Reproductive Health

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Open Access
Assessment of midwives and clinicians adherence to national obstructed labour management protocols at Thyolo District Hospital, Malawi
(2019-03-01) Chamalawa Kamaliza, Esmie
Obstructed labour is a significant cause of maternal and neonatal mortality at Thyolo District Hospital. This study aimed to investigate midwives’ and clinicians’ adherence to obstructed labour management protocols in order to better understand the gaps in providing quality of care. Key results show an adherence rate of 24% to obstructed labour management protocols at Thyolo District Hospital which indicate poor quality of care to obstructed labour women. This study was a descriptive cross-sectional study conducted at Thyolo District Hospital. The study populations were all case files of women with obstructed labour managed from 1st July 2015 to 30th June 2016. Simple random sampling was used to obtain 90 case files of women that experienced obstructed labour. Data was collected using an audit checklist and checklist for structural factors. Data was analyzed using SPSS version 16.0 and results were presented using descriptive and inferential statistics. Ethical clearance was obtained from College of Medicine Research and Ethics Committee (COMREC). Permission to conduct the study was obtained from the District Health Officer, Thyolo District Hospital. Factors that contributed to low adherence were lack of supervision, inadequate resources and lack of performance appraisals. Generally, Midwives and clinicians are not adhering to obstructed labour management protocols at Thyolo Hospital. Supervision, performance appraisal, human and material resources are needed to promote adherence.
Open Access
Compliance with focussed antenatal care among pregnant women in Dowa district, Malawi
(2017-02-01) Machika, Davison Bester
Antenatal care has for a long time been regarded as a crucial basic component of any reproductive health program. The World Health Organisation introduced Focused Antenatal Care, a model which recommends initiation of Antenatal Care visits as soon as the woman realises that she has missed her monthly period and make four targeted visits throughout the pregnancy period. Despite its significance, pregnant women persistently underutilise the Focused Antenatal Care model which has proven to be effective especially in developing countries like Malawi. Therefore, a study was conducted aimed at examining pregnant women’s compliance with the Focused Antenatal Care model in Dowa District, Malawi. A descriptive cross-sectional study using a structured questionnaire was used in selected health facilities of Dowa and Mponela. A total of 386 pregnant women were recruited using simple random sampling method. Data from the completed questionnaires were entered using CSPro version 6.0 and analysed using STATA. Descriptive statistics and logistic regression were the two statistical tests employed in this study. Responses from open ended questions were manually grouped, coded and frequencies were run to come up with percentages under each response. The results showed a high prevalence of late antenatal care attendance, 71.2%, and those making fewer than four antenatal visits were at 67.2%. Factors associated with non compliance included; lack of adequate knowledge, denial of being pregnant (OR 2.1, 95% CI 0.62, 7.11), cost of starting antenatal care (OR 1.6, 95% CI 0.38,0.68), long distance to health facility (OR 1.5, 95% CI 0.80, 2.84), value attached to Focused Antenatal Care (OR 7.5, 95% CI 0.73, 7.77), in adequate health workers (OR 1.13, 95% CI 0.69, 1.87) and having age above 35 years (OR 1.38, 95% CI 0.66, 2.85). There is high prevalence of non compliance with Focused Antenatal Care among pregnant women in Dowa District. Health education should be intensified to raise awareness. Outreach clinics should be revitalised to make the service accessible.
Open Access
A descriptive study on the magnitude and factors associated with domestic violence against pregnant women in Nsanje District, Southern Malawi
(2012-08-01) Chasweka, Robert John
Domestic violence (DV) against pregnant women exists in Malawi but its magnitude is unknown due to scanty published data on the subject. The aim of the study was to determine the extent of, and factors associated with DV against pregnant women attending antenatal clinic at Nsanje District Hospital in the Southern Region of Malawi. A descriptive quantitative study using a random sample of 292 pregnant women was conducted. A structured questionnaire was administered to each pregnant woman that consented to participate in the study. Relationships among variables were established by running a correlation matrix using SAS. Statistical significance about the association between variables was determined by Chi-square tests. The findings indicate that the majority (58.6%) of women were psychologically, physically and sexually abused during pregnancy. Positive correlations were found between DV and witnessing abuse in the home (p<0.05), smoking partners (p<0.01), family debt (p<0.01) and being ever hurt before this pregnancy (p<0.05). Associations were found between DV and male control of finances and decision making, alcohol use by partner, marital conflicts and being pregnant; but not with bride price, age, and low education status. Majority of women (40.9%) found disclosing acts of violence to uncles and parents helpful, and 63.7% suggested marriage counselling as a helpful service. Over 90% of women regarded DV as a private life issue and therefore hindered disclosure. Some of the recommendations from the study include public awareness campaigns, couple counselling, and routine antenatal screening services for DV, and Government’s commitment in implementation of laws and policies that protect the rights of women.
Open Access
Determinants of cervical cancer screening uptake among women of childbearing age in Mangochi District Malawi
(2021-04-01) Mpachika, Felistas Sungeni
Cervical cancer (CC), a deadly disease, has a high burden and mortality at global and local level. Despite the burden, Malawi registers low uptake of cervical cancer screening (CCS). This study examined the determinants of uptake of cervical cancer screening among women of child bearing age in Mangochi district. A quantitative cross-sectional study was conducted in five health facilities offering visual inspection using acetic acid (VIA). A total of 482 women between the ages of 18-49 were selected using a multi-stage sampling method. Data that were collected through a structured questionnaire were coded and analysed using SPSS version 22. Logistic regression model was used to identify factors associated with CCS. Few respondents (13.1%) had ever been screened for CC. Those between 18-24 years were less likely to undergo CCS compared to those in 25-35 years category (AOR=0.38, 95% CI 0.19-0.77, P = 0.007). Respondents who had not received health education on CC were less likely to undergo CCS than those who had received (AOR=0.20, 95% CI 0.10-0.41, P=0.000). HIV positive respondents were more likely to screen than their HIV negative counterparts (AOR= 2.41, 95% CI 1.22-4.78, P=0.012). Respondents with high-level of knowledge on signs and symptoms of CC were more likely to undergo CCS than those with low-knowledge (AOR=2.91, 95% CI 1.51-5.63, P=0.002). Cervical cancer is preventable and one strategy to prevent it is through timely screening. This study has established that age, religion, ethnicity, residence, HIV status and health education are among the determinants of CCS uptake. We therefore recommend that CCS should be offered to all WCBA in this era of HIV infection, that community based screening services should be encouraged to reach out to more women residing in rural areas, that health education should be offered in all strategic areas in health facilities to give out information to clients accessing other health services and that the integration of antiretroviral therapy (ART) and CCS clinics should be rolled out to most health facilities to offer CCS to HIV positive women.
Open Access
An examination of the management of infertility in Thyolo and Blantyre districts
(2017-06-01) Nindi-Nyondo, Anda
The provision of infertility services is given a very low priority in many developing countries as it is mainly regarded as none life threatening and usually associated with high cost of treatment. Nonetheless, in Malawi, infertility is one of the priority sexual and reproductive health (SRH) issues according to the national SRH and Rights policy (2009). However, little is documented on the availability and quality of infertility services in the country. This study therefore sets out to assess the type of infertility services provided at all levels of health service delivery by assessing health care providers (HCP) knowledge, practice, barriers to provision of services and client‟s satisfaction. The study was conducted over a period of one year. It employed a cross section research design using a mixed method approach. Quantitative data was collected from 73 HCP through interviews and observation while qualitative data was collected through in-depth interviews with 27 clients receiving infertility services. Quantitative findings were analysed using SPSS version 16 and descriptive statistics were computed. While qualitative data was analysed manually using thematic content analysis. Study results revealed a generalised lack of knowledge and good practice of infertility management among all HCP assessed. Similarly, HCP cited lack of knowledge and skills (45.2%, n=33) as the main barrier to provision of infertility services. Clients cited long duration of receiving infertility services and failure to integrate male clients in the service as reasons for their dissatisfaction. A gap exists between policy and the actual infertility management practice. In order to improve infertility service provision, there is need for Ministry of Health, Reproductive Health Unit and its policy makers to develop a standard guideline for training and provision of infertility services. Furthermore, there is need for integration of infertility services in already existing RH services in all levels of service provision.
Open Access
Experiences of secondary school students in Mulanje District on parent-adolescent communication about sexual and reproductive health issues
(2019-04-01) Likoya, Esnart Vanessa
This study explored the experiences of secondary school students in Mulanje district on parent-adolescent communication about Sexual and Reproductive Health Issues. Communication on SRH issues between parents and children rarely occurs despite the fact that parents live and spend most of the time with their children. Lack of openness when discussing SRH issues between parents and children negatively impacts on the lives of adolescents. The study employed a descriptive explorative qualitative research. The study was done at Mulanje mission community Day secondary School, in Mulanje District and involved secondary school adolescents aged 12-19 years. Purposive sampling was used to recruit the study participants. Data were collected through in -depth interviews on twenty-two participants using a semi structured interview guide. Qualitative data analysis was done manually using Content analysis. Data that emerged from the analysis was coded and categorized into themes. The study found that the majority of adolescents perceive SRH communication with parents as important. However, the study established that communication between parents and their children does not occur most of the times and if it does, parents give inadequate information because of fear of promoting negative behaviors. The main sources of SRH information were teachers (school), friends and youth centers. Socio cultural factors were found to be a main barrier as it is considered a taboo for parents to talk openly SRH issues in their cultures Common triggers of SRH discussions were; Physiological changes occurring in the children’s life, child’s behavior and negative events/ situations happening in the family and community. The study also established that parents focused on less sensitive SRH topics sensitive SRH topics. It is evident that communication between parents and adolescents on SRH matters is less and inadequate, as such, adolescents are prone to risky sexual behaviours. It is therefore important to empower parents with the necessary knowledge and skills so that they can ably and effectively communicate SRH information to their children.
Open Access
Factors associated with utilization of postpartum family planning services between 6 and 12 months of delivery at Ntchisi District Hospital
(2012-08-01) Bwazi, Chrissy Verles
This study examined factors that determine the utilization of family planning services at Ntchisi District Hospital in the central region of Malawi. The study design was quantitative descriptive. The study sample comprised 193 postpartum mothers who stayed between 6 and 12 months after delivery. The women were recruited using the convenience sampling method. A structured questionnaire was used to collect data and the analysis was conducted using SPSS version 16.0. Cross tabulations were performed to establish the relationships and associations between the utilization of postpartum family planning services and variables such as demographic characteristics, knowledge, culture, subjective norms and the previous experiences faced by the women with use of different contraceptive methods. Chi-square tests were used at 5% level of significance. The Theory of Reasoned Action (TRA) guided the study. Findings showed that knowledge about PPFP services was almost universal at 94.3% (n = 182). About 75% of the respondents were using the contraceptives in the first year of delivery. Only 59.8% (n = 115) women started using the contraceptives when their children were six (6) months old yet 82.3% (n = 159) respondents were sexually active during the same period. At the end of the first year, 90.2% (n = 174) were sexually active. There were statistically significant associations between PPFP utilization and duration of lactation amenorrhea, past behaviour and habits related to contraception, time of resuming sexual activity, level of education, marital status, age and parity of respondents, husband’s approval and postpartum counselling the mothers received. Results demonstrated that the women do not effectively utilize postpartum family planning services at Ntchisi District Hospital. Although about 75% were using contraception in the first year of childbirth, they started late. Some of the associated factors were marital status, respondents’ level of education, desire for more children as marriage security and inadequate counseling of mothers during ante and postnatal care. Lack of husbands’ approval for the services, past behaviour and habits related to contraception as well as the time of resumption of sexual activity after delivery, were the major setbacks for the use of the PPFP services.
Open Access
Health care providers’ perspectives on factors influencing provision of youth friendly sexual reproductive health services to adolescents in Dedza, Malawi
(2019-04-15) Chimera, Lucy Jonas
Youth Friendly Sexual and Reproductive Health Services (YFSRHS) continue to be underutilized by adolescents despite their availability in most hospitals in Malawi leading to an increase in sexual reproductive health problems among adolescents. This study explored the factors influencing provision of YFSRHS to adolescents from the providers’ experiences. This was a descriptive qualitative study conducted at Dedza District Hospital, Chitowo, and Mtakataka Health Centres. Data were collected from a purposive sample of 17 nurses, clinicians and medical assistants through in-depth interviews using a semi-structured interview guide and was analyzed using thematic analysis method. Main themes identified from the findings were; adolescents’ behaviours during service delivery, views on YFSRHS utilization, motivation to provision of YFSRHS, challenges providers encounter, and suggestions on improving provision of YFSRHS to adolescents. The study found that adolescents’ behaviours, YFSRHS delivery system challenges, and health care providers’ challenges negatively affect the quality of YFSRHS given to adolescents. The passion for adolescents’ health and need to safeguard their future has been identified as the major motivating factor to the utilization of YFSRHS. However, health care providers reported often times finding themselves in a dilemma between fulfilling their duties and respecting their personal, religious, and moral values and beliefs in regards to provision of YFSRHS to adolescents. Therefore, interventions aimed at increasing utilization of YFSRHS by adolescents should aim at making communities aware of the availability of YFSRHS in the hospitals, addressing misconceptions associated with YFSRHS, and addressing providers’ personal, religious and moral values and beliefs towards provision of YFSRHS to adolescents along with the health service delivery related improvements
Open Access
Health seeking behaviour of women with cervical cancer at Gynaecological Ward- Zomba and Queen Elizabeth Central Hospitals, Malawi
(2012-08-01) Chadza, Eleanor Thoko
Worldwide cervical cancer is the second most common form of cancer in women and the leading female cancer in sub-Saharan Africa, South America and South East Asia. It causes an estimated 275,000 deaths in the world annually with the highest prevalence being in the developing countries. In Malawi, between 2001 and 2002, cervical cancer accounted for approximately 28% of all female cancers nationally. Cervical cancer is preventable and Malawi is one of the African countries that has had the greatest success in introducing cervical cancer prevention and treatment. Despite the effort by the Malawi government to increase sites for cervical cancer screening, women still report late for cervical cancer services. The study was conducted at Zomba and Queen Elizabeth Central Hospital gynaecological wards since these are tertiary health institutions which are also referral centres. It was done to explore health seeking behaviour of women with cervical cancer. The target population for this study was all women diagnosed with cervical cancer that had been admitted at the hospital at any stage but not terminally ill patients. The planned sample size was thirty but it reached saturation at twenty-four participants. Data collection was done using semi-structured interview guide and face to face in-depth interviews which were conducted in Chichewa. The data was analysed using content analysis. The study revealed that women have knowledge of symptoms and risk factors of cervical cancer. However, they lacked knowledge of the causes of cervical cancer as such they thought the symptoms would stop or that they had been bewitched and first visited the traditional healer. The women also encountered a lot of challenges to access health care services. They reported challenges in terms of distance, transport, economic factors, family support and health care providers. The women need to have information about cervical cancer by increasing awareness of the disease through using locally understood messages. Women should be empowered to make decisions about their health as well as financially. More nurses and clinicians should be trained on cervical cancer screening so that all districts and some selected health centres should be able to provide the service to women in order to prevent them from walking long distances. Ministry of Health should prioritize cervical cancer as a national problem and allocate substantial resources for national awareness. There is also need to address the challenges for the women to access the services in an operable state.
Open Access
Investigating household health expenditure during birth period in Blantyre District, Malawi
(2018-05-01) Majamanda Kambale, Annielisa
In Malawi, the majority of women access reproductive health care in public health facilities. The Malawi government policy is for free provision of health services. However, despite the offer of free services, there is now increasing cases of informal payments for members to access services in public health facilities. In public health facilities, informal payments arise as corruption increases resulting in frequent stock outs of essential medical supplies and other informal costs, increased demand of health services due to limited availability of health facilities and shortage of staff. Informal payments are mostly done using out of pocket financing. Effects of these informal payments and other birth related coasts have the potential of denying women services at this critical time as well as access and utilization of services. It is not clear how women are affected by these informal payments while trying to access reproductive health services especially during birth period. This study titled ‘Investigating Household health expenditures during birth period in Blantyre District, Malawi’ aimed at examining health expenditures during birth period in Malawi. In this study, a total of 388 Households were recruited using random sampling method. Data were collected on expenditure and cost attributes incurred by Households during birth period using structured questionnaires. Data analysis was conducted using SPSS version 20.0 and Statistics were presented using frequencies, tables and charts. About 33% of women were asked to make informal payments while accessing birth services at public health facilities such as medicines, Ultra sound scanning services, laboratory services and cesarean section operations among others. Informal payments were propagated by frequent stock outs of essential medicines and supplies. This is where more births (87%) took place. More than 58% of the charges were done using out of pocket payment as only 10% of participants had Health Insurance as a mode of prepayment. Transportation during the birth period costed from MK9000 to MK45, 000 between public and private transport respectively. More than 50% of women expressed willingness to enrol in a health prepayment organisation if available in their community. Women rely on public health facilities for birth services because they offer free services. However, informal payments in public health facilities resulting from increasing corruption, increasing demand and limited resources plus other expenses for birth preparedness such as transport are resulting in increased expenditure for birth. Free services are therefore used not as an option but because Households cannot afford paying services using out of pocket expenditures. Malawi has a significant potential to improve maternal health by strengthening strategies that provide financial risk protection to households. The study recommends the establishment of mechanisms that provide financial risk protection for households to attain universal healthcare. There is a need to scale up awareness among the general population to resist all forms of corruption. There is also need to strengthen accountability and transparency mechanisms in the health system to ensure effective monitoring of resources at all levels.
Open Access
Knowledge, attitude, and practices of the youth on emergency contraceptive pills at selected family planning clinics in Lilongwe
(2019-05-01) Kainja Malota, Joyce
There is evidence that emergency contraceptive pills (ECP) reduce unintended pregnancies. However, literature shows that 31% of pregnancies among the youth are unintended and that most of them end up in unsafe abortions. The purpose of this study was to determine knowledge, attitudes and practices of family planning clients aged between 15 and 24 years on ECPs. The study specifically explored knowledge and described attitudes practices of the youth clients on ECPs. The study was conducted at two health facilities in Lilongwe using a cross-sectional sign and 262 clients were sampled. Data were collected using a structured questionnaire through face-to-face interviews. The collected data were analysed using descriptive statistics and Chi-square tests at 5% level of significance to establish relationships between demographic variables and knowledge, attitudes and practices of emergency contraceptive pills. Results showed that knowledge of what ECPs are; indications for using ECPs and when to use ECPs, were significantly positively associated with higher education (p=0.015;p=0.002; p=0.002), respectively. Also, affordability and ever bought ECPs were also positively associated with higher education (p=<0.001; p=0.015), respectively. Positive attitude towards use of ECPs was significantly in rural areas and older age (p=0.047; p=0.049), respectively. The results showed that the majority (84.5%, n=221) lacked knowledge of ECPs. However, most of them (91.5%, n= 240) had a positive attitude towards ECPs even though only 0.4% (n=1) had ever used ECPs and that the majority (93.1%, n=244) did not know anyone who had ever used ECPs. The study has demonstrated that for the youth to use ECPs, they need clear and adequate information. Therefore, there is need to promote health education to the youth on ECPs to improve their knowledge.
Open Access
Perception of men and women towards the use of Jadelle as a family planning method
(2014-01-01) Osaio-Kamara, Brima
There are various family planning methods which are available for use in Malawi. One of these methods is the implant Jadelle. It is one of the most effective and long-lasting family planning methods such that most women using it will not become pregnant. In Malawi, where stock-outs are common and consistent access to short-term contraceptives is poor, long-term reversible methods like Jadelle offer an important option for men and women who want to delay, space or end their child-bearing years. It is clear that the use of Jadelle may be influenced by perceptions of women and their spouses. The perceptions of men and women on the use of the implant Jadelle as a family planning method in Malawi are unknown. Therefore this study was conducted to explore the perceptions of men and women on the use of the implant Jadelle as a family planning method. The study used a descriptive qualitative study design. Ethical approval and clearance were granted by the chief nursing officer at QECH and COMREC. The sample comprised of 5 couples who were using Jadelle. These couples were purposively sampled. The setting for the study was family planning clinic at Queen Elizabeth Central Hospital (QECH). The participants who accepted to participate in the study gave a written consent. They underwent individual interviews of 30- 45 minutes which were audio recorded. Data were analysed using manifest content analysis in which categories and themes were created. This study found that both men and women lacked knowledge about the mode of action of the implant Jadelle on the reproductive tract; they had wide spread misinformation and misconceptions; they were not given adequate information during Pre-insertion and Post-insertion counseling; and their main sources of knowledge about the implant were the radio and health talks. There were multiple factors that influenced their use of Jadelle as a family planning method; they accepted the use of Jadelle as a FP method because of its long lasting effectiveness and freedom it brought to them; the common side effect of Jadelle implant that affected its acceptability was the disruption of the menstrual cycle; and that both men and women made decisions on the issue of child spacing. In conclusion, this study established that both men and women generally lacked knowledge about the mode of action of Jadelle as a family planning method. It also established that their main sources of information about Jadelle were significant others, media and health talks. As such family planning providers should intensify one-on-one counseling to all the FP clients to ensure that they have clear and adequate information about Jadelle which may allow them to make informed choices.
Open Access
Perceptions of healthcare providers on the provision of contraceptives to adolescents at Mitundu Community Hospital, Lilongwe
(2020-09-01) Kachigamba Chimbalanga, Linda
Contraceptive use among adolescents is still low in Malawi and Mitundu community hospital catchment population is not an exception. This has contributed to increased adolescent pregnancy rate which contributes to obstetric complications and high abortion rates among adolescents. Several barriers are contributing to adolescents’ underutilization of contraceptive methods and one of them is unfriendly attitudes of healthcare providers in the provision of contraceptives to adolescents. The purpose of this study was to explore the perceptions of healthcare providers on the provision of contraceptives to adolescents at Mitundu community hospital. The following were the objectives of the study; to explore healthcare providers’ views towards the provision of contraceptives to adolescents and to identify challenges that healthcare providers encounter in the provision of contraceptives to adolescents. A qualitative descriptive study was conducted among healthcare providers who are working at Mitundu community hospital. The study recruited 10 participants through purposive sampling method. A semi-structured interview guide was utilized to collect data which was analyzed using thematic analysis. The findings revealed that most of the healthcare providers were uncomfortable to provide contraceptives to adolescents due to various perceptions which they hold. Some of the perceptions established were contraceptive provision influences adolescent sexual behavior, fear of contraceptives side effects, and the idea that condoms only and not hormonal contraceptives are for adolescents. This posed a dilemma among providers to balance their personal beliefs and professional roles hence they prescribed condoms and abstinence to adolescents who went to the hospital seeking contraceptive methods. Despite this, healthcare providers face different challenges when providing contraceptives to adolescents, and these include lack of privacy, shortage of staff, and unavailability of hormonal contraceptives. As such, vi the researcher recommends that Reproductive Health Directorate and District Management organize training on Youth Friendly Health Services for nurses and the clinical team. It is also important that they should provide supportive supervision and get regular updates on adolescents’ uptake of contraceptives. It is also necessary that Mitundu Community Hospital management should lobby for more staff to work in the youth centre. The study findings may provide a basis to carry out a similar study in a similar setting on a larger scale to make the transferability of the findings possible.
Open Access
Perspectives of adolescents on the quality of youth friendly health services at Chikwawa District Hospital
(2017-06-01) Perenje, Sylivia
This descriptive quantitative study aimed at assessing the quality of Youth Friendly Health Services offered to adolescents at Chikwawa district hospital. Sample size was 110 adolescents aged 15 to 19 years who came for reproductive health services at antenatal clinic, family planning clinic, HIV testing and counseling clinic and ART clinic. Data analysis was done using Statistical Package for Social Science (SPSS) version 20.0. SERVQUAL (Service Quality) model developed by Parasuraman, Berry, and Zeithaml (1985) was used to guide the study. SERVQUAL model uses 5 elements namely tangibles, reliability, responsiveness, assurance and empathy to assess quality from the perspective of the service user. SERVQUAL tool was used to measure the gap between quality expectations and quality perceptions using gap score analysis. Associations between expectations, perceptions and demographic characteristics were done using Independent- samples t- test. Findings revealed that there was an average gap score of -5.31 meaning that reproductive health services that are provided to adolescents are not of good quality in relation to the expectations of adolescents in all the dimensions of quality. One of the limitations of the study was use of one method of data collection (SERVQUAL tool). There was need to use observation as another method of collecting data in order to validate some of the variables in tangibility, reliability, responsiveness, assurance, and empathy dimensions of quality. In conclusion, the study revealed that adolescents have high service quality expectations in all the five dimensions of quality. The study also revealed that service quality perception of adolescents towards YFHS was lower than their expectations mostly in tangibles and responsiveness dimensions. This calls for service providers to provide quality services in order to meet the expectations of adolescents.
Open Access
Psychosocial experiences of early childbearing among teenagers in Zomba district, Malawi
(2021-04-01) Dzuwalatsoka, Lumwira Henry
Teenage childbearing in Malawi is very high (29%), and socioeconomically burdensome, with Zomba having a higher rate than the national average (34.9%). A review of literature for Malawi revealed that little was yet known about the psychosocial experiences of teenage childbearing, yet most of the teen marriages and pregnancies are occurring in this region and Zomba in particular. This study explored psychosocial experiences of early childbearing. This was an explorative descriptive qualitative study. The target population was 13-19-year-olds living in Zomba District. A purposive sample of 16 teenagers (pregnant and parenting), was recruited comprising of 8 males and 8 females. Data were collected through audio-recorded face to face in-depth interviews using an interview guide. Data were analysed using content analysis. Results revealed that teenagers’ experience emotional trauma that included embarrassment, regrets, fear of parental reprimand, depression, emotional shock, and parental verbal abuse. They suffer social injustices like stigma, discrimination and rejection from parents; peers and community members. Corporal punishment and support withdrawal was part of the social problems. The study recommends that teenagers be equipped with sexual and reproductive health life skills so they can delay pregnancy; SRH policies should address gaps to ensure reproductive health services respond adequately to teenagers’ psychosocial needs. Extensive research is required to focus on both couples & single teen parents; parents of teens that are experiencing or experienced childbearing and on psychosocial experiences of health workers as they manage teen parents. These findings highlight psychosocial challenges experienced by childbearing teenagers. Childbearing teenagers require quality comprehensive psychosocial services.
Open Access
A qualitative exploration on use of long acting reversible contraceptives among married women at Mzimba South District Hospital
(2021-04-01) Phethi, Chisomo
Long acting reversible contraceptives (LARC) are safe, cost-effective, and highly effective in the prevention of unplanned pregnancies for almost all women in the reproductive age group. Nationally, most married women 30% (4839) use Depo Provera with a high discontinuation rate of 41%, while 12% (1936) use Implants and 1 % (161) IUD, with a discontinuation rate of 8% for both. Records at Mzimba South District Hospital for the 2016-2017 fiscal year on the use of Implants and IUD among married women remains very low. Literature on quantitative studies indicates lack of knowledge, dependence on a provider for information, partner disapproval, myths, and misconceptions as some of the underlying factors to low uptake of Implants and IUD and yet did not capture detailed reasons as to why married women do not use Implants and IUD. The aim was to explore factors influencing the use of LARC among married women at Mzimba South District Hospital and a descriptive exploratory qualitative design was used. A purposive sample of 10 married couples was used. Data were analysed manually using thematic content analysis. The study findings generated 5 themes: inadequate knowledge of married women and their partners on Implants and IUD, source of information about Implants and IUD, reasons for partner approval/disapproval to use of Implants and IUD, reasons why married women do not use Implants and IUD for family planning, myths, and misconceptions among couples on use of Implants and IUD, perceptions of couples on use of Implants and IUD. Several factors influenced the use of Implants and IUD such as inadequate knowledge, myths and misconceptions, men’s approval, cultural beliefs, provider bias, health problems and side effects. Comprehensive contraceptive counselling on LARC is essential in knowledge acquisition hence promote LARC uptake among couples at the facility level.
Open Access
Quality of health Information, education and counselling services for effective secondary prevention of sexually transmitted infections at Bwaila STI Clinic
(2016-11-01) Kanyama Njinga, Salome
Sexually Transmitted Infections (STIs) are preventable, though the public continue to be infected and increase reproductive health morbidity and mortality in Malawi. The purpose of this study was to explore and describe the quality of Information, Education and Counselling (IEC) services provided to STI patients at Bwaila hospital in Lilongwe District. A descriptive quantitative design was utilised. The participants were recruited using systematic random sampling method and a total of 384 STI participants were recruited to participate in the study. Data were collected using semi structured questionnaire and observational checklists and analysed using Statistical Package for Social Science (SPSS) version 20.Relationship between variables was established using cross tabulations and Chi-square tests (χ2). The quality of IEC services provided to clients attending the STI clinic was sub-standard. This was attributed to inadequate structures and provider practices during provision of IEC. On average, the facility scored 59% on IEC services rendered which is far below the recommended 80% to be regarded as providing quality IEC services. Many participants (65.4% n=251) were not informed about the type of STI they are infected with and acquired limited knowledge on STI signs, symptoms, transmission, complications, prevention, partner notification and return visit. The attendance of group IEC was significantly associated with acquisition of knowledge on STI transmission (χ2=273.347, df=3, p value=0.000) and time adequacy opinion (χ2= 271.806, df=1, p value=0.000). Infrastructure renovations, increasing staff, development of protocols, refresher courses emphasising on IEC messages and interpersonal communication skills are some of the strategies which could improve provision of IEC.

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