School of Nursing

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Open Access
Knowledge, attitude and practice of hypertensive clients about self-care home management at LCH (OPD II) medical clinic
(2004-10) Kamwedo-Muyakha Maria Isabella
A descriptive, quantitative and qualitative study was conducted at Kamuzu Central Hospital (OPD II) medical clinic. Experiences from the health workers at Kamuzu Central Hospital (KCH) had shown that the hypertensive clients lacked knowledge on the disease process hence clients do not know what actually happens in their bodies (Ozotiosauka, 2004). In this view, it was important to conduct a study whose purpose was to find out if hypertensive clients have got knowledge about how they can manage their condition at home. The study focused on knowledge, attitude, drug compliance and practice of hypertensive clients in the control of high blood pressure. Nursing literature in Malawi lacks information on the self-care home management for hypertensive clients. No such study has ever been conducted in Malawi. Orem's self-care model was used to guide the study with emphasis on self-care home management of hypertensive clients. Sample size of twenty clients was drawn from KCH Medical Clinic (OPD II) using a simple random sampling method. A pilot study was conducted at Likuni Hospital to ensure validity and reliability of the research instrument. Data was collected using an interview guide. Data was analysed manually using descriptive statistics and content analysis to describe qualitative data. Study findings revealed lack of adequate knowledge for hypertensive clients about the disease process and its cause, need for psychological support from health workers and also the usefulness of the medical clinic for the general public. Recommendations were made basing on the results, emphasizing the importance of the information, education and communication (IEC) to hypertensive clients and also establishment of other medical clinic services within the Central Region to cater for those clients living in other districts in order to promote health and maintain self-care management at home. In conclusion, we have seen that participants' lack of knowledge on the disease process was related to inadequate information, education and communication, low level of education and poor communication between clients and health workers.
Open Access
Social factors associated with improper waste disposal at the central market in Lilongwe City
(2014-12-01) Banda, Modesta
Urbanization in the developing countries such as Malawi has brought about a serious environmental degradation due to a rapid and uncontrolled population growth. One of the consequences of such population increase is improper waste disposal as solid waste is enormously generated. Additionally, poor sanitation facilities, along with high population pressure and waste management systems, are becoming a threat to the health of the residents of the cities. Current solid waste management in many places has not met the required standard for proper waste collection and disposal creating excess waste that accumulate within the urban environment causing immense health and environmental hazards. The deterioration of sanitation in the urban environment has reinforced incorrect disposal habits as people do not understand their individual impact on such an environment. The overall aim of this study was to explore the social factors associated with improper waste disposal at the Central Market in Lilongwe City. The study used a descriptive cross-sectional design where quantitative method of data collection from the respondents was used at Lilongwe Central Market. The target population was vendors who have been doing business at the market within a period of 6 months prior to the study and buyers who have been shopping at the central market within that same period. Systematic random sampling was used to select 128 vendors and 127 buyers who met the inclusion criteria at Lilongwe Central Market. Data were collected using a structured questionnaire and the analysis of the quantitative data was done using SPSS 16.0. The major findings of this study on social factors associated with improper waste disposal were; use of un-recommended methods to dispose waste at the market because of lack of bins and responsibility by vendors and buyers towards waste management. However, results showed that 78% of the respondents were willing to participate on issues concerning waste management in order to reduce health and environmental problems. In conclusion, improper waste disposal can cause health and environmental problems to the general public if proper measures are not put into place. For example, making waste bins available at strategic places in the market. Therefore, waste should be managed at all times to prevent negative outcomes.
Open Access
Factors associated with antiretroviral therapy adherence among HIV infected men at Chilomoni Health Centre in Blantyre District
(2014-12-01) Lijoni, Lilian Mercy
Low adherence to anti retro viral therapy (ART) increases morbidity and mortality rates among AIDS patients and promotes the emergence of ART resistance. Little is known regarding factors associated with adherence to ART among HIV-infected men at Chilomoni Health Centre in Blantyre District where the research was done. The purpose of the study to explore factors associated with adherence among HIV-infected men receiving Anti retro viral Therapy at Chilomoni Health Centre in Blantyre District. A quantitative cross sectional study was conducted to explore factors associated with adherence among HIV-infected men receiving Anti retro viral Therapy at Chilomoni Health Centre in Blantyre District and permission was granted by relevant authorities to conduct the study. Between May 19 to July 07 2014, 237 HIV-infected men were systematically randomly sampled from all HIV-infected men attending ART clinic at Chilomoni Health Centre. They gave a written consent before joining the study. Two hundred thirty seven questionnaires were completed at the clinic before the respondents left for home and were personally collected by the researcher. Descriptive analysis was used to analyze the data. This study found that there are variations in respondents’ knowledge of HIV/AIDS and the importance of adhering to Anti retro viral therapy. Most of the HIV-infected men (83.3%) had positive perception about patient level factors affecting their adherence to ART, medication level factors helping them to adhere to ART and the clinic level factors making it possible for them to adhere to ART. The respondents perceived that they received adequate support for them to adhere to ART. However, all the respondents 100% were not adhering to ART. In conclusion, it has been observed that despite HIV-infected men having knowledge on HIV and AIDS and the importance of adhering to ART, perceiving positively to patient, medication and clinic level factors and receiving support from family, friends and health care workers they are still not adhering to ART.
Open Access
Factors influencing clinical teaching at Bwaila and Kamuzu Central Hospitals by registered nurse midwives
(2015-05-01) Kaunga Kalua, Beatrice
Clinical teaching is teaching which takes place in a clinical area for an individual or a group of students and usually involves patients and clinical procedures. Registered nurse midwives in this study provided clinical teaching to nursing students. As clinical teachers, registered nurse midwives play a crucial role in the development of the nursing students professionally. However, evidence from literature indicates that although clinical teaching enhances clinical learning, registered nurse midwives are confronted with different challenges as they engage in the experience. For example, lack of training in clinical teaching, shortage of nursing personnel and increased numbers of students to teach. The objectives of the study were to describe the role of registered nurse midwives in clinical teaching, identify factors that promote clinical teaching, describe benefits of clinical teaching to registered nurse midwives, and describe challenges faced by registered nurse midwives during clinical teaching. This descriptive study used quantitative methods and data were collected using a structured questionnaire. Data were analyzed using SPSS version 16.0. Descriptive statistics were computed and results were reported as frequencies and percentages. The study showed the following results: 100% of the respondents were aware of their role in clinical teaching and appreciated that clinical teaching offered them the opportunity to reflect on and improve their practice. Ninety-nine percent of the respondents also indicated that they were proud to see students developing professionally. However, the following are some of the challenges that were met by registered nurse midwives in the course of teaching students: 98% of the respondents were not trained in clinical teaching, 97% indicated increased workload due to shortage of the nursing staff, 85% said they had inadequate clinical resources and teaching space, 91% had large numbers of students to be taught and supervised by a single clinical supervisor, and these registered nurse midwives did not receive rewards for the service (91%). The results call for the government through Ministry of Health and Ministry of Education to continue training of more nurse midwives into the healthcare system as it is currently doing to increase nursing staff in the country. In addition, the government in collaboration with nursing colleges should train all registered nurse midwives to be fully prepared clinical teachers to equip them with necessary skills for teaching roles. Nursing colleges should also increase their effort in sourcing resources to be used by students in the clinical area in combating inadequacy of the resources during clinical placements. Regarding increased workloads due to increased intakes of the students in the colleges, registered nurse midwives as clinical facilitators should just be encouraged and motivated through use of incentives in their role as there are no immediate solutions to the problem.
Open Access
Registered nurses lived experiences on family involvement in the care of hospitalised children at Queen Elizabeth Central Hospital, Malawi
(2015-07-01) Phiri, Patrick GMC
Family involvement entails that care is planned around the family and the hospitalised child. Families need to be involved because they are custodians of valuable information for provision of care. QECH is the main referral hospital which provides specialised care to children across Malawi. Shortage of nurses is a chronic health problem at this hospital. The average nurse-patient ratio in paediatric unit is ratio is 1:84. This ratio is very high. However, nurses are expected to involve families in child care. Evidence shows that nurses’ experiences about family involvement are key factors in the way care is delivered. Little is known about nurses’ experiences on family involvement in the care of hospitalised children at QECH in Malawi. The objective of the study was to describe registered nurses experiences when involving families in the care of hospitalised children at Queen Elizabeth Central Hospital. A descriptive qualitative design using semi structured interview guide was used. Data was collected from 14 full time registered nurses at QECH and analysed using thematic content analysis. Six themes emerged from the data: Rationale for family involvement, nurses’ experiences on family involvement, power and control, factors influencing nurses’ efforts on family involvement, core concepts of family centred care, factors influencing nurses’ efforts on family involvement and nurses’ impression with family involvement. The findings of this study are consistent with those from western countries and show that registered nurses are knowledgeable on family involvement and their experiences are mixed but are constrained by socio-cultural and institutional factors. These factors should be subjected to further research because their implications may be greater than perceived. The findings support the notion implementation of family involvement is inconsistent. This status quo may continue unless authorities provide support in form of human and material resources and develop a policy.
Open Access
Perceptions of lecturers in teaching large classes at Kamuzu College of Nursing
(2015-10-01) Matiki Chizimba, Dorothy
Over the past 5 to10 years, nursing training institutions in Malawi including Kamuzu College of Nursing have been experiencing pressure from a number of societal forces such as increased demand for accessibility to tertiary education and shortage of nurses to increase student enrolment. The increased enrolment coupled with limited teaching resources and faculty consequently led to large classes. The purpose of this study was to investigate the perceptions of lecturers in teaching large classes at Kamuzu College of Nursing. A qualitative descriptive exploratory study was done among faculty members who teach large classes at Kamuzu College of Nursing, a constituent college of the University of Malawi. Purposive sampling method was used to recruit 15 participants for the study. A semi- structured interview guide was utilized to collect data and analysis was done using thematic content analysis. Clearance from COMREC and consent from participants were also obtained. Findings revealed that large classes affected students‟ learning and lecturers‟ functioning; teaching and assessment methods used by lecturers; and also resource availability. Students were affected with reduced teacher-student interaction and reduced clinical learning experiences among others. On the other hand, teachers had to cope with large numbers of scripts to mark which affected timeliness of feedback to students. Traditional teaching methods such as lecture were highly used for teaching and low quality multiple choice examinations had replaced essays. Recommendations for government, college management and lecturers were made.
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Pathways to care for clients with first episode psychotic disorders at Zomba Mental Hospital, Malawi
(2015-10-01) Nyirongo, Distress
The aim of this study was to describe the pathways to care taken by clients with first episode psychotic disorders at Zomba Mental Hospital. A quantitative descriptive study was conducted among clients with first episode psychotic disorders at Zomba Mental Hospital (ZMH) in Zomba District, Malawi. Consecutive sampling technique was used to recruit the participants and a total number of 266 clients were interviewed using a structured questionnaire. Data were analyzed using SPSS Version 16. Findings revealed that 58% of the participants first consulted general practitioners (GPs), 28% consulted traditional healers, 8% consulted religious healers, 4% went straight to ZMH and 2% were first in contact with police. However, 24% of the participants who consulted the general practitioners did not receive any treatment for their symptoms. The median duration before reaching ZMH was 42 weeks and clients who first consulted traditional healers had the longest delay. Gender, symptoms, diagnosis and proximity had a significant statistical association with first seeking help from health professionals. Conclusion was made that most clients with first episode psychotic disorders seek other pathways before going to ZMH, and that there is significant delay between the onset of symptoms and receipt of appropriate care. It is therefore recommended that mental health professionals should emphasize on mental health awareness campaigns in the communities and working collaboratively with all care providers involved.
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Knowledge, beliefs and practices of mothers related to anaemia in under-five children at Kamuzu Central Hospital, Malawi
(2015-10-01) Macheso, Felistas
Childhood anaemia is a major health burden which contributes to underfive morbidity and mortality in Malawi. It is estimated that 63% of children in Malawi have anaemia, however, anaemia is preventable. The purpose of this study was to explore knowledge, beliefs and practices among mothers whose underfive children were admitted with anaemia at Kamuzu Central Hospital. The study was cross sectional descriptive and it used both quantitative and qualitative methods. The study recruited 198 participants for the structured quantitative interviews and 12 participants were recruited for the qualitative in-depth interviews. The quantitative data was analyzed using descriptive and Kruskal- Wallis H statistical tests using SPSS version 16.0. The qualitative data was analyzed following principles of qualitative content analysis. The findings revealed that majority of mothers were young mothers within the age group of 20-24 years (41.4%; n=82) and unemployed (44.4%; n=88). The findings also revealed that majority of mothers (59.1%; n=117) had average knowledge related to causes and symptoms of anaemia in under-five children. Anaemia in under-five children was positively related to the education status of mothers (p = 0.005) such that mothers with higher education level (college level) had adequate knowledge of anaemia than mothers who had primary or no formal education. The study also found that majority of children had inadequate consumption of food containing iron. In addition, the study revealed that mothers received information related to nutrition from under-five clinics however mothers were not given information related to anaemia. The challenges that participants encountered in accessing health care services for under-five children were long walking distances, lack of medicine and lack of comprehensive screening of children. There is need to educate mothers on early recognition of signs of anaemia in children to prevent complications; update health workers on nutrition counselling, anaemia checkups and follow up. Furthermore, there is need for multisectoral collaboration to improve the health and nutrition status of the children.
Open Access
Caregivers’ perception regarding parental participation in care of hospitalised children at Queen Elizabeth Central Hospital, Malawi
(2015-10-01) Phiri, Lophina
Parental participation is one of the cornerstones of pediatric practice. Evidence from literature has shown that effective parental participation depends on caregivers’ preparedness, adequate communication between caregivers and Health Care Workers (HCW) and the negotiation process. Queen Elizabeth Central Hospital (QECH) is the major referral hospital for the country and caregivers stay with their children in the hospital and participate in the care. However, little is known about the perception of these caregivers regarding their participation in the care of their hospitalised children. The study aimed to explore caregivers’ perception regarding parental participation in the care of their hospitalised children at QECH. A descriptive qualitative design using a semi-structured interview guide was used to collect data from 20 caregivers in the pediatric department and thematic analysis was done guided by the Colaizzi method. Seven main themes emerged from the data and these were lack of role negotiation by health care workers, inadequate role preparation for caregivers, care given by caregivers to their hospitalised children, poor HCWs- Caregivers communication, benefits of caregivers’ participation in the care of hospitalised children, needs of caregivers participating in the care of hospitalised children and overall impression of caregiver’s participation. The study findings showed that caregivers view their participation in hospitalised child care as appropriate, important and satisfying. However, gaps exist in the way caregivers participate in the care of their hospitalised children due to inadequate role negotiation, role preparation for caregivers and inadequate information for caregivers. Given this, it is recommended that management should develop protocols and guidelines for the implementation of parental participation in the care of hospitalised children to promote best practices.
Open Access
Parents' perceptions of available support following diagnosis of childhood cancer at Kamuzu Central Hospital, Lilongwe,Malawi
(2015-10-01) Gundo, Beatrice
The purpose of this study was to explore parents' perception of available support following diagnosis of childhood cancer at Kamuzu Central Hospital, Lilongwe, Malawi. The study utilized descriptive design of quantitative research to achieve research objectives. Sixty participants participated in the study. Data were collected using a questionnaire developed by the researcher based on literature review. Statistical Package for the Social Science (SPSS) version 20 was used to analyze the data. Majority of the parents reported that there are nurses and doctors who care for their sick children. They also reported availability of information regarding children’s condition, treatment, food, spiritual support and accommodation if needed. The parents rated highly the availability of treatment (excellent, 68.4%, n=41). Majority of the parents reported that provision of accommodation was good (good, 85%, n=51) and that they are treated as an individual rather than a typical parent of cancer child (good, 100%, n=60). Parents also reported that children are not cared for holistically (e.g. mental, emotional and social needs) instead only their physical needs are met (81.7%, n=49) and all parents reported that there is poor provision of advice on how to get information or to contact other parents, organizations. In relation to treatment, parents reported poor explanation on treatment (70%, n=42), and on the types of cancer services available (80%, n=48). Majority of the parents reported that provision of spiritual support is good (76.7%, n=46) and there is adequate treatment at the facility (83.3%, n=50), however they are not provided with an opportunity to make decisions about treatment (71.7%, n=43).vi The study highlights areas of concern for practice, management, education and research relevant to paediatric oncology. Health professionals need to update themselves on peadiatric oncology through conducting research and attending research conferences on pediatric oncology. They also need to facilitate parents’ access to information and should be able to give timely, appropriate information.
Open Access
Lived experiences of older women of Traditional Authority Kachindamoto in Dedza: A psychosocial perspective
(2015-11-01) Mpeketula Matewere, Sekundina
Experiences of older women in Malawi have not been extensively explored despite evidence on abuse of older people and the growth of their population globally. This was a qualitative study which employed hermeneutic phenomenology to explore lived experiences of older women of Traditional Authority Kachindamoto in Dedza. Purposive sampling was done. The sample comprised of sixteen older women. Face to face in-depth interviews were conducted using a semi structured interview guide. Data analysis was done using Interpretive Phenomenological Analysis. Findings revealed multiple psychosocial challenges which older women experience as a result of elder abuse, HIV and AIDS, different forms of loss and finally being the uncertainty of obtaining support. A common psychosocial impact expressed was living a life of torture endured silently leading to low self-esteem. Despite these problems, some older women who were still living with their spouses expressed positive experiences. There is evidence that older women who still have their spouses are respected in society than those without. Additionally, the study has identified other coping mechanisms that facilitate positive living among older women without spouses. The implication is that the multifaceted and multidimensional nature of older person’s challenges calls for a renewed action that have to involve multi-disciplinary as well as multi-sectoral collaboration and coordination in offering services for older people.
Open Access
Factors that contribute to effective clinical teaching of student nurse/midwife technicians in Malawi
(2015-11-01) Chalera, Jane
Clinical teaching is an essential task in the production of competent nurse/midwife technicians. There is the increased disease burden in Malawian hospitals in the face of the shortage of nursing staff and at the same time there is increased student intake in nursing colleges with inadequate faculty members (Muula & Maseko, 2005). All these factors negatively affect clinical teaching. A quantitative, descriptive cross sectional design in data collection and analysis was used to investigate factors that contribute to effective clinical teaching of student nurse/midwife technicians in Malawi. Structured questionnaires were used on 130 nurse educators who consented to take part in the study. A response rate of 94% was achieved. SPSS version 19.0 was used to analyse the data. Results of this study revealed the factors that contribute to effective clinical teaching as: clinical teaching environment (79.9%, n=104), use of innovative clinical teaching methods(18.6%, n=24), adequate clinical teaching resources (10.2%, n=13), small number of nursing students (71.2, n=93), year of study (44.1%, n=57) and learning outcomes for the clinical setting (54.2%, n=70).Among the recommendations is empowering nursing students to actively participate in their own learning and evaluation of own achievement of clinical objectives as these are critical to their development as competent, self-directing professionals, capable of assuming responsibilities inherent in the ever-changing and expanding health care system.
Open Access
Quality of care provided to hospitalized under-five children suffering from severe malaria at Kamuzu Central Hospital, Lilongwe, Malawi
(2015-11-01) Nyirongo Chiluzi, Blessings Chimwemwe
Background: Severe malaria, the number one cause of morbidity and mortality in Africa and Asia causes imminent death in an under-five child if left unattended to. As such provision of timely, quality care to this age-group helps save lives and it also results in 46% reduction of all neurological impairments. To explore and describe the quality of care that is provided to hospitalized underfive children suffering from severe malaria at Kamuzu Central Hospital, Children’s’ Special Care ward. This was a descriptive, study that utilized qualitative approach. Purposive sampling was used to recruit participants. A semi-structured interview guide was used to collect data. Data was collected through face to face in-depth interviews by the researcher from 24th June 2014 to 25th July 2014. A digital tape recorder was used to record interviews with permission of the participants. A total of 25 Health Care Workers (HCWs’) were interviewed. Thematic Content Analysis (TCA) was used to analyze data manually. Demographic data was collected using a questionnaire computed and analyzed using descriptive statistics. Despite the fact that triage was implemented and that very sick children were priotized for urgent care, findings generally indicated that the quality of care that majority of hospitalized under-five children suffering from severe malaria received was poor and below standard. Major attributable reasons for poor quality care were severe shortage of Health Care Workers, poor and unfriendly infrastructures and shortage of essential medical supplies required for resuscitation. Severe shortage of staff, poor infrastructures and shortage of essential medical supplies required for resuscitation resulted in delivery of poor quality care by Page health care workers. It is therefore, recommended that more Health Care Workers should be deployed, there is need for infrastructure renovations and increased hospital funding by government to improve resource mobilization and availability.
Open Access
Perceptions of student nurses on teaching and learning in skills laboratory at Nkhoma College of Nursing and Midwifery Lilongwe, Malawi
(2015-11-01) Karonga, Emily Flonie
In the past teaching and learning of clinical skills were wholly practiced at bedside in which patients were used as teaching aids and then changed to practical room which was teacher dominated. The profound change in nursing education and health care system had made these teaching methods less effective, as a result skills laboratory teaching and learning has been adopted as a strategy to support students’ development of skills before clinical placement. A descriptive quantitative study was conducted to describe perceptions of student nurse/midwives on teaching and learning in skills laboratory at Nkhoma College of Nursing and Midwifery in Lilongwe, Malawi. Data were collected from 91 students using a questionnaire and analyzed using SPSS software package version 16.0. Percentages and frequencies were used to summarise results. The results showed that, all the participants indicated that demonstration was predominantly used and the majority 92.4% (n=84) identified the demonstration to be the most useful learning strategy while small group discussion, self directed learning, peer learning, role play and reflection were viewed least useful. The majority 86% (n=78) needed educational video films while 13.2% (n=12) needed real objects such as dead body and placenta. Benefits of learning in skills laboratory included; participants became competent 87.9% (n=80), gained confidence 85.7% (n=78) and patients’ safety 29.7% (n=27). However, limited time for practice 81.3% (n=74), inadequate learning resources 42.9% (n=39), overcrowding of students during skills laboratory sessions 36.3% (n=33) and inadequate supervision 26.4% (n=24) were some of the challenges faced during learning. The recommendations made included; Opening time for skills laboratory should be revisited, enough resources should be available, in-service training for nurse educators should be conducted on effective use of the skills laboratory, replication of the same study at different nursing colleges with a larger sample and investigating the impact of skills laboratory teaching and learning on clinical performance.
Open Access
Management of diabetes and self-care practices among older adolescents with type 1 diabetes at two central hospitals
(2015-11-01) Chimbe, Etta
The study aimed at assessing knowledge levels and practices on management of type 1 diabetes among adolescents at Queen Elizabeth and Kamuzu Central Hospital. It was a quantitative research that used a descriptive cross sectional design. The participants were recruited using convenience sampling method, with a total of 46 adolescents. Data was collected using a structured questionnaire on various aspects of diabetes that included knowledge on management, self care practices, type of support and challenges faced in managing the condition. The data was analyzed using two statistical packages; IBM SPSS Statistics version 20, to enter and summarize data and R version 3.1 to analyze statistical relationships between variables of interest. Relationship between demographic variables and knowledge of diabetes was established using spearman correlation for continuous variables and for categorical variables, Chi-square test was used. A total of 63% (n=29) of the respondents knew the cause of type 1 diabetes and 58% (n=42) had inadequate knowledge on managing hyperglycemia. There was a significant association between age and number of admissions (P=0.022) and no link between knowledge and self care practices (P>0.05). Majority (64%, n=28) of the adolescents were injecting themselves with insulin. Sixty four percent (n=39) of the adolescents were inappropriately doing the self monitoring of blood glucose. Majority of the adolescents (70%, n=32) knew why changing insulin injection site is important and 78% (n=36) of them were not counseled on diet plan. Psychological support was the least provided by family (11%, n=13) and health care providers (9%, n=11). Lack of blood glucose monitoring equipment and erratic insulin supply were mentioned as some barriers affecting management and self care practices.vi Knowledge, ability to perform self care practices and support, affects diabetes management behaviors among adolescents. Findings from the study revealed inadequate knowledge amongst the adolescent’s on diabetes and diabetes self care practices. Therefore, there is need to train health care providers on diabetes and develop health education materials for adolescents with type 1 diabetes
Open Access
Traditional Birth Attendants (TBAs) are not Allowed to Assist Childbirth but why are Women in Mzimba District Still Giving Birth with the Assistance of (TBAs)?
(2015-11-01) Mwase, Atisiya Clara
Policy change for Traditional Birth Attendants stipulates that TBAs should not conduct deliveries because they contribute to high maternal mortality. TBAs are supposed to encourage women to deliver at a health facility with the assistance of skilled birth attendants. The study aimed at investigating the reasons women in Mzimba District specifically at catchment areas of Mkoma and Manyamula Health Centres and Mzimba District Hospital still prefer giving birth with the assistance of TBAs. A descriptive and exploratory qualitative method was used in this study to explore reasons women were still giving births at TBAs. Purposive sampling was used to select 3 health facilities within Mzimba District where many women prefer to deliver with the assistance of TBAs. Purposive sampling was also used to select both women and male participants for the study. Nineteen women of childbearing age of between 18-49 years; and men participated in the study. Data was collected through in-depth face to face interviews and focus group discussions. Data was analyzed manually using thematic content analysis. Descriptive statistics was used to analyse the demographic data using Statistical Package for the Social Science (SPSS) version 16.0. The demographic data showed that the majority of the participants were 18-24 years old; all were Christians and married; had primary level of education and their main source of income was peasant farming; and on average the participants had given birth to 3 children. Three main themes emerged from the qualitative data: awareness on policy change for TBAs, women’s lack of decision making power, and barriers to deliver with skilled attendants. Based on the results, it is vii recommended that a multi-sectoral collaborative approach should be used to address the challenges.
Open Access
Utilization of family planning methods among women on antiretroviral therapy in Dedza district, Malawi
(2015-11-01) Namijingo Kamwendo, Nancy
There is evidence indicating that HIV infection reduces fertility desires, but does not eliminate it. ART initiation can restore fertility in women, influencing increased fertility intentions. Meeting contraceptive needs of HIV positive women can help avoid unintended pregnancies, which would reduce maternal deaths. Literature has shown that despite being beneficial to mother and child health outcomes, utilization of family planning among clients on ART is low. This study explored current FP use, identified frequent used FP methods and underlying factors among women on ART in Dedza. This was a descriptive quantitative study. Data collection was through face-to-face interviews using a structured questionnaire. The sample consisted of 382 reproductive age women on ART, attending Dedza district hospital ART clinic. Computation of descriptive statistics determined frequencies and proportions. Chi-square test at 5% level of significance determined associations. About 55% (210) of the respondents were using family planning methods, and most of them used condoms, followed by an injectable hormone. Only 74 (48%) used the condom consistently and 103 (49%) used dual methods. Parity of the client was the significant predictor of family planning utilisation for women on ART, at Dedza district ART clinic. Generally, current use of contraceptives other than condoms was very low. These findings highlight the need for integration of family planning services and ART clinics in order to strengthen family planning services among women living with HIV on ART.
Open Access
Assessing the promotion of clinical reasoning in classroom teaching among student nurses: A case of St Joseph's College of Nursing
(2015-12-01) Banda Bonyonga, Mtinkheni Wezi
The assessment of how clinical reasoning is promoted among student nursing and midwifery technicians followed the anecdotal reports from the public on the poor quality of client care provided by the nurses in the health facilities. These observations by the stakeholders pointed to the teaching and learning processes involved in the preparation of the nursing midwifery technicians. If the level of performance of the nursing midwifery technician is in question then the teaching and learning processes involved needs to be assessed because the educational level at which a student nurse is prepared makes the difference on how the nurse performs her duties in practice. This led to a concurrent exploratory mixed method study with the purpose of determining how clinical reasoning was promoted in classroom teaching among the student nurses. The population consisted nurse educators (n=18) and student nurses (n= 90). Quantitative data was collected from the educators and student nurses using questionnaires to determine the teaching styles of the educators, learning preferences and clinical reasoning levels of the student nurses. Qualitative data determined the educators and student nurses perceptions on the teaching and learning experiences from eight educators and three students’ focus groups. Quantitative data were analyzed using the statistical package SPSS Version 20.0 and descriptive statistics were run for frequencies, means and standard deviations. Content analysis was used for qualitative data. The results indicated that there was lack of diversity in the use of teaching styles among the nurse educators. The Expert Teaching Style was the most preferred (mean= 4.06 and SD=.981); the less preferred (mean= 3.55 and SD=1.24) was the Facilitator Teaching Style. The dominant teaching method was the lecture method; student nurses preferred lecture method but felt that interactive teaching methods were important in their learning processes and development of clinical reasoning abilities. Students also lacked diversity in their learning preferences as they (54.7%) preferred to learn together in a classroom environment. The learner centered learning environment where individual thinking, expression of own opinions and learning from peers was the least preferred (6.67%) by the learners. These results are in agreement with the learner dependence from the qualitative results. Therefore based on these results there is need for improvement of the teaching/learning processes in order to improve quality of nursing care provided in the health facilities in Malawi.
Open Access
Exploring knowledge, attitudes and practice of parents/guardians on home management of diarrhoea in children less than five years in Ekwendeni
(2015-12-01) Kasonda, Esau Abraham
This is a descriptive cross sectional study done to explore knowledge, attitude and practice of parents or guardians on home management of childhood diarrhoea. A semi structured questionnaire was used to interview parents or guardians of children less than five years old who presented to Ekwendeni Mission Hospital for the treatment of childhood diarrhoea and those who visited the underfive’s clinic for growth monitoring and immunizations. The specific objectives for the study were to assess knowledge of parents/guardians on the four basic rules of home management of childhood diarrhoea, to determine the attitude of parents/guardians on modern management of childhood diarrhoea and to find out home care practices of parents/guardians in the treatment of childhood diarrhoea before taking the child to the health facility. The study was conducted at Ekwendeni Mission Hospital in Mzimba District and the sample was drawn from parents or guardians of children aged five years or less who presented to the hospital’s outpatient department with a complaint of diarhoea and those who came to under five’s clinic for growth monitoring and immunizations. The study topic was chosen because it is one of the major concerns of the WHO in the reduction of deaths among children under the age of 5 years since diarrhoea accounts to 16% of all childhood death worldwide (WHO, 2010). Children from developing countries (including Malawi) are the worst hit as diarrhoeal diseases account for an estimated 17.5-21% of causes of death in children less than five years of age (WHO, 2010). However, a few studies have explored issues related knowledge, attitude and practice on management of childhood diarrhoea in Malawi. In addition, the results from the demographic and health surveys in Malawi do not give adequate information on the four rules of managing diarrhoea in children at home. This means that these demographic survey reports do not provide clear evidence on people’s attitude towards modern treatment of diarrhoea. Information from the current study will enable health workers to determine whether information given to parents and guardians on home management of childhood diarrhoea is adequate and if the information given has any impact on the home care practices in the communities. Two sampling methods were used in the selection of participants in this study. A consecutive sampling technique was used in selection of parents or guardians of children with diarrhoea and a random sampling technique was used to select parents or guardians of children who attended the underfive’s clinic at Ekwendeni Mission Hospital. A total of 327 parents or guardians were interviewed using a carefully designed semi structured questionnaire. Among the 327 respondents, 100 (30.6%) were parents/guardians of children who presented with diarrhoea at the time of data collection. Two data collectors administered a questionnaire to respondents at the hospital’s outpatient department from 12th December 2013 to 14th February 2014. Data was coded manually and entered into the computer. Analysis was done using Epi info version 7, a statistical package recommended for health related research. Presentation of results was done using tables and figures. The results have indicated that parents or guardians had partial knowledge about the four rules in home management of childhood diarrhoea. Knowledge about giving more fluids including oral rehydration solution (ORS) was better than knowledge about continued feeding and zinc. Most of the respondents had a positive attitude towards modern management of childhood diarrhoea but lack of resources and lack of knowledge about diarrhoea were the main barriers that affected the recommended home care practices of diarrhoea. It is recommended that health workers should give full information about diarrhoea and its management in order to improve home care practices for childhood diarrhoea.
Open Access
Factors hindering implementation of learner-centred teaching strategies in Christian Health Association of Malawi nursing colleges
(2015-12-01) Nyirenda Chirwa, Mercy Patricia
Meaningful learning requires learner-centred teaching strategies, which focuses on the needs of the learners. The study therefore, aimed to explore factors hindering implementation of learner-centred teaching strategies. A descriptive cross sectional design was used. A total of 72 nurse educators participated in the study and completed questionnaires. This was complemented by observation checklists for data gathering: eleven lessons were observed while the nurse educators taught their different courses.. The study found that a combination of learner and teacher-centred approaches were used by the nurse educators. However, classroom observation revealed that traditional lecture methods dominated most classrooms. The main challenges were lack of training for nurse educators in learner-centred teaching strategies; negative nurse educators and students attitudes towards the learner-centred teaching strategies and large numbers of students per class. It is assumed that training and support may improve educators’ attitudes and teaching methods. Therefore, the study recommended that a policy should be in place that promotes learner-centred teaching and learning strategies, adequate resources and ongoing support to educators for instance training in learner-centred teaching strategies. Furthermore, the results showed that there was a significant relationship (p<0.05) between nurse educators and students attitudes towards learner-centred teaching strategies. In addition, there was a significant correlation (p=0.01) on lack of resources to implement learner-centred teaching strategies and lack of orientation to these teaching strategies in the training. Nonetheless, the study showed no significant correlation (p>0.05) between years of experience; educational level and knowledge of learner centred teaching strategies as well as its use.