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Open Access
Acceptability of integrating HIV early infant diagnosis (EID) into under-five outreach immunization clinics in Lilongwe rural areas in Malawi
(2020-03-01) Makanda, Mphatso
Human Immunodeficiency Virus (HIV) disease progresses quickly in children. Without treatment, 50% of the children living with HIV die before 2 years of age. Hence, HIV exposed infants are recommended to have an Early Infant Diagnosis (EID) at 4-6 weeks of age. This is so that infected children are identified and started on treatment timely. However, it has been observed that 29% of HIV exposed infants receive EID test late in Malawi. Hence, there is need to identify better strategies to increase EID testing rates at 6 weeks. This study aimed at assessing acceptability of integrating EID into under-five outreach immunization clinics in Lilongwe rural areas among mothers of under-five children. This was an observational, analytical, cross sectional study. It used quantitative study methods to answer the researched question. A questionnaire was used to collect data from study participants. The data was analyzed using Stata version 14. We enrolled 100 mothers in the study regardless of their HIV status. Almost all of them (99%) indicated that the integration of EID in immunization clinics is important. The majority of them (96%) also indicated that they would accept their infants to have an HIV EID test at outreach immunization clinics. Availability of HIV test providers was reported to be the number one facilitator of the integration and it was seconded by the availability of infrastructures at the immunization clinics. The study also found out that unavailability of HIV testing providers have the greatest potential of hindering the integration of HIV EID in immunization clinics seconded by unavailability of shelter at the outreach immunization clinics. Integration of HIV early infant diagnosis into under-five outreach immunization clinics of Lilongwe rural areas is acceptable among mothers of under-five children. The integration can aid in increasing EID test rates of HIV exposed infants at 6 weeks of age.
Open Access
Antiretroviral therapy adherence and the youth: An assessment of teen clubs’ implementation fidelity in southern Malawi
(2020-03-01) Kunje, Gertrude Magomero
Globallythereare2.1millionadolescentslivingwithHIV.1.7millionarein subSaharanAfrica.MalawihasoneofthehighestHIV/AIDSprevalenceratesinthe worldwith12.0%ofthoseaged15-49yearsinfected.AdherencetoARThasprovedto bedifficultforpeoplelivingwithHIVandoftenfallsbelowtherequiredlevelsandthus, youthslivingwithHIVareamongthepopulationgroupswithpoorerARTadherence rates.Fidelityisdefinedasadherence,integrityandqualityofimplementationofan intervention.HoweverhighlevelsofadherencearecrucialtothesuccessofHIV therapiesinordertosustainviralsuppression. Objective:ToassessthefidelityofimplementingteenclubsdesignedtoenhanceART adherenceinBlantyreDistrict WeconductedaFormativeEvaluationQualitativeResearchthatwasguided byaConsolidated FrameworkforImplementationResearchusing KeyInformant Interviewstoestablishifteenclubinterventionisimplementedwithfidelity.Thestudy wasconductedinfiveBlantyreHealthCentreTeenClubsnamely:Chilomoni,Chileka, SouthLunzu,Mpemba,NdirandeandLightHouseClinicatQueenElizabethCentral Hospital. Weusedacasestudymethodandpurposivesampling.Eligiblestudy participantswereteenclubfacilitatorswhohavefacilitatedteenclubsforatleasta year.IndepthInterviewswereaudiorecordedandthentranscribedverbatim.Thematic contentanalysiswasusedtoanalyzethedatamanually. HalfofthesampledteenclubshadguidelinesforconductingTeenClub Activities.TheexistedguidelinescompliedwiththeBaylorInternationalPediatricsAIDS Initiative.However,someelementswerenotfollowed.Trainingoftheteenclub vi facilitatorswasoneofthefactorsthatinfluencedcompliancewiththeguidelines. From theresults,theassessmenthasgeneratedinformationonattributes thatleadtocomplianceandnoncomplianceofHIVteenclubguidelinesinrelationto implementationfidelityoftheteenclubintervention.Ateenclubcannotbeoperated withoutthedesignatedguidelinesthatareestablishedtobefollowedassuchthey shouldbecompliedwith.
Open Access
Applying a gender lens in cervical cancer programming: the assessment of sexually active young men involvement in cervical cancer preventive efforts
(2020-03-01) Nkosi, Chimwemwe Nyambose
Cervical cancer remains a public health concern across the world especially in developing countries including Malawi. Much as country’s policies calls for male involvement in sexual reproductive health, their involvement in cervical cancer prevention is still not clear. Sexually active young men are usually left behind despite their important role in its prevention.The study’s main objective was to assess the involvement of sexually active young men in cervical cancer preventive efforts in Lilongwe Urban. This was mixed methods study. A sample of 196 randomly selected study participants and 10 key informants were interviewed. Inclusion criteria were sexually active young men aged 15 to 24 patronising Bwaila and Kawale health centres. Thematic analysis was used for qualitative data and analysed using NVivo 7.4 software. Quantitative data was analysed using STATA version 14 statistical program. The study findings suggest knowledge of causes of cervical cancer, partner’s risks and whether one is circumcised or not as having a significant impact on young men involvement in cervical cancer preventive efforts. Their non-involvement is attributed to a number of factors which includes structural barriers in terms of access to cervical cancer information and services, lack of a standalone policy, lack of access points of the services such as youth-friendly health corners. Culturally, the misconception that cervical cancer is a feminine disease and men as sole decision makers also deters them from assessing the services.The study findings suggest low involvement of sexually active young men in cervical cancer prevention despite their willingness and their important role in the disease prevention. Deliberate efforts therefore have to be put in place to involve them if the disease is to be contained. The study suggests their involvement in policy and programme formulation as well as implementation and integration of cervical cancer in youth friendly health services as some of the strategies that could be employed to increase their involvement
Open Access
Assessing adherence of hospital waste disposal management at Mangochi District Hospital
(Kamuzu University of Health Sciences, 2022-03-01) Buluzi, Mercy Susan
Hospital waste management services are aimed at improving health status of hospital workers and also people surrounding the hospital. This study aimed at assessing adherence of hospital waste disposal management processes at Mangochi District Hospital. Questionnaire and Observations were used in the study to collect data. Results from the study is going to help in the adoption of the most efficient method of waste disposal utilization of health services and providing a basis for designing public health measures for Mangochi District Hospital. Needle prick incidences were high due to improper waste disposal management among workers at Mangochi District Hospital. 427people on ART prophylaxis between 2017 and 2019, 127people were due to needle prick incidences by June 2019 representing 29.7% (Prophylaxis hard cover 2017 to 2019). Therefore, this study’s significance was that cleaners acquired knowledge on care to prevent risks and understand the process of waste disposal management, and the managers were reminded to do on job trainings for cleaners. The benefits of proper medical waste management minimized the spread of infections and reduced the risk of accidental injury to staff, patients, visitors and community.
Open Access
Assessing effectiveness of teen clubs in improving ART outcomes among HIV infected adolescents: A case of Zingwangwa Health Centre
(2022-03-01) Chilimba, Francis
Adolescents and young adults present a growing share of people getting newly infected or living with HIV. Globally, 40% of all new infections occur in adolescents (10-19 years) and young adults (20-24 years). Compared to their adult counterparts, about half of HIV infected adolescents who are on ART are reported to be non-adherent to ART. Further evidence available also suggests that there is little specialized care for adolescents living with HIV as opposed to their adult counterparts. Other studies conducted to measure ART outcomes among adolescents in urban clinics in Zimbabwe showed that adolescents and young adults had high loss to follow up, unlike adults in the same set up HIV positive adolescents on ART have usually lower viral suppression rates when compared to adults and children, meaning their viral load remains relatively high even though they are on ART. According to spectrum data for 2018, viral load suppression in all ART clients in Malawi was at 89%. A further analysis also indicated that the viral load suppression was different across different age and sex groups. Where as in adults the suppression rates were at above 82%, viral load suppression in children 0 -14 years was at 58%. Additionally, a 2019 study by Umar et al in selected six districts of the southern region of Malawi showed that viral load suppression among adolescents aged 13 – 24 was at 61% Interventions aimed at improving optimal ART uptake among adolescents would therefore go a long way in improving ART outcomes among the adolescents, and one such intervention is teen clubs, implemented in selected health facilities in the country. The main objective of the study is to assess whether teen clubs as a model of care for HIV and AIDS can improve ART outcomes among infected adolescents. Using a retrospective analytical cross sectional design, the study assessed ART outcomes among adolescents aged 10 – 24 years attending teen club and those not enrolled in any teen club program, but were enrolled in ART program at Zingwangwa Health Centre. The study employed quantitative data collection and analysis methods. Sample size for study participants was 225 and it was nearly evenly matched for cases (113) and controls (112). This number represented all adolescents aged 10-24 years and on ART at the facility. Patient level data was collected from all the 113 adolescents belonging to the teen club, as well as the 112 adolescents not enrolled in any teen club program but on ART at the health facility. The data was abstracted from patient records such as attendance registers, ART, Defaulter, Viral Load and High Viral Load registers. In addition to the facility registers, viral load results were accessed from Lab Management Information System (LIMS) database for all the adolescents registered at the health center. Out of the total 225 adolescents enrolled in the study, results showed that 79 adolescents had high viral load (HVL), representing 35% of total adolescents while 146 had low detectable levels (LDL) of viral load (<1000 copies). For the 112 adolescents not enrolled in any teen club program, 44 had high viral load levels (>1000 copies), thus representing about 39% of the total non-teen club adolescents, while 68 had low detectable levels for viral load, which is about 61% of adolescents on ART but not in any teen club program. On the other hand, out of the 113 adolescents enrolled in teen club program at the health center, 35 adolescents had high viral load level, representing about 31% of total adolescents in the program, while a total of 78 adolescent teen club members, representing about 69% had a low detectable viral load level. Despite results of the study showing that more adolescents enrolled in the teen club reporting to have low viral load levels than their counterparts, calculated p-value of 0.192 and Pearson Chi2 value of 1.7058 suggest there is no strong statistical evidence to suggest an association between viral load level and belonging to a teen club program or not. In terms of adherence to ART, results show that there was no statistical significant difference in adherence between youths in teen clubs and those not in teen clubs evidenced by p-value being greater than 0.05. (p-value = 0.0814). However, adherence level for youth in the teen club was higher (89.7%) when to compared to that of the youth not belonging to teen club (86.7%) Results of the study show teen club program is effective in ART care of HIV infected adolescents, demonstrated by better ART outcomes among adolescents that are exposed to teen club program when compared with adolescents not enrolled in teen club program
Open Access
Assessing factors that hinder effective utilisation of family planning services by perinatally HIV infected adolescents in Chiradzulu district
(2020-03-01) Siyasiya, Gloria
Adolescents who have perinatal HIV are equally sexually active and a higher proportion of them is becoming pregnant and bears children. This is happening when family planning services are being provided at the teen clubs where they access HIV services. The study aimed at assessing reasons why these adolescents are not utilizing the family planning services that are being offered. The objectives of the study were to: establish perinatally HIV infected adolescents’ knowledge of the importance of family planning, identify sexual and reproductive health services available for perinatally HIV adolescents, determine the support system that is available for perinatally HIV infected adolescents and determine the challenges that the perinatally HIV infected adolescents face during care.This qualitative study was conducted at Chiradzulu District Hospital and Namitambo Health Centre from March to May 2019. The researcher recruited19 adolescents aged 15-19 years, who were perinatally infected with HIV and were aware of their HIV status. The results showed that most perinatally HIV infected adolescents are aware of the importance of family planning. Additionally, it was found that misconceptions about and side effects of some family planning methods are the main reason for non-contraceptive use.Parents/guardians are the main source of support but they do not have adequate knowledge about reproductive health issues relating to the adolescents, hence fail to provide the needed support. The study also showed that the majority of the adolescents who have a romantic relationship disclosed their HIV status to their partners. The findings also revealed that there is to involve parents and traditional leaders in issues of sexual and reproductive health so that they know the kind of support they could provide to their adolescent children. Additionally, improving the sexual and reproductive health information and services for adolescents will help create contraceptive demand by these adolescents.
Open Access
Assessing implementation of teen clubs for HIV+ adolescents: case study for Lilongwe and Dowa health facilities
(Kamuzu University of Health Sciences, 2020-10-01) Tembo, Tawona
Adolescents bear a significant proportion of global disease burden including HIV and AIDS. Despite the roll out of HIV and AIDS services and ART programs in sub-Saharan countries including Malawi, adolescents continue to face challenges in accessing the services. This is due to poor design of service delivery strategies that are not sensitive to their health needs. Differentiated care model, also known as Teen Club emerged as a proven intervention to bridge the gap for provision of HIV and AIDS services for HIV positive adolescents. The aim of this study was to assess how the Teen Club model is being implemented to establish service utilization and sustainability. This was a facility based cross-sectional study conducted at Dowa and Lilongwe District Hospitals. Mixed method approach was employed. Eight service providers were recruited using purposive sampling to collect qualitative data using in-depth interviews and analyzed using Nvivo 8.0. Quantitative data was collected using a checklist and analyzed using SPSS v 20. Ethical approval was sought from College of Medicine Research and Ethics Committee. The study revealed various gaps on how Teen Clubs are being implemented affecting sustainability of the model. Bottle necks include inadequate provider trainings, lack of permanent funding and poor integration of the model into HIV programs at facility level. Poor implementation of Teen Club in the areas under study has affected maintenance of the model and service access by the adolescents. Therefore, there is need to develop a minimum standard service delivery package that would be adopted and supported by all key players in order to sustain the model and improve service utilization.
Open Access
Assessing teachers and parent’s knowledge, attitudes, perceptions and awareness on type 1 diabetes in children presenting to the children’s diabetic clinic at Queen Elizabeth Central Hospital
(2017-10-17) Kasiya, Marrianne
Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from inadequate insulin production or reduced tissue sensitivity to insulin. Type 1 diabetes is an endocrine disorder characterized by the absolute deficiency of insulin caused by the autoimmune destruction of the β cells of the pancreas. DM is a lifelong condition which requires continuous self-management by patients. Early diagnosis and improved management will reduce the risk of complications of the disease. The majority of young people with diabetes spend many hours at school and/or in some type of child care program. Trained and knowledgeable staff are essential to provide a safe school and child care environment for children with diabetes. The child’s parents/guardians and health care provider(s) should work together to provide school systems and child care providers with the information necessary to enable children with diabetes to participate fully and safely in the school and child care setting experiences. This study assessed the knowledge, attitudes, perceptions and awareness of teachers and parents of children with Type 1 diabetes presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. This study employed a mixed methods research design to data collection, analysis and interpretation integrating qualitative and quantitative approaches. Twenty-three parents attending QECH diabetic children’s clinic in the under-five department and 65 teachers from different primary and secondary schools around Blantyre Urban were interviewed. Majority of the respondents explained that diabetes mellitus was concerned with how overly increased or reduced sugar levels affected the way the body carried out its normal functions.Teachers were more general about the disease, while parents were more particular in defining the disease; 67% of the teachers were willing to host diabetic children in their class compared to 33% who were not willing. It was however clear that the teachers had no confidence in handling such conditions. Fifteen of the 25 parents reported that the school was limited in capacity and expressed concern over their children’s performance. The findings highlight the importance of diabetic education for both the teachers and the parents. The study has identified the need to take into account the major differences between children and their care givers in managing Type 1 Diabetes and also the need to invest considerable amount of efforts and resources aimed at supporting Type 1 diabetic children by establishing school clinics or ensuring the presence of school nurses in schools
Open Access
Assessing the capacity of district hospitals in mobilizing and allocating resources after health care decentralization at Kasungu and Nkhotakota district hospitals
(Kamuzu University of Health Sciences, 2021-01-01) Lifa-Udedi, Evelyn Zione
Delivery of efficient health services requires adequate and consistent availability of the right resources, be it human, financial, equipment or material resources. Decentralization has been considered a strategy to aid in resource mobilization for the health sector. The study aimed to assess the capacity of district hospitals in mobilizing and allocating resources after health care decentralization in Kasungu and Nkhotakota District. This was a cross sectional qualitative study which focused on DHMT members. A purposively selected sample of 14 participants from DHO and DC. Data was collected through in-depth interviews. Data analysis was done by on excel and Atlas Ti. All content with similarities were then grouped in different code groups that reflected the theme to which they presented and analysis was done based on the themes. A majority of participants were male at 79%, while 64% of the participants were within the young and productive age. 57%, had more than 10 years of experience working in government at senior level management while 71% of the participants had graduate level training. The results indicate that: there is lack of power and authority vested on DHMT as decision makers; inadequate and at times unclear decision-making powers (for recruitment, approvals); expectation that public institutions cannot be innovative (ability to think beyond the government funding), and lack of political will (inability of those in power to be ethical and just in making decisions affecting the health system). DHMT capacity in resource mobilization is limited. It is recommended that DHMT should receive skills and competency strengthening training particularly in regards to resources mobilization.
Open Access
Assessing 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, Ted
Chitipa 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.
Open Access
Assessing 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, Fyness
Currently, 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.
Open Access
Assessing the relationship between adverse childhood experiences (ace) and high HIV risk behaviours among male and female adolescents: A cross sectional study in Balaka, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Kaponda, Alice Siyenunu
Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) are a range of events (that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours eg sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks eg multiple sexual partners and infrequent condom use. The study assessed the relationship between reported adverse childhood experiences and sexual risk behaviours among adolescents’ in Balaka district. This was a cross-sectional study design. It used secondary data from the Malawi Longitudinal Study of Families and Health (MLSFH) study. This study used data from the 2017/2018 data collection wave which interviewed adolescents aged between 10-19. Logistic regression analysis was performed in STATA v14 to assess the association between ACEs and HIV risk behaviours (multiple sexual partners and infrequent condom use). Adolescents who reported having exposed to physical abuse were 1.5771 times likely to have multiple sexual partners as compared to those who were not exposed to reported physical abuse (OR=1.5771, Cl = 0.7879 – 3.1566 at 95%) and AOR was 1.4245 among the exposed. Adolescents exposed to physical abuse and sexual abuse had 1.3019 and 1.4048 respectively risk of not Infrequently use condoms amongst the exposed than in the non-exposed. No association was found between reported emotional abuse and infrequent condom use (OR=1). The study revealed that there was an association between ACEs and sexual risk behaviours. There is a need to institutionalise comprehensive sexuality education from lower primary age groups, not confined to the limited coverage of life skills as at present.
Open Access
Assessing the relationship between adverse childhood experiences (ace) and high hiv risk behaviours among male and female adolescents: a cross sectional study in Balaka, Malawi
(Kamuzu University of Health Sciences, 2020-12-01) Kaponda, Alice Siyenunu
Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) are a range of events (that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours eg sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks eg multiple sexual partners and infrequent condom use. The study assessed the relationship between reported adverse childhood experiences and sexual risk behaviours among adolescents’ in Balaka district. This was a crosssectional study design. It used secondary data from the Malawi Longitudinal Study of Families and Health (MLSFH) study. This study used data from the 2017/2018 data collection wave which interviewed adolescents aged between 10-19. Logistic regression analysis was performed in STATA v14 to assess the association between ACEs and HIV risk behaviours (multiple sexual partners and infrequent condom use). Adolescents who reported having exposed to physical abuse were 1.5771 times likely to have multiple sexual partners as compared to those who were not exposed to reported physical abuse (OR=1.5771, Cl = 0.7879 – 3.1566 at 95%) and AOR was 1.4245 among the exposed. Adolescents exposed to physical abuse and sexual abuse had 1.3019 and 1.4048 respectively risk of not Infrequently use condoms amongst the exposed than in the non-exposed. No association was found between reported emotional abuse and infrequent condom use (OR=1). The study revealed that there was an association between ACEs and sexual risk behaviours. There is a need to institutionalise comprehensive sexuality education from lower primary age groups, not confined to the limited coverage of life skills as at present.
Open Access
Assessing uptake and utilization of modern contraceptive method amongst young people in tertiary institutions of Lilongwe University of Agriculture and Natural Resources and Kamuzu College of Nursing in Lilongwe
(Kamuzu University of Health Sciences, 2019-10-01) Kayira, Yewo
Modern contraceptive uptake and utilization still remains a significant global health issue among young people. Despite a number of interventions on modern contraceptive services targeting young people in primary and out of schools, evidence on Modern contraceptive use in tertiary institutions is limited. Hence, an assessment on uptake and utilisation of modern contraceptives among tertiary institutions of LUANAR and KCN was carried out in Lilongwe between 2017 and 2019. A cross sectional exploratory study which used a mixed methods approach to assess uptake and utilisation of modern contraceptive methods among young people in tertiary institutions of LUANAR and KCN in Lilongwe. 8 focus groups were conducted, 6 key informants were interviewed and 220 females and male students were interviewed using self-administered questionnaires from the two institutions which were purposively selected. The study found out that Modern contraceptives uptake was higher among young people of LUANAR and KCN while utilisation was lower. On comparative basis, utilisation and knowledge of modern contraceptives was higher among students at KCN than LUANAR. Male condoms and emergency contraceptive services were frequently accessed. Barriers to access modern contraceptives were noted and included: provider attitudes, privacy and confidentiality, shortage of some modern contraceptives and long waiting time at the clinics. Access to modern contraceptives among young people in tertiary institutions is influenced by individual, health system related and environmental factors. Tertiary institutions students need information on modern contraceptives to reduce sexual and reproductive health problems. Providing young people with access to modern contraceptives in tertiary institutions can reduce teenage pregnancies, abortions and maternal deaths.
Open Access
Assessment of factors associated with linkage to care amongst adults accessing HIV services at Bwaila hospital, Lilongwe district, Malawi.
(2020-03-01) Gondwe, Clifton Muvwala
Despite the policy progress made in Malawi about HIV and AIDS, the prevalence rate remains among the highest in the world. Despite many people being tested HIV positive not all have been linked to HIV care. Linkage to care is a crucial early step in successful HIV treatment. Linkage to HIV care is still a challenge in Malawi as 32% is not yet linked to care. This group may pose a threat of transmitting the infection to the population. Currently the country is striving to meet the 90.90.90 UNAIDS target The main objective of the study was to assess factors associated with linkage to care amongst adults accessing HIV services at Bwaila Hospital in Lilongwe District.This was a descriptive cross-sectional study that employed qualitative methods. Eighteen in-depth interviews were conducted with clients above 18 years old and 2 focus group discussions with Health Providers at Bwaila Hospital. Purposive sampling method was used to recruit study participants. Thematic analysis was used to analyze data. Findings indicate that linkage to care is affected by one‟s perception towards Antiretroviral Therapy initiation, physical escort of clients by providers, integration of services, existence of support partners, shortage of staff leading to high workload, poor coordination of services at the facility and distance to the facility. Interventions aimed at improving linkage to care in HIV services should focus on integration of health services. In addition, additional human resource and ease of access to health services should also be considered
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Assessment of health worker’s knowledge and utilization of partograph to diagnose fetal distress during labor at Bwaila Hospital, in Lilongwe Malawi
(2022-03-01) Chiwala, Luke
World Health Organization recommended the partograph in management of women during labor to improve maternal and neonatal outcomes. Despite gains made in reducing maternal health, neonatal deaths from complications of labor and delivery persists. Quality of care and the use of the partograph in labor can help to avert deaths from labor complications. The way health workers use that partograph to diagnose fetal distress during labor needs to be investigated. This facility based cross-sectional study was conducted at Bwaila hospital using both qualitative and quantitative methods. A total of 911 partographs of births at Bwaila for the month of April and May 2020 were reviewed. Fifteen (15) midwives in the maternity ward were interviewed. Descriptive statistics and logistic regression were used to analyze quantitative data. Thematic analysis was applied to analyze data from in-depth interviews. Midwives had good knowledge about the partograph. Utilization of partographs and diagnosis of fetal distress was poor. Meconium-stained liquor (AOR=2.33; 95% CI =1.51-3.59, p<0.001), vacuum extraction (AOR=4.64; 95% CI= 1.61-13.58, p=0.004), Crossing alert line (AOR=1.70; 95% CI =1.09-2.66, p=0.020)., Male sex (AOR=1.75; 95% CI=1.17-2.62, p=0.006) and Birth Weight (AOR= 0.9992234; 95% CI= 0.9988441 - 0.9995922, p <0.001) were factors associated with birth asphyxia. Improving staffing levels, consistent supportive supervision, availability of equipment and supplies, in-service trainings on labor management and partograph, introduction of incentives, improving inter-professional collaboration, are necessary to improve quality. Partograph needs to be reviewed and modified to meet context needs. Electronic fetal monitoring should be used in busy setting.
Open Access
Assessment 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 Pandor
Health 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.
Open Access
The association between severely deranged vital signs and Dysglycaemia in severely ill children admitted to Queen Elizabeth Central Hospital (QECH), Blantyre Malawi
(Kamuzu University of Health Sciences, 2021-07-01) Mayani, Ednas Billiat
Abnormal blood glucose level commonly occurs in children presenting to the hospitals in low income settings. The presence of low blood glucose levels could be a marker of disease severity. Vital signs are routinely checked in sick children and most settings use a combination of deranged vital signs to determine disease severity. Blood glucose is a quick, bed side test and could serve as a complementary indicator of disease severity in low resource settings. The study aims to determine the association between the presence of severely deranged vital signs and dysglycaemia in severely ill children admitted to a tertiary hospital in Malawi. This was a crosssectional study which used secondary data from Paediatric department collected from December 2016 to January 2019. Multinomial logistic regression was used to determine the association between severely deranged vital signs and dysglycaemia. A total of 5247 children, aged 0 to 18years were recruited into the study. 353(6.7%) had lowglycaemia,105(2.0%) had hypoglycaemia and 771(14.7%) had hyperglycaemia. The presence of any severely deranged vital sign, specifically, hypoxia (oxygen saturation <90%) and coma score of<2 were associated with both hypoglycaemia and hyperglycaemia. The Adjusted Odds Ratio (AOR) for the association of any severely deranged vital sign with hypoglycaemia was 1.76(95% CI 1.2–2.6) and 1.5(95% CI 1.3–1.8) with hyperglycaemia. Hypoxia had odds ratio of 2.0(95% CI 1.2–3.4) for hypoglycaemia and 1.5 (95% CI 1.2–1.9) for hyperglycaemia whilst for reduced coma score the odds was 6.5(95% CI 4.2–10.2) and 2.3(95% CI 1.8–2.9) respectively. The results have shown that the presence of any severely deranged vital sign is associated with dysglycaemia especially hypoglycaemia and hyperglycaemia. As such dysglycaemia might be used as a complementary marker of disease severity in low resource settings.
Open Access
Barriers and facilitators to the uptake of HIV testing services among adolescents and young adults in Machinga district, Malawi
(2020-03-01) Sakala, Joseph Jasper
While studies generally indicate a low uptake of HIV testing Services (HTS) among young people, other reports also indicate a worrying HIV burden among the same group. For example, the United Nations Children’s Fund (UNICEF) recently reported that globally, new infections have been dropping in all demographic groups except amongst young people where they have largely remained constant. The low HTS uptake among young people, therefore, mean that many of these infections remain undiagnosed, limiting the ability to control transmission.The study’s objective was to explore the factors that motivate, as well as factors that hinder, the uptake of HIV Testing Services among adolescents and young adults in Machinga District of Malawi at the individual, interpersonal, community and health service system levels. 24 In-depth interviews and 4 key-informant interviews were used to collect data, and purposive sampling was used to identify respondents. Respondents were adolescents and young adults aged 15-24 years, as well as HTS and youth-friendly health service (YFHS) providers. Data from audio recordings were transcribed in Microsoft Word and analyzed for content to generate themes. Data coding and analysis was done using Atlas 7. The study found that perceived risk of infection, perceived benefits of knowing one’s status for couples, availability of community-level youth clubs and other interaction fora, and the provision of HTS through outreach clinics were key facilitators for HIV testing. The findings also established that fear of a positive result, poor communication in relationships and families, cultural norms as well as lack of youth-friendly HIV testing services were key barriers to HIV testing. The study establishes the critical role of mobile HIV testing through outreach clinics and other community-based avenues in encouraging access to HTS by young people. The findings also suggest that stigma and misconceptions associated with HIV/AIDS are still issues in Malawi as evidenced by the fear of a positive result also emerging as a critical barrier to HTS
Open Access
Burden and predictors of metabolic syndrome in adolescents and young adults in Blantyre district, Malawi.
(2020-02-07) Mwakhwawa, Queen
Metabolic syndrome (MetS) is a major public health concern as it is on the rise in developing countries. However, there is limited regional and national data specifically in adolescents to help drive interventions against MetS. To describe the burden and predictors of MetS in adolescents and young adults in Blantyre district. This was a cross-sectional study that used secondary data. MetS related risk factors from socio-demographic characteristics, anthropometric indices and body composition by deuterium dilution technique (DDT) were assessed. MetS was diagnosed using 1) the international diabetes federation (IDF) criteria by the presence of three or more of the following components: raised blood pressure (BP), raised fasting blood glucose (FBG), reduced high density lipoprotein (HDL), raised triglycerides and larger waist circumference (WC), 2) Metabolic syndrome severity score (MSSS) using these inputs: age, gender, race, weight, height, FBG, BP and HDL on an online calculator. Multivariate logistic regressions were applied to identify MetS -associated risk factors. The study enrolled 371 adolescents and young adults aged 10-28 years The most prevalent MetS component was raised FBG at 31.3 % and reduced HDL at 30 % while the least common component was raised blood pressure BP at 3%. The overall prevalence of MetS was 3.1% by MSSS and 2.5% by IDF criteria and all participants had mild MetS. There was no difference in MetS prevalence by all socio-demographic characteristics and anthropometric indices including history of treatment for acute malnutrition except for waist to height ratio (WHtR). High WHtR and excess fat % were associated with MetS in unadjusted regression analysis with Odds Ratio (OR) 95% Confidence interval (CI)) of 5.18 (0.33,0.91) and 8.87 (1.91,41.08) respectively. After adjusting for sex, age, maternal occupation, WHtR and WHR, participants with excess fat % had 6 times more risk of MetS compared to those with no excess fat%, OR (CI) of 5.88, (1.37,35.4). Conclusions: MetS was relatively rare in this population at 3% prevalence. Abnormal body composition, especially presence of excess fat% increases the odds of presence of MetS.