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- ItemOpen AccessExploring barriers to cervical cancer screening among women living with HIV (WLHIV) attending an ART clinic at Nkhoma Hospital, Malawi(Kamuzu University of Health Sciences, 2020-11-01) Kabota, Beatrice PhakiraWomen living with HIV (WLHIV) are at higher risk of developing cervical cancer than those who are HIV negative. In order to increase access to services, international policy recommendations include the integration of cervical cancer screening into HIV care: a pilot study carried out in Malawi reported high uptake of cervical cancer screening after integration with HIV care in Malawi. However, evidence has shown that despite attempts at integration, there is still underutilization of cervical cancer screening services among WLHIV in clinics across Malawi. Hence this study that aimed to explore the barriers to cervical cancer screening among WLHIV attending the Anti-Retroviral Treatment (ART) clinic at Nkhoma Hospital, Malawi. A qualitative study design , was carried out at Nkhoma Hospital ART clinic. Seventeen in-depth interviews were conducted among WLHIV who had never accessed cervical cancer screening services. Data was analyzed using thematic analysis method. Eight (8) themes emerged from the study. These include: (i) poor communication approaches, (ii) lack of knowledge of where to access screening services, (iii) fear emanating from negative experiences shared by peers, and fear of a cancer diagnosis itself), (iv) feeling of embarrassment over exposure of private body parts, (v) myths and misconceptions (vi), low perceived vulnerability, (vii) long travelling distances and (viii) long waiting times. These findings confirm the need to improve delivery of cervical cancer screening for WLHIV at Nkhoma Hospital. They highlight the need for client-centered counseling and support to overcome fears and misconceptions, and designing health promotion messages that may directly address the concerns of WLHIV.
- ItemOpen AccessExploring HIV services needs of people at Lilongwe Central Market, Malawi(Kamuzu University of Health Sciences, 2020-12-01) Jere, James H.C.Reaching all people with HIV services, including those in the informal economy, is critical to meeting the UNAIDS goals of 95-95-95. However, people who sell in the market, prioritise their business over attendance at health facilities, inevitably limiting the services they can access if these services are not in their place of business. An exploratory qualitative study design was used to explore market traders' preferences for the type and delivery methods of HIV services at Lilongwe Central Market, Malawi. We conducted four Key informant interviews (KIIs), three with officers responsible for planning HIV services at both the District and Council levels, and one with a market chairman. Sixteen In-depth interviews (IDIs) were conducted with traders in different businesses at Lilongwe Central market. All interviews were face-to-face and were audio-recorded and later transcribed. Data were analysed thematically and was guided by the Differentiated Services Delivery framework. HIV services preferred by market traders include HIV testing, Antiretroviral Therapy, HIV awareness campaigns, and Condom’s dispensation. These services could be offered when the market is less crowded via a temporary shelter or mobile vans. Service providers can be both trained peers and health professionals depending on the service. To mitigate the stigma associated with HIV-specific services these HIV services should be offered in an integrated care setting. Therefore, to accelerate the achievement of UNAIDS 95-95-95 goals by 2030, HIV services should be available to all those who require them at times and locations that are convenient for them, through providers they have chosen and provided in an integrated manner to mitigate stigma. This necessitates the development of new approaches to closing gaps and the inclusion of under-served groups, such as traders, in markets.
- ItemOpen AccessAn exploration of the predictors of depression and anxiety in older people (60+years) using secondary data collected from the Malawi longitudinal study on families and health(Kamuzu University of Health Sciences, 2020-12-01) Khosa, JusticeDepression and anxiety are amongst the common mental health problems amongst the elderly population and contributes greatly to poor quality of their life. Depression alone was projected to become the second leading cause of morbidity and mortality in older adults by the year 2020. A better understanding of these two conditions is vital for planning appropriate interventions for such special populations. However, there are limited studies focusing on these conditions in low and middle-income countries including Malawi. The purpose of this study was to examine the occurrence and predictors of depression and anxiety amongst older persons (≥ 60 years) in Malawi. A cross-sectional study was conducted utilizing secondary data collected by the Malawi Longitudinal study on families and health. Data was extracted from the parent study on depression and anxiety utilizing the Patient Health Questionnaire module 9 (PHQ-9) and the Generalized Anxiety module 7 (GAD-7) respectively. Chi-Square test and logistic regression explored the association between the two conditions and the social as well as physiological variables. Data was analyzed using Stata version 14.0. Mean age was 72 years with SD of 8.5. Overall, about 24.69% (n=200) of participants were depressed with 40.49% having minimal depression, 26.47% mild depression, 9.01% moderate depression, and 2.43% having moderate to severe depression. On the other hand, about 19.63% had anxiety, with 24.53% (n=171) having mild anxiety, 5.16% (n=36) moderate anxiety, and 1.43% (n=10), a severe form of anxiety. Marital status (widows, divorced), having high blood pressure, experiencing pain, and age were found to be predictors of both anxiety and depression. There is a need for programs that can effectively address the needs of older adults focusing on both physical and mental wellbeing in Malawi.
- ItemOpen AccessAssessing the psychological, social and economic effects of caregiving on caregiver of mentally ill older patients accessing services at St John of God Hospital, Mzuzu(Kamuzu University of Health Sciences, 2020-12-01) Chikopa, FynessCurrently, in Malawi, there is scarcity of data on studies conducted on the psychological, social and economic effects of caregiving on caregivers of mentally challenged patients, who are also older persons above 60 years of age. Mentally challenged refers to all elderly suffering from any type of mental illness. A number of caregivers are affected psychologically, socially and economically due to their caregiving role, which affects quality of care, while little is done in managing these effects. Therefore, the study sought to identify psychological, social and economic challenges that affect the care-givers to inform the development of appropriate strategies. The study sought to describe how the psychosocial and economic effects of caregiving on caregivers of mentally ill older patients affects the quality of care of mentally ill older patients and documenting recommendations to address psychosocial and economic effects of caregiving on caregivers of mentally ill older patients. The study employed a cross-sectional design and qualitative research method. In-depth interviews were used to gather information from caregivers of older mentally ill patients and health workers who assist these elderly clients at St John of God Mental Health Clinic. A semi-structured interview guide was used by the researcher to acquire information from the respondents. A total of 22 people participated in the study; 14 caregivers and 8 health workers. All the participants were above 18 years of age. The caregivers were 14; 8 females and 6 males, respectively. The health workers were 8; 3 clinicians and 5 nurses. Data collection was done from 22nd October to 20th November, 2020. Data was analysed using thematic analysis. Ethical clearance to conduct the study was obtained from the College of Medicine Research Ethical Committee (COMREC). Female caregivers were more depressed than male caregivers. The caregivers experienced stigma and discrimination and were isolated in their communities because they cared for the older mentally challenged patients. Caregivers were also faced with financial problems, which affected the quality of health care provided to the patient by the caregivers since the caregivers were affected. Recommendations were made to ensure caregivers provided quality care, including provision of support to the caregivers by the relatives; the health workers to provide mental health education to prevent stigma and discrimination in the community and the government to ensure that mental health service is available in all their health facilities. Caregivers face social, psychological and economic problems during their provision of care to mentally ill older patients. There is need to provide comprehensive management of caregivers in order to alleviate these problems for the patient to receive quality care.
- ItemOpen AccessFactors that influence uptake of assisted partner notification for HIV index testing services among new diagnosed HIV positive adults at Ndirande Health Centre, Blantyre(Kamuzu University of Health Sciences, 2020-12-01) Puleni, Paul C.To achieve first 95 where 95% of PLHIV need to know their status, the Ministry of Health introduced the 2019 Active index testing policy, in which assisted partner notification services (APNS) were chosen as the key innovative and effective strategy to increase HIV case identification. We conducted descriptive qualitative research to assess barriers and facilitators to uptake of APNS among newly diagnosed HIV positive clients at Ndirande Health Centre. The study used mixed variational sampling. The study sought in-depth opinions and perceptions from index clients who accepted APNS, partners who either accepted or refused APNS and health care workers who provide index testing services. Data collection was done through in-depth interviews and key informant interview guides. Data analysis was done manually using thematic inductive and deductive analysis. The study results were thematically analysed and presented in the context of the theoretical framework, the Socio-Ecological Model. The study showed that lack of knowledge among partners of index clients, wrong physical addresses, non disclosure of results for fear of intimate partner violence (IPV), lack of provider knowledge, the proximity of the contact house to the neighbour’s, and the COVID 19 pandemic were the key barriers to uptake of APNS. Knowledge of APNS, stability of marriage, gender, health care worker training, health care worker notification, home tracing, and testing were the key facilitating factors to the uptake of APNS. Sensitisation and demand creation, screening for intimate partner violence, provision of funds to support home tracing and testing, provider skills training and health care worker notification approach were the strategies used to increase uptake of APNS.Non-disclosure of HIV testing results for fear of IPV was the major prohibitive factor to the uptake of APNS. Health care workers should actively screen and look for IPV, particularly in clients with unstable relationships and optimize health care worker notification approach which reduces IPV occurrence, support disclosure, and increase APNS uptake.
- ItemOpen AccessEvaluating the impact of mandatory folic acid fortification programme on the prevalence of Spina Bifida in Southern Region of Malawi: A central hospital based secondary data study(Kamuzu University of Health Sciences, 2020-12-01) Chapweteka, BlessingsWithout evidence, we can not know if a Malawian fortification programme of 2015 has been effective. We conducted the study to evaluate the impact of folic acid fortification programme on the prevalence of spina bifida in the southern region of Malawi. We used a pre post case-control quasi experimental comparative study design. We assessed the total number of births for the southern region, Mw in 2014. Then we reviewed case notes of spina bifida patients who presented to QECH from the southern region, Mw in that year (2014). We did the same for 2018. Spina bifida cases were defined as a documented confirmed case note diagnosis of spina bifida, myelomeningocele or meningocele. The control group comprised of case notes of patients who presented to QECH from the southern region with conditions like sepsis, malaria and diarrhea. To obtain prevalence, we divided the number of cases with the total number of births, expressed per 10,000 live births. The prevalence for 2014 and 2018 were compared to assess the programme’s impact. We performed logistic regression to assess the odds of spina bifida before and after the programme using; gender, birth weight; tribe; maternal age at delivery; number of children by mother; district of residence; pre-natal use of folic acid and use of chronic medications. The before and after odds were compared to assess for accuracy of prevalence. We used Z test to assess the significance of the odds at 95% confidence interval and 0.05 marginal error. SPSS software version 20 was used. The prevalence increased by 13.6% from the pre-fortification to the post-fortification period. Occurrence of spina bifida was statistically associated with female gender (OR 2.51 (1.019-6.198) p= 0.45), absent history of spina bifida (OR 0.191 (0.41-.884) p=0.034), mean birth weight of 2850g, family size 72% ≤3 children and maternal age 77% ≤ 30 years. The study showed that the mandatory folic acfortification programme in Malawi might have not been effective in reducing the prevalence of spina bifida.
- ItemOpen AccessAssessing the impact of health centre management committees in curbing drug pilferage and promoting public service delivery: A case of Chitipa district(Kamuzu University of Health Sciences, 2020-12-01) Bandawe, TedChitipa District Hospital registers high numbers of drug cases due to pilferage despite the availability of Health Centre Management Committees (HCMC). One of the key responsibilities of HCMCs is to monitor drug and supply chain at both facility and community level. This comes against the background that 15% of the stock outs at Chitipa Distric Hospital were due to drug pilferage in 2018. At national level, millions of drug funds are lost every year due to drug pilferage. However, since the introduction of the national drug investigation unit (DTIU) in 2017, drug theft cases have declined and most perpetrators were apprehended. Focus Group Discussions and Key Informant interviews were used to collect data in five facilities in Chitipa. A total of 100 (48 males, 52 females) participated in the study. Of these thirty (11 males, 19 females) were members of Health Centre Management Committee and ten (4 males, 6 females) were local leaders. The rest that took part in the focus group discussions were community members affiliated to HCMC committees. Lack of Information among community members is one factor contributing to poor functionality of the Health Centre management committees. What is clearly emanating from this research is that grassroots’ participation in Chitipa District council is a farfetched idea because local elites are exploiting the new found window of opportunity in the decentralization initiative to promote patronage and neopatriomonism at the expense of the grassroots participation in decision-making. The study could not establish strength of association between the factors identified and the functionality of the HCMCs. The findings highlight the importance of using the socio-ecological model in community engagement so as to identify and address factors at every level.
- ItemOpen AccessHypertension service delivery capacity assessment in Malawi: Results from Malawi longitudinal study of families and health in Balaka, Machinga, Mchinji and Rumphi health care facilities(Kamuzu University of Health Sciences, 2020-12-31) Mbulaje, Lucia Davie AmbajilynManagement of hypertension has challenges due to different factors. These include unavailability of drugs, poor infrastructure, inexperienced personnel, insufficient diagnostic tools, and high treatment costs. Malawi adopted a Package for Essential Non-communicable (PEN) and was incorporated in Malawi Standard Treatment Guidelines (MSTG) for the management of various diseases including hypertension in 2015. Since the inception of the MSTG, the service delivery capacity for hypertension care in some health care facilities has not been well researched. We conducted this cross-sectional study to assess health service capacity to deliver comprehensive hypertension care. Data were extracted from the parent study of Health Care Facility questionnaire of the Malawi Longitudinal Study of Families Health. Descriptive statistics were analyzed using Stata version 14. Of the facilities managers’ qualifications, 53.6% or they were Medical Assistants and 45.8% of them had 2 years of post-secondary education. Most of the managers 82.1% did not have in-service training or update on topics specific to the diagnosis and/or management of hypertension. In 57.1% of the facilities, copies of protocols and guidelines for the or management of hypertension were not available. Aspirin was the most available drug (89.3%) and Calcium Channel Blockers were not available in 69.7% of the health care facilities. We have found gaps in health facilities capacity to deliver comprehensive hypertension care. Future interventions should aim in targeting the highlighted gaps to improve capacity.
- ItemOpen AccessBurden of and factors associated with virological failure among HIV positive patients on antiretroviral therapy (ART) in Nsanje district, Malawi(Kamuzu University of Health Sciences, 2021-08-18) Mphande, ShupeIn efforts to fight HIV, many countries including Malawi started implementation of universal ART eligibility for all HIV infected individuals as a strategy for reaching the 90-90-90 targets. This led to the increase in ART coverage hence intensifying the need for scale-up of ART monitoring, for which the current gold standard is Viral Load (VL) testing. Despite the increasing access to ART and VL monitoring, numerous studies have demonstrated suboptimal levels of viral suppression (VS) in different populations in many low-resource settings. Therefore, this research will help to determine the burden of virological failure and focus on factors leading to virological failure which will in turn lead to better targeting strategies and policy change. The main objective of the study was to determine the burden of virological failure and factors associated with virological failure among HIV patients on ART in Nsanje district. This was a cross sectional quantitative study using Laboratory information system database, ART master cards and registers. The study targeted HIV positive patients on ART for > 6 months from July 2015 to June 2019 in 14 facilities in Nsanje district. The criteria for the study was a VL result within the stated period. Data was analyzed using STATA version 16. 451 participants were enrolled in this study. 267(59.2%) participants were married, and 278 (61.6%) started ART due to WHO clinical stage. Of the 451 study participants, 321(71.2%) failed to achieve viral suppression (VL=<1000 copies). In univariate analysis, age at ART initiation, occupation (OR 0.203, 95% CI 0.11, 0.39; p<0.003), marital status, duration on ART (OR 0.55, 95% CI 0.33, 0.92; p=0.023) and ART adherence (OR 5.125, 95% CI 3.01, 8.74; p<0.0001) were associated with VF. Age and Fair/poor adherence (AOR 4.221, 95% CI 2.41, 7.38; p<0.0001) was statistically significant in multivariate analysis. Age, ART adherence, marital status, occupation and duration on ART were identified as some of the factors associated with VF. Proper strategies should be developed in order to reduce VF and improve adherence.
- ItemOpen AccessExploring factors affecting the HIV/AIDS workplace policy development and implementation in selected public hospitals in Lilongwe, Malawi(Kamuzu University of Health Sciences, 2021-10-01) Kapangama, PatriciaMalawi has a national workplace HIV/AIDS policy. Despite its existence, the adoption of the policy is low. Many organizations are yet to adopt the policy as a guiding document in recognizing and addressing HIV/AIDS as a workplace issue. There is a dearth of information on the factors that affect the policy’s implementation in public institutions. Objective: The study’s main objective was to explore factors affecting the development and implementation of HIV/AIDS workplace policy in public hospitals in Lilongwe district. An exploratory qualitative cross-sectional study was conducted from June to July 2020 at Bwaila hospital and area 25 health Centre in Lilongwe district, Malawi. Twenty-four in-depth interviews (IDI) with employees and 6 key informant interviews (KII) with hospital administrators were conducted. All IDIs and KIIs were digitally recorded, transcribed and translated verbatim into English. The data were analyzed using thematic analysis. The study found that major factors affecting the HIV/AIDS workplace policy’s development and implementation included stigma and discrimination, lack of knowledge and inadequate resources. The main challenges facing policy implementation were lack of policy sensitization, stigma and discrimination, lack of employee involvement, lack of privacy and confidentiality and lack of management commitment. The potential optimizing factors were staff sensitization, adequate resources, establishing of a staff welfare committee, strengthening HIV prevention, provision of additional support to staff and HIV/AIDS workplace policy availability. There is a low implementation of the HIV/AIDS workplace policy in the selected public hospitals due to poor enforcement of the policy, lack of hospital management support and commitment to developing and implementing the HIV/AIDS policy at the workplace. Close supervision by the Ministry of Health and regular monitoring and evaluation at all public health institutions, provision of regular sensitization and staff involvement would ensure the development and implementation of HIV/AIDS workplace policy.
- ItemOpen AccessThe state of cervical cancer screening in imprisoned women in Malawi: A case of Maula Prison(Kamuzu University of Health Sciences, 2021-12-01) Mendulo, ReginaMalawi is one of the countries with the highest burden of cervical cancer in the world with less than ten percent of women screened for cervical cancer. The study aimed to investigate the state of cervical cancer screening among incarcerated women at Maula prison. Findings of this study provide knowledge of the challenges that prisoners face when accessing screening services so that relevant policies and strategies may be developed to address the challenges. The study employed a cross-sectional qualitative study design. A total of 31 prisoners aged between 18 to 49 participated in the study. Among these, 15 women participated in in-depth interviews, while 16 women participated in two focused group discussions (FGDs) consisting of 8 women per group. All interviews were recorded and transcribed verbatim. Data was analysed using a thematic content analysis approach. All participants were knowledgeable of cervical cancer. Screening services were periodically provided in the prison. Early diagnosis and treatment were the key benefits for undergoing screening. Poor environment consisting of poor sanitation and hygiene, Preference of female health practitioners during screening, poor treatment by prison officers & health care givers when accessing care and poor living conditions were reported as challenges that affected screening uptake in the prison. Incarcerated women experience gender-specific health-related challenges, including menstruation, pregnancy, and development of certain forms of cancer that affect their sexual reproductive health. The prison culture hinders prisoners from receiving quality care while in incarceration. Positive living conditions, environment and policies must be put in place to support screening uptake among this population.
- ItemOpen AccessFactors associated with retention in care among people living with HIV/AIDS in Ubungo Municipality, Tanzania(Kamuzu University of Health Sciences, 2021-12-01) Moshi, Sylivia DenisGlobally, approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. In sub-Saharan Africa 54% of those who are not yet eligible for ART were lost to follow-up before becoming eligible, while 32% of the people living with HIV who were eligible for ART were lost before initiating treatment. Although the retention rate of HIV infected people in Tanzania has increased slowly from 39.4% to 54.5% from 2008 to 2016, there remains some challenges in achieving optimal rates. A convergent mixed method design was used to determine factors associated with retention in care among PLHIV at Ubungo municipality, Tanzania. Quantitatively, a descriptive cross -sectional design was applied and data was collected using an interviewer-administered questionnaire among 365 participants that were systematically selected. Quantitative data were analyzed using SPSS software and descriptive statistics was used to summarize findings in tables, graphs and charts. In addition, Chi square test was used to determine the factors associated with retention in HIV care. Qualitatively, we conducted a descriptive study and drew a purposive sample of 18 participants for In-depth Interviews and 18 health care workers for Key informant Interviews (KII). All data were digitally recorded and then transcribed, translated, coded, analyzed thematically. The data collection was conducted between May and July 2021. Ninety-three percent (93%) of the participants were retained in HIV/AIDS care. The majority (81.1%) never missed their clinic appointments. The main reason for missing a clinic appointment was forgetfulness. Eighty-seven per cent of the participants were aware of the risks of missing appointments. However, 94.8% participants continued using the ARVs despite missing the clinic appointment and obtained drugs from friends, relatives or another clinic. Only 1.1% of the participants were lost to follow-up. All socio- demographic charactersitics, sex, age, marital status, education level and occupation were not associated with retention. However, sense of wellness and good worker’s attitude were related to reported retention during the Key informant and in-depth interviews. The study reports a high rate of retention on HIV/AIDS care and treatment attributed to awareness of alternative clinics to collect the ARVs from and the consequences of missed appointment. Health care workers should strengthen counselling efforts to further minimize the rates of missed clinic appointments of longer than six months, focusing om factors associated with poor retention in HIV/AIDS care and treatment.
- ItemOpen AccessAssessment of the effectiveness of health management information system training in Malawi: A case of Lilongwe District(Kamuzu University of Health Sciences, 2022-03-01) Tambala, Jime PandorHealth Management Information Systems remains the fundamental systems in the medical sector to support patients’ data and data for decision making. However, despite capacity rendered by different stakeholders to improve HMIS systems infrastructure, there exist data quality issues which affecting effective delivery of health care services in all districts of Malawi, Lilongwe included. As such, the study investigated the effectiveness of HMIS user Training in improving data quality in health systems in Malawi, a case of Lilongwe District. This was a cross-sectional study which used a mixed approach of both qualitative and quantitative methods, a total of 60 health workers participated in the study. In-depth interviews were conducted to analyze the perception of health workers towards HMIS training and to determine the factors that affect effectiveness of training of HMIS in Malawi. A semi-structured questionnaire was used to assess whether the structure and mode of delivery of HMIS training respond to the training needs. The study also measured quality of data by assessing four data dimensions; accuracy, completeness, timeliness and consistency. The study findings showed that good coordination in data management, data ownership, good documentation and team work were perceived as effects and benefits of HMIS training. While data verification, data analysis and use of electronic systems such as EMR and DHIS2 were perceived as skills acquired through HMIS trainings. Key data quality dimensions influenced by HMIS trainings were completeness, correctness while timeliness and consistency had some gaps which warrant for further investigations. According to this study HMIS training is clearly showing to be effective on HMIS performance. However further consideration should be given to how participants are selected, training duration, refresher trainings, staff retention, monitoring and supervision.