.001), residency (OR 14.24; 95% CI, 7.95-25.53; P≤0.001), HIV status (OR 16.24; 95% CI, 3.78-69.69; P≤0.001), parity (OR 0.19; 95% CI, 0.99-0.39; P≤0.001), mode of delivery (OR 3.87; 955 CI, 2.59-5.78; P≤0.001) and diabetes mellitus (OR 17.37; 95% CI, 7.22-41.84; P≤0.001). Out of the total 6,856 deliveries, 164 (2.4%) had HDP of which 14 were excluded. out of the 150 study participants with HDP majority of them 93 (62%) were in the age range of 15-35 years. More than half of respondents with HDP (68.7%) place of residence is in rural.
Open Access
Effects of working conditions on healthcare providers’ provision of quality maternal healthcare services at Kamuzu Central hospital and Bwaila district hospital in Lilongwe district, Malawi
(2020-03-01) Mawanga, Jacqueline Zambezi
In developing countries, health workforce is one of the predominant challenges affecting the health care systems’ function of providing quality services including maternal care. The challenge relates to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve maternal healthcare services in hospitals. The research study was assessing the effects of working conditions on healthcare provider’s ability to provide quality maternal healthcare services in two major hospitals; Kamuzu Central hospital and Bwaila district hospital of Lilongwe district. Methods: The research study was a qualitative descriptive approach applying in-depth interviews and focus group discussions using interview and discussion guides respectively. Participants were selected using purposive sampling. Data was digitally collected using audio recorders. The data was manually analyzed using thematic analysis. The study has reviewed many working conditions that surround health workers at maternity departments of these two major public hospitals in Lilongwe district. The status of these identified working conditions received mixed reactions as majority of study participants expressed them as poor and pathetic, and that hugely affects their ability to provide quality maternal healthcare services. Health system and health managers have major role to play in supporting health workers available on the ground in order to improve maternal healthcare services that have higher potential to reduce maternal mortality rates in this country.Both health workers and managers explained their perceptions on existing working conditions and how they are related to work motivation and overall performance.
Open Access
Investigating the status of menstrual hygiene Management absorbent interventions in Malawi – A situation analysis in the schools of Malawi
(2020-03-01) Masanda, Anna Sylvia
Menstrual Hygiene Management (MHM) is a challenge in low and middle income countries (LMICs) due to limited resources. Despite presence of various MHM absorbent interventions1 in Malawi, anecdotal evidence and grey literature suggest that women and girls still face MHM challenges. This study was aimed at investigating the status of Menstrual Hygiene Management interventions in the schools of Malawi. In order to meet the set objective, a desk review of relevant MHM policies/guidelines governing MHM interventions on absorbents and infrastructure were reviewed. To get more details on the available interventions, relevant stakeholders at central and district level were contacted and schools benefiting from MHM interventions were visited to appreciate integration of MHM in WASH infrastructure interventions. 118 schools were selected using convenient sampling from selected 14 districts in the country. This study found that Malawi has no standalone policy on MHM and there are no designated infrastructure standards for MHM facilities. The research found 56 organizations that are working on MHM interventions where all of them have a component on absorbent MHM but only 12 also have a component on MHM infrastructure. Despite existence of efforts in integrating MHM in other policies, there is a need for a clear policy to govern MHM interventions in Malawi. Malawi should consider having a live database that should be updated from time to time that will help targeted interventions
Open Access
An exploration of the relationship between herbal medicine use and anti-retro viral therapy adherence among people living with HIV in Blantyre, Malawi.
(2020-03-01) Noniwa, Thokozani
Antiretroviral Therapy(ART) adherence is defined as being able to consistently take 95% of the prescribed Antiretroviral(ARV) drugs by an HIV infected person. According to the World Health Organisation(WHO), most people living with HIV and AIDS in Africa use also herbal medicines to treat opportunistic infections and obtain symptomatic relief. The main objective of this research was to explore potential relationship between use of herbal medicine and Antiretroviral Therapy adherence among People Living with HIV. Specifically, the study was designed to determine use of herbal medicine among People Living with HIV, establish patterns of herbal medicine use, explore potential interruption to ART medication due to herbal medicine use and determine associated factors for herbal medicine use among People Living with HIV. The study adopted the phenomenological study design. Data was collected through individual in-depth interviews. Purposive sampling was used to select study participants. Data analysis was done using thematic content analysis. This analysis was done guided by the study objectives to generate emerging themes. Three main themes emerged from the data. The themes framed through the lens of HIV and AIDS care included: (1) patients’ perspectives on ART medication, (2) herbal medicine use in relation to HIV infection and ART adherence, and (3) perceived quality of medical care. Subthemes were discussed under each of the main themes. This study has shown that herbal medicines are widely being used by People Living with HIV and this consequently interrupts their adherence to Antiretroviral Therapy. Some of the People Living with HIV use the herbal medicines separately from ARVs while some use them concomitantly with ARVs. Inadequacies in the health system delivery have also shown to promote use of herbal medicine among People Living with HIV. This has largely affected ART adherence as some of them default ART around the time that they switch to herbal medicine
Open Access
The impact of demographic and socio-economic characteristics on feeding and caring practices for children under two years in rural Malawi
(2020-03-01) Kalepa, Josephine
UNICEF conceptual framework on the causes of malnutrition shows clear link between socio-economic and demographic characteristics with inadequate dietary intake and diseases which are immediate causes of malnutrition. This study was carried out to determine the impact of caregiver’s demographic and socio-economic characteristics on child dietary intake and health seeking behaviour for children less than two years in rural Malawi to inform the design of health and nutrition programs targeting rural population. This was a cross-sectional study based on secondary analysis of data collected through International Lipid-Based Nutrient Supplements (iLiNS-DOSE) Project from June 2009 to December 2013. A total of 1932 caregivers and children were included in analysis. Logistic regression model was used to investigate the effect of socio-economic and demographic characteristics on minimum dietary diversity and care-giver’s health seeking behaviour for common childhood illnesses. Only 2.5% of the children were able to meet minimum dietary diversity (≥4food groups) at 6 months. Care givers that had attained complete primary education were 2 times more likely to meet child minimum dietary diversity as compared to caregivers with no education [OR 2.5 (95% CI:0.27,24.8)]. The odds of practicing appropriate care seeking behaviour increased by 0.07 for caregivers aged 18 to 24 years [ OR 1.07 (95% CI: 0.40,2.83) Interventions aimed at improving the socio-economic status of rural households in Malawi can greatly improve children dietary diversity.
Open Access
An exploration of the relationship between herbal medicine use and anti-retro viral therapy adherence among people living with HIV in Blantyre, Malawi.
(2020-03-01) Noniwa, Thokozani
Antiretroviral Therapy(ART) adherence is defined as being able to consistently take 95% of the prescribed Antiretroviral(ARV) drugs by an HIV infected person. According to the World Health Organisation(WHO), most people living with HIV and AIDS in Africa use also herbal medicines to treat opportunistic infections and obtain symptomatic relief. The main objective of this research was to explore potential relationship between use of herbal medicine and Antiretroviral Therapy adherence among People Living with HIV. Specifically, the study was designed to determine use of herbal medicine among People Living with HIV, establish patterns of herbal medicine use, explore potential interruption to ART medication due to herbal medicine use and determine associated factors for herbal medicine use among People Living with HIV. The study adopted the phenomenological study design. Data was collected through individual in-depth interviews. Purposive sampling was used to select study participants. Data analysis was done using thematic content analysis. This analysis was done guided by the study objectives to generate emerging themes. Three main themes emerged from the data. The themes framed through the lens of HIV and AIDS care included: (1) patients’ perspectives on ART medication, (2) herbal medicine use in relation to HIV infection and ART adherence, and (3) perceived quality of medical care. Subthemes were discussed under each of the main themes. This study has shown that herbal medicines are widely being used by People Living with HIV and this consequently interrupts their adherence to Antiretroviral Therapy. Some of the People Living with HIV use the herbal medicines separately from ARVs while some use them concomitantly with ARVs. Inadequacies in the health system delivery have also shown to promote use of herbal medicine among People Living with HIV. This has largely affected ART adherence as some of them default ART around the time that they switch to herbal medicine
Open Access
Enablers and barriers to condom use and uptake among young people living with HIV in Mchinji district, Malawi
(2020-03-01) Chirambo, Paul Bingo
Young people aged 15 to 24 years account for 25% of new HIV infections among adults. Those living with HIV are at risk of passing on the virus to their sexual partners and children. As such consistent condom use is regarded as a comprehensive and sustainable approach to HIV prevention. The aim of this study was to explore factors enabling and hindering the uptake and consistent use of condoms among young people living with HIV in Malawi. This was a cross-sectional study utilizing both quantitative and qualitative research methods. It involved young people living with HIV (YPLHIV) aged 15 to 24 years in four antiretroviral therapy (ART) facilities in Mchinji District, Malawi with a sample size of 308. Quantitative data was collected using a structured questionnaire while qualitative data used in-depth interviews and focus group discussion (FGD) guides. Data was analysed using STATA (quantitative data) and N Vivo (qualitative data). 77% (237) of young people reported ever had sexual intercourse. The prevalence of condom use at last sexual intercourse was 73 % (P
Open Access
Factors that are related to adherence and care seeking for hypertension treatments in individuals on antiretroviral therapy in central Malawi
(2020-03-01) Phiri, Khumbo
Hypertension which occurs in 1 out of 3 adults is the most common non communicable disease (NCD) in Malawi. Despite its high prevalence, treatment coverage for hypertension is low. Low rates of health seeking behavior, unhealthy lifestyles and poor access to health care remain key challenges to the prevention, control and management of hypertension. The objective of the study is to identify the factors related to care seeking for hypertension among adults on antiretroviral therapy (ART). We conducted in-depth interviews with 30 individuals who are 18 years or older, on ART who also have hypertension. Interview questions focused on challenges and enablers to care seeking for hypertension and patients’ perceived risks and benefits to health care utilization for hypertension. Andersen’s behavior model for health services utilization (BMHU) was used as an organizing framework. Data were analyzed through constant comparison methods using Atlas.ti 8, applying both deductive and inductive techniques using a modified grounded theory approach. The results are presented based on common themes within the BMHU framework. The most common barriers for care seeking, adherence to medication and general management of hypertension included financial challenges due to poor health and weakened physical ability and medication side effects. At the health system level, lack of integrated care, lack of available hypertension medications, long wait times, and poor quality of care were the major challenges to care seeking. Respondents perceived risks of hypertension influenced their decision to start or stay on hypertension treatment. Knowledge about the benefits of treating hypertension encouraged individuals to properly manage their hypertension, despite barriers to care.Among our participants on ART with hypertension there was a high level of knowledge about the risks of hypertension and high motivation for treatment, but individuals faced significant challenges to care seeking. Patient barriers could be reduced through integration of hypertension treatment within ART clinics, free or low cost access to antihypertensives, improvements in the supply chain for hypertension medication, and support services (counseling or other) for patients with multi-morbidity.
Open Access
Antiretroviral therapy adherence and the youth: An assessment of teen clubs’ implementation fidelity in southern Malawi
(2020-03-01) Kunje, Gertrude Magomero
Globallythereare2.1millionadolescentslivingwithHIV.1.7millionarein subSaharanAfrica.MalawihasoneofthehighestHIV/AIDSprevalenceratesinthe worldwith12.0%ofthoseaged15-49yearsinfected.AdherencetoARThasprovedto bedifficultforpeoplelivingwithHIVandoftenfallsbelowtherequiredlevelsandthus, youthslivingwithHIVareamongthepopulationgroupswithpoorerARTadherence rates.Fidelityisdefinedasadherence,integrityandqualityofimplementationofan intervention.HoweverhighlevelsofadherencearecrucialtothesuccessofHIV therapiesinordertosustainviralsuppression. Objective:ToassessthefidelityofimplementingteenclubsdesignedtoenhanceART adherenceinBlantyreDistrict WeconductedaFormativeEvaluationQualitativeResearchthatwasguided byaConsolidated FrameworkforImplementationResearchusing KeyInformant Interviewstoestablishifteenclubinterventionisimplementedwithfidelity.Thestudy wasconductedinfiveBlantyreHealthCentreTeenClubsnamely:Chilomoni,Chileka, SouthLunzu,Mpemba,NdirandeandLightHouseClinicatQueenElizabethCentral Hospital. Weusedacasestudymethodandpurposivesampling.Eligiblestudy participantswereteenclubfacilitatorswhohavefacilitatedteenclubsforatleasta year.IndepthInterviewswereaudiorecordedandthentranscribedverbatim.Thematic contentanalysiswasusedtoanalyzethedatamanually. HalfofthesampledteenclubshadguidelinesforconductingTeenClub Activities.TheexistedguidelinescompliedwiththeBaylorInternationalPediatricsAIDS Initiative.However,someelementswerenotfollowed.Trainingoftheteenclub vi facilitatorswasoneofthefactorsthatinfluencedcompliancewiththeguidelines. From theresults,theassessmenthasgeneratedinformationonattributes thatleadtocomplianceandnoncomplianceofHIVteenclubguidelinesinrelationto implementationfidelityoftheteenclubintervention.Ateenclubcannotbeoperated withoutthedesignatedguidelinesthatareestablishedtobefollowedassuchthey shouldbecompliedwith.
Open Access
Impact of media training and journalist support on the development of health research reporting in Malaw
(2020-03-01) Phumisa, Josephine Semu
n 2012, the Science Communication Department at Malawi-Liverpool Wellcome Trust established the Journalist in Residence programme. It was established to train journalists and give them support when reporting health research stories from Malawi-Liverpool Wellcome Trust. However, the programme has not been evaluated since its inception. Objective: To assess the impact of media training and support through the Journalist in Residence programme on the development of health research reporting in Malawi. Qualitative approaches were used to conduct in-depth interviews with 5 journalists, 2 editors, 2 consultants, 5 researchers, and 3 Ministry of Health Officials. Two Focus Group Discussions were also conducted with Community Advisory Group members selected in Blantyre and Chikwawa. All interviews and focus group discussions were recorded and transcribed verbatim. Data were analysed using Nvivo11. The findings show that most stakeholders recognize that JIR programme has a positive impact on the development of health research reporting in Malawi. The quantity and quality of health research stories are reported to have increased after introducing the programme. Additionally, journalists are motivated to write health research stories as they get training as well as support in the programme. The health research work of Malawi-Liverpool Wellcome Trust is now being recognized by policy makers and the public at large through stories published by journalists in the programme.The evaluation found that JIR programme is a powerful tool to achieving the development of health research reporting in Malawi through all its aspects.
Open Access
Applying a gender lens in cervical cancer programming: the assessment of sexually active young men involvement in cervical cancer preventive efforts
(2020-03-01) Nkosi, Chimwemwe Nyambose
Cervical cancer remains a public health concern across the world especially in developing countries including Malawi. Much as country’s policies calls for male involvement in sexual reproductive health, their involvement in cervical cancer prevention is still not clear. Sexually active young men are usually left behind despite their important role in its prevention.The study’s main objective was to assess the involvement of sexually active young men in cervical cancer preventive efforts in Lilongwe Urban. This was mixed methods study. A sample of 196 randomly selected study participants and 10 key informants were interviewed. Inclusion criteria were sexually active young men aged 15 to 24 patronising Bwaila and Kawale health centres. Thematic analysis was used for qualitative data and analysed using NVivo 7.4 software. Quantitative data was analysed using STATA version 14 statistical program. The study findings suggest knowledge of causes of cervical cancer, partner’s risks and whether one is circumcised or not as having a significant impact on young men involvement in cervical cancer preventive efforts. Their non-involvement is attributed to a number of factors which includes structural barriers in terms of access to cervical cancer information and services, lack of a standalone policy, lack of access points of the services such as youth-friendly health corners. Culturally, the misconception that cervical cancer is a feminine disease and men as sole decision makers also deters them from assessing the services.The study findings suggest low involvement of sexually active young men in cervical cancer prevention despite their willingness and their important role in the disease prevention. Deliberate efforts therefore have to be put in place to involve them if the disease is to be contained. The study suggests their involvement in policy and programme formulation as well as implementation and integration of cervical cancer in youth friendly health services as some of the strategies that could be employed to increase their involvement
Open Access
Acceptability of integrating HIV early infant diagnosis (EID) into under-five outreach immunization clinics in Lilongwe rural areas in Malawi
(2020-03-01) Makanda, Mphatso
Human Immunodeficiency Virus (HIV) disease progresses quickly in children. Without treatment, 50% of the children living with HIV die before 2 years of age. Hence, HIV exposed infants are recommended to have an Early Infant Diagnosis (EID) at 4-6 weeks of age. This is so that infected children are identified and started on treatment timely. However, it has been observed that 29% of HIV exposed infants receive EID test late in Malawi. Hence, there is need to identify better strategies to increase EID testing rates at 6 weeks. This study aimed at assessing acceptability of integrating EID into under-five outreach immunization clinics in Lilongwe rural areas among mothers of under-five children. This was an observational, analytical, cross sectional study. It used quantitative study methods to answer the researched question. A questionnaire was used to collect data from study participants. The data was analyzed using Stata version 14. We enrolled 100 mothers in the study regardless of their HIV status. Almost all of them (99%) indicated that the integration of EID in immunization clinics is important. The majority of them (96%) also indicated that they would accept their infants to have an HIV EID test at outreach immunization clinics. Availability of HIV test providers was reported to be the number one facilitator of the integration and it was seconded by the availability of infrastructures at the immunization clinics. The study also found out that unavailability of HIV testing providers have the greatest potential of hindering the integration of HIV EID in immunization clinics seconded by unavailability of shelter at the outreach immunization clinics. Integration of HIV early infant diagnosis into under-five outreach immunization clinics of Lilongwe rural areas is acceptable among mothers of under-five children. The integration can aid in increasing EID test rates of HIV exposed infants at 6 weeks of age.
Open Access
Assessment of factors associated with linkage to care amongst adults accessing HIV services at Bwaila hospital, Lilongwe district, Malawi.
(2020-03-01) Gondwe, Clifton Muvwala
Despite the policy progress made in Malawi about HIV and AIDS, the prevalence rate remains among the highest in the world. Despite many people being tested HIV positive not all have been linked to HIV care. Linkage to care is a crucial early step in successful HIV treatment. Linkage to HIV care is still a challenge in Malawi as 32% is not yet linked to care. This group may pose a threat of transmitting the infection to the population. Currently the country is striving to meet the 90.90.90 UNAIDS target The main objective of the study was to assess factors associated with linkage to care amongst adults accessing HIV services at Bwaila Hospital in Lilongwe District.This was a descriptive cross-sectional study that employed qualitative methods. Eighteen in-depth interviews were conducted with clients above 18 years old and 2 focus group discussions with Health Providers at Bwaila Hospital. Purposive sampling method was used to recruit study participants. Thematic analysis was used to analyze data. Findings indicate that linkage to care is affected by one‟s perception towards Antiretroviral Therapy initiation, physical escort of clients by providers, integration of services, existence of support partners, shortage of staff leading to high workload, poor coordination of services at the facility and distance to the facility. Interventions aimed at improving linkage to care in HIV services should focus on integration of health services. In addition, additional human resource and ease of access to health services should also be considered