School of Nursing

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Open Access
Assessing cardiopulmonary resuscitation knowledge and attitudes among nurses working in adult general wards at Kamuzu Central Hospital, Malawi
(2019-06-01) Macias, Madalo Kalukusha
This study looked at knowledge of nurses in diagnosing patients who need cardiopulmonary resuscitation; examined nurse’s knowledge on how to conduct cardiopulmonary resuscitation; and nurse’s attitude towards cardiopulmonary resuscitation in adult general ward at Kamuzu Central Hospital. A descriptive quantitative survey approach was used for the study. Data was collected using a self-administered questionnaire which also included 10 questions adopted from American Heart Association written Basic Life Support exam version 11 of year 2010. Analysis of the data was done using Statistical Package for Social Science version 23 and Excel packages to draw out mean, frequencies and percentages. A sample of 61 nurses in adult general wards was recruited using consecutive sampling. The results of the study showed that 65% (n=40) could be able to diagnose a patient needing cardiopulmonary resuscitation. Nurse’s attitude towards cardiopulmonary resuscitation was positive in 73% (n=44) of the nurses. However, knowledge on cardiopulmonary resuscitation graded using American Heart Association pass rate of 84% was very poor as only 7 % (n=4) of the nurses passed. A chi square test using fishers exact test at 5% significance level showed that nurses with experience of less than ten years had significantly higher knowledge of cardiopulmonary resuscitation at 63.4 % compared to those between ten and fifteen years of experience at 23 % with p value of 0.042.Periodic CPR trainings for the nurses and consider CPR certification for all bedside nurses. CPR knowledge among nurses is very low but needed. CPR trainings can help to rectify the problem.
Open Access
Assessing family involvement in chronically ill children health care at Queen Elizabeth Central Hospital, Malawi
(2018-01-01) Kamwendo, Anizia
Family involvement has been recognized as the standard of care in caring for children with chronic illnesses. Studies have suggested that family involvement in child’s care increases family understanding of the child’s illness, management and sharing in decision-making between the family and the health care providers. In Malawi, though family members stay with their hospitalized children, they only played a role of providing food and supportive care due to cultural expectations and due to lack of available nursing care. Studies had revealed family members' desires to be involved in both the physical care of their children and in decisions regarding their care. However, there was no information regarding the perception of health providers on family involvement. The aim of this study was to assess the perception of healthcare providers on the practice of family involvement in chronically ill children’s health care at Queen Elizabeth Central Hospital. A descriptive qualitative study was done using semi structured interview guide to collect data from 16 health care providers working with children with cancer conditions. Thematic analysis was done guided by Collaizi’s framework. Five main themes identified from the data were: perception of health care providers on family involvement in the care of children, health care providers’ practice of family involvement in children’s care, inadequate involvement of other family members, lack of care giving role negotiation, factors that facilitate involvement of caregivers in children’s health care and challenges encountered by health care providers to involve families in children’s health care. From the study findings, it was found that there was a discrepancy between the health providers’ perception and practice in regards to most of the areas of family involvement in child’s care. For the few areas that the caregivers were involved, the health care providers only interacted with the caregiver who was available in the hospital with the child, the other family members were not involved. Furthermore, results have shown that health care providers were not aware of their role of negotiating the caregiver role in caring for their children. Health care providers need to have the appropriate theoretical knowledge and practical skills to negotiate roles with the families.
Open Access
Assessing the preceptorship model in clinical teaching of undergraduate nursing and midwifery students in Malawi
(2021-06-01) Mhango, Lucky
Preceptorship is one of the models applied in clinical teaching where nursing educational institutions rely on registered nurses (RNs) trained as preceptors to take the role of clinical instructors. Malawi adopted the preceptorship model in response to a critical shortage of human resources. This study, therefore, aimed at assessing the preceptorship model in clinical teaching of undergraduate nursing and midwifery students in Malawi. This explanatory sequential mixed methods study was conducted at four public tertiary hospitals; a mental hospital, Christian Health Association of Malawi (CHAM) hospital and five district hospitals. A total of 87 preceptors completed a Clinical Preceptor Experience Evaluation Tool (CPEET) and 12 participated in face-to-face individual interviews. Quantitative data were analysed through descriptive statistics while qualitative data were analysed by thematic content analysis. Results revealed that a preceptorship model is an effective approach to clinical teaching with benefits to both the students and preceptors. Post hoc comparisons using the Tukey HSD test indicated that the role domain mean scores for the respondents with 4-5 years of post-registration experience (M = 6.61, SD = 0.36) was significantly different (p=0.02) than those with >9 years (M = 6.13, SD = 0.60). These results showed that respondents with 4-5 years of experience were more confident than those with >9 years of experience. The study revealed some constraints in the implementation of the preceptorship model and the main challenges included the high preceptor-to-student ratio due to staff shortages, lack of resources and poor collaboration with faculty members. These factors compromised the effectiveness of the preceptorship model in facilitating student learning.
Open Access
Assessing the promotion of clinical reasoning in classroom teaching among student nurses: A case of St Joseph's College of Nursing
(2015-12-01) Banda Bonyonga, Mtinkheni Wezi
The assessment of how clinical reasoning is promoted among student nursing and midwifery technicians followed the anecdotal reports from the public on the poor quality of client care provided by the nurses in the health facilities. These observations by the stakeholders pointed to the teaching and learning processes involved in the preparation of the nursing midwifery technicians. If the level of performance of the nursing midwifery technician is in question then the teaching and learning processes involved needs to be assessed because the educational level at which a student nurse is prepared makes the difference on how the nurse performs her duties in practice. This led to a concurrent exploratory mixed method study with the purpose of determining how clinical reasoning was promoted in classroom teaching among the student nurses. The population consisted nurse educators (n=18) and student nurses (n= 90). Quantitative data was collected from the educators and student nurses using questionnaires to determine the teaching styles of the educators, learning preferences and clinical reasoning levels of the student nurses. Qualitative data determined the educators and student nurses perceptions on the teaching and learning experiences from eight educators and three students’ focus groups. Quantitative data were analyzed using the statistical package SPSS Version 20.0 and descriptive statistics were run for frequencies, means and standard deviations. Content analysis was used for qualitative data. The results indicated that there was lack of diversity in the use of teaching styles among the nurse educators. The Expert Teaching Style was the most preferred (mean= 4.06 and SD=.981); the less preferred (mean= 3.55 and SD=1.24) was the Facilitator Teaching Style. The dominant teaching method was the lecture method; student nurses preferred lecture method but felt that interactive teaching methods were important in their learning processes and development of clinical reasoning abilities. Students also lacked diversity in their learning preferences as they (54.7%) preferred to learn together in a classroom environment. The learner centered learning environment where individual thinking, expression of own opinions and learning from peers was the least preferred (6.67%) by the learners. These results are in agreement with the learner dependence from the qualitative results. Therefore based on these results there is need for improvement of the teaching/learning processes in order to improve quality of nursing care provided in the health facilities in Malawi.
Open Access
Assessment of knowledge and practices on hypertension among adult outpatients of unknown hypertension status at Nathenje Health Centre in Lilongwe, Malawi
(2019-06-01) Katanga, Pempho Carol
Hypertension is one of the most common non-communicable diseases with a high burden of disease both globally and locally. In Malawi, it is prevalent in about a third of the adult population, and is estimated to be the second leading cause of death. It places a great economic burden yet 94.9 % of hypertensive adults are not aware of their state. Adequate hypertension control requires public awareness which facilitates adoption of healthy lifestyles by individuals. The main objective of the study was to determine knowledge and practices on hypertension among adults of unknown hypertension status in the general outpatient department of Nathenje Health Centre in Lilongwe, Malawi. The specific objectives were to: assess knowledge of adults on hypertension; identify sources of information about hypertension among adults; describe practices of adults that relate to hypertension; determine the prevalence of modifiable risk factors for hypertension among adults, and; examine the relationship between awareness of hypertension and participants’ age, education, marital status, gender and number of health facility visits. A quantitative cross-sectional study was conducted among 384 adults, aged 18 years and above, at Nathenje Health Centre. Systematic random sampling was used to select participants. Data were collected using a questionnaire and was analysed using SPSS version 20; descriptive statistics and Pearson’s Chi-square test were used in the analysis. Among the study participants, 40.6 % had never heard about hypertension. Stress, excess salt intake and diabetes were the most well-known risk factors. Only 11.4 % of those who had heard about hypertension were aware of the asymptomatic nature of hypertension, 28.5 % were aware of the lifelong nature of hypertension treatment, 64.9 % were aware that hypertension has complications and 64.5 % knew that hypertension can be prevented. Misconceptions regarding hypertension were present. Association was noted between awareness of hypertension and participants’ age (p = 0.021) and education level (p = 0.000). The study highlights the presence of knowledge gaps and practices that facilitate hypertension development. Gaps and opportunities in the role of health workers and institutions in hypertension prevention have been highlighted. Prevention strategies for hypertension include the effective use of information dissemination channels.
Open Access
Assessment of knowledge, practices and barriers to foot care among patients with diabetes mellitus at Zomba Central Hospital, Malawi
(2019-05-01) Chibwe, Evelyn
Foot ulceration is one of the most common complications among patients suffering from Diabetes Mellitus. Good knowledge and practice regarding foot care has been documented to reduce the risk of such foot complications and amputation. This descriptive cross sectional study was conducted to assess knowledge, assess practices and identify barriers to foot care among patients with diabetes at Zomba Central Hospital. A structured questionnaire was used to assess foot care knowledge, practices, and other related variables of 81systematically selected diabetic patients. Data obtained were analyzed using Statistical Package for the Social Sciences Software version 20.0. Descriptive statistics and bivariate correlations with 95% confidence interval were computed and findings have been presented in tables and figures. Of 81 Diabetes patients, 82.7% (n=62) had good knowledge and 26.6 % (n=21) had good practice on foot care. With regard to knowledge, 90.1% (n=73) were aware of the first thing to be done when they found redness/bleeding between their toes and 75.3% (n=61) were aware of the importance of inspecting the feet. Poor foot practices included; 81.5% (n=66) walked bare footed and 66.7% (n=54) used a stone to clean their feet. Barriers to foot care reported by respondents were: lack of knowledge and lack of money to buy appropriate materials. The findings have highlighted the gaps in knowledge, practices and barriers to foot care in DM patients. The study recommends enhancement of health education on foot care, continual motivation and support to patients with Diabetes. The study was done in one hospital, if multiple sites where used the data could have been enriched.
Open Access
Assessment of quality of care offered to HIV exposed children under 24 months and their mothers during follow up visit at Mzimba North Health Centre- Malawi
(2017-01-01) Chimbatata, Chikondi Sharon
Literature in the Sub Saharan Africa indicates that, delivery of quality care during follow up period for HIV exposed children is poor leading to high rates of loss to follow up. According to national statistics of 2015 in Malawi, only 16% of HIV exposed children were retained in care at 24 months. Little is known in Malawi regarding the delivery of quality care to HIV exposed children during follow up period. A descriptive quantitative cross sectional study which was guided by Donabedian (SPO) framework was conducted to investigate the quality of care offered to HIV exposed children during follow up period. A sample size of 250 mother - baby pairs attending follow up visit at Mzimba North Health Centre was recruited. Data were collected using a structured questionnaire which was developed based on study objectives. The objectives were to; assess the availability of physical infrastructure, human and material resources for the delivery of quality care (Structure); to assess if children were provided with care according to national guidelines (Process) and to determine mothers’ satisfaction with the care they were provided during follow up visit (Outcome). Results on Structure found infrastructural deficiencies which included inadequate equipment, clients’ waiting area and counsultation rooms and there were also no counselling rooms while on Process, there was a higher uptake on Nevirapine (97.2%) and cotrimoxazole administration (100%), infant Deoxyribonucleic Acid test (89.2%) and exclusive breast feeding (95.6%) however, counselling and growth monitoring were inadequate. Under Outcome, all mothers were satisfied with the care provided. Overall, there were critical service delivery gaps on Structure and Process. It is critical that more efforts are invested on the improvement of these gaps.
Open Access
Assessment of stress in caregivers with children admitted in critical care units at Queen Elizabeth Central Hospital, Blantyre, Malawi
(2020-09-01) Jere, Jester
Admission of a child to Critical Care Unit (CCU) is an unexpected and stressful event for the caregiver which may result in physical and mental exhaustion. If stress in caregivers goes unnoticed, they become emotionally traumatised and this affects their role in the parenting of a critically ill child. This was a descriptive cross-sectional study that utilised quantitative data collection and analysis approaches to describe stress experienced by caregivers of critically ill children admitted in CCU at Queen Elizabeth Central Hospital. Caregivers who had critically ill children admitted in various CCU in the paediatric department were recruited using convenience sampling technique. The researcher in person conducted interviews using a structured questionnaire to 385 caregivers who were 18 years of age and above. Data analysis was done with the aid of the Statistical Package for Social Science (SPSS) version 20. Descriptive and inferential statistics were used to present results of the study. Results of the study revealed that the average level of stress in caregivers was 3.41. Appearance of the child was the most stressful element in CCUs while healthcare workers’ conduct caused minimal stress to caregivers. Two components emerged from Principal component analysis (PCA) and these were stress related to child situation and stress related to healthcare workers. The findings also show that the level of stress in caregivers was significantly associated with the age of the caregiver and child and the nature of admission. Gender, residence, religion, education, ethnicity, prior admission, the gender of the child did not affect the level of stress. Healthcare workers require knowledge and skill in assessment of stressful situations in caregivers. Healthcare workers’ support will assist caregivers to cope while fulfilling important caregiver roles that are therapeutic to the critically ill child.
Open Access
Caregivers’ perception regarding parental participation in care of hospitalised children at Queen Elizabeth Central Hospital, Malawi
(2015-10-01) Phiri, Lophina
Parental participation is one of the cornerstones of pediatric practice. Evidence from literature has shown that effective parental participation depends on caregivers’ preparedness, adequate communication between caregivers and Health Care Workers (HCW) and the negotiation process. Queen Elizabeth Central Hospital (QECH) is the major referral hospital for the country and caregivers stay with their children in the hospital and participate in the care. However, little is known about the perception of these caregivers regarding their participation in the care of their hospitalised children. The study aimed to explore caregivers’ perception regarding parental participation in the care of their hospitalised children at QECH. A descriptive qualitative design using a semi-structured interview guide was used to collect data from 20 caregivers in the pediatric department and thematic analysis was done guided by the Colaizzi method. Seven main themes emerged from the data and these were lack of role negotiation by health care workers, inadequate role preparation for caregivers, care given by caregivers to their hospitalised children, poor HCWs- Caregivers communication, benefits of caregivers’ participation in the care of hospitalised children, needs of caregivers participating in the care of hospitalised children and overall impression of caregiver’s participation. The study findings showed that caregivers view their participation in hospitalised child care as appropriate, important and satisfying. However, gaps exist in the way caregivers participate in the care of their hospitalised children due to inadequate role negotiation, role preparation for caregivers and inadequate information for caregivers. Given this, it is recommended that management should develop protocols and guidelines for the implementation of parental participation in the care of hospitalised children to promote best practices.
Open Access
Clinical supervision experiences of third year nursing students by staff nurses at Mzuzu Central Hospital
(2017-02-01) Malikha, Evelyn
Nursing Students require clinical supervision in order to be supported and guided in acquisition of competences and skills for their professional growth. Nursing students at Mzuzu Central Hospital are no exception. Anecdotal report showed that nursing students were not guided by staff nurses during the clinical practice at MCH and this motivated the researcher to do an investigation. Insufficient clinical supervision hampers student professional growth and development, creating clinically incompetent practitioners with harmful percussion for their patient and the profession. The purpose for this study was to explore the experiences of Mzuzu University third year undergraduate nursing students’ clinical supervision during their clinical learning at MCH. Clearance to conduct the study was obtained from COMREC, MCH research committee and from participants’ consent agreement. A qualitative descriptive study was done among the third year undergraduate nursing students during their clinical practices at MCH. Target population was the entire third year undergraduate nursing student (40) doing clinical practice at MCH. Purposive sampling method was used to recruit 13 participants for the study upon reaching data saturation. A semi- structured interview guide was utilized to collect data and analysis was done using themes. Findings reveal that poor student –supervisor relationship, inadequate resources in the placement area, and the growing numbers of students in the placement area contributed to inadequate clinical supervision of nursing students by clinical staff. It was also evident that clinical staffs at MCH were struggling as they were understaffed and some were not competent enough to supervise the students which made things difficult as it was not easy to support students as expected. Therefore, recommendations such as clinical staff orientation in clinical supervision through in service training and supervisor –student ratio as NMCM recommends are made by the researcher to the learning institution as well as the clinical teaching facility.
Open Access
Collaborative capacity and structural features that enable team effectiveness: Perceptions of health care workers in Malawi
(Kamuzu University of Health Sciences, 2021-08-01) Soko, Tulipoka Nellie
research in acute health care settings has shown that Collaborative Capacity can be improved by the way an organization supports its staff. Lack of Collaborative Capacity results in fragmented health services which do not meet the multiple, complex condition, and needs of the patients. This study, therefore, investigated the perceptions of health care workers on the relationship between Collaborative Capacity and Structural Features that Enable Team Effectiveness, Leadership, and Patient-Centered Care in Blantyre, Malawi. The study employed a quantitative descriptive cross-sectional design. We adapted the Care Coordination survey and administered it to health care workers. Descriptive statistics, as well as univariate and multivariate analysis, were computed. The level of significance was set at p=.05. Analysis of Variance and the Kruskal-Wallis test were used to test differences in the mean ranks among variables. A total of 384 health care workers participated in the study by completing the Care Coordination Survey, resulting in a response rate of 100%. Collaboration Capacity differed significantly across Cadres/Roles. Health care workers had different Perceptions regarding Collaborative Capacity, Structural Features that Enable Team Effectiveness, Leadership and Patient-Centered Care. Health care workers’ Perceptions of Collaborative Capacity were positively associated with supportive organizational context and Patient-Centered Care. This study has established that Collaborative Capacity was positively associated with Communication and Information Technology, Staffing and Resources, Supervisory Support and Patient-Centered Care.
Open Access
Determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central Hospitals in Malawi
(Kamuzu University of Health Sciences, 2021-08-01) Somanje Kachale, Fannie
Maternal near-miss cases which are more frequent than maternal deaths can lead to more robust conclusions on problems and obstacles that have to be overcome during the process of maternal health care. In Malawi, there is little information on the circumstances surrounding maternal near-misses. The aim of the study was to describe determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central Hospitals in Malawi. This study used a mixed methods approach to collect data on determinants of care for maternal near-miss cases at Kamuzu and Queen Elizabeth Central hospitals in Malawi. This was a convergent design in which both quantitative and qualitative data were collected simultaneously from February to July 2017. Quantitative and qualitative data were integrated through merging the two data sets with an aim to balance the respective strengths and weaknesses as well as maximizing the yield of the complementary sources of evidence. This study has found that the magnitude of maternal near-miss in the local setting is very high (35.1%, n=161). The demographic characteristics that were significantly linked to maternal near-misses in the local setting are marital status, occupation, admission mode, means of transport and age. The obstetric characteristics that were significantly associated with maternal near-miss were fetal presentation, mode of birth, birth status and child sex. However, age and mode of birth were strong determinants of maternal near-miss. Women aged 31-35 years had significantly 4 chances of experiencing maternal near-miss. Women who had laparotomy for uterine rupture had 83 chances of being a maternal near-miss case while those who had emergency caesarean had 4 times chances compared with those who had a vaginal birth. Using the adapted World Health Organization Quality of Care Assessment tool, the quality of care offered to women was found to be below standard and this was corroborated by reports from midwives who stated that some patients were not checked blood pressure, emergency care was not performed within 30 minutes of diagnosis, no handovers were made when transferring patients from theatre to postnatal ward. The magnitude of maternal near-miss was very high compared to other parts of Africa and numerous preventable determinant factors were identified. In addition, the quality of care provided to maternal near-miss cases was below standard. It is essential that Malawi should include maternal near-miss ratio as an indicator for evaluating its maternal health services.
Open Access
Determinants of paediatric health services utilization at Daeyang Luke Hospital, Lilongwe - Malawi
(2016-11-01) Khombe, Ida Apatsa
Health service utilization is crucial for the survival of under-five children. Underutilization of health services is associated with increased number of deaths among under-five children. There was a decline in paediatric health services utilization by under-five children from Daeyang Luke Hospital (DLH) catchment area between the years 2011 and 2013. Therefore, this study was conducted to explore the determinants of utilization of paediatric health services at the hospital. Andersen model of health service utilization was used to guide the study. The study used a cross-sectional descriptive quantitative design for data collection and analysis. A semistructured questionnaire was used to interview parents or guardians of under-five children. The results showed that 97 % (n=146) of parents and guardians had knowledge about the services that are offered at DLH, 98 % (n=147) had good health seeking behaviours in times of sickness of their under-five children, 70 % (n=105) were living within a distance of five kilometers from DLH and 80 percent of the respondents reported good waiting time at the hospital. However, the study also revealed inconsistence in utilization of paediatric services at DLH. Logistic regression analysis yielded significant results in marital status, religion, waiting time, distance, service delivery, bills and distance. Service delivery had almost five times likelihood of influencing service utilization (odds ratio 4.6). Just over half (53%) of parents or guardians could not afford to pay for the cost of care. Therefore, the results warrant the need to subsidize the cost of care to under-five children living within Daeyang catchment area, in order to enhance health service utilization.
Open Access
Effects of flooding on mental health of victims in Mzuzu City, Malawi
(2018-06-01) Mwafulirwa, Glory Wezi Sopera
Floods caused by climate change have large social consequences for communities and individuals. The mental health effect of floods on victims in Malawi is not documented. A cross-sectional quantitative study was conducted in Mzuzu city to investigate the effect of the April 2016 flood on the victims. An interviewer administered structured questionnaire was used to interview conveniently sampled adults who were living in the affected areas. Data was analyzed by comparing mental health indicators before and after the floods, using Statistical Package for Social Sciences(SPSS). A total of 351 interviews were completed; 70.7% of the respondents were females. The proportion of participants who reported being happy, had injuries, were able to provide for their dependents, accessed health services and had a good appetite before and after the floods were found to be statistically significant as they decreased after the floods and had p<0.001. On average, signs and symptoms of mental illnesses such as depression and post-traumatic stress disorder (PTSD) were reported in 56% of respondents. 19.3% received no support like others who did in form of food, shelter and counseling. Of those that received support, 79.8% reported that the support received had no effect on their mental health. Hence 61.5% indicated they needed to be provided with housing; 37.3% indicated they needed loans; 1.14% indicated they needed counseling services, for their mental health to be at optimal level. Flood victims in Mzuzu city had mental health issues as they presented with symptoms of mental problems. Their mental health indicators such as mood, physical health and eating pattern diverted from the normal state. A comprehensive mental health assessment should be considered for flood victims and a policy incorporating comprehensive mental health services in managing disaster victims should be developed.
Open Access
Experience of HIV positive mothers on delayed HIV testing of exposed infants at Mchinji District Hospital
(2019-06-01) Mphatso, Chiyanjano
Many HIV-infected infants and children die from HIV/AIDS without HIV diagnosis or treatment. All HIV-exposed infants at the age of 4-6 weeks should receive a diagnostic test for DNA-PCR and early initiation of ART among those identified HIV infected. However, reports have indicated serious delays in HIV testing for HIV exposed infants. The aim of this study was to examine experiences of HIV positive mothers on delayed HIV diagnosis of exposed infants at Mchinji District Hospital. A descriptive qualitative design was used to conduct this study. Mchinji is among the districts in the central region of Malawi where HIV prevalence was estimated as high as 7.6 %. The site was selected because data from the facility had shown significant delay in HIV testing and diagnosis for exposed infants. The statistics for 2015/2016 extracted from the health information systems for Mchinji district hospital showed that only 47% of exposed infants were tested for DNA-PCR within six weeks of age. The study participants were women in the child bearing age (15-45 years) who were confirmed HIV positive and had an infant of more than six weeks of age who had not been tested for DNA-PCR or had been tested for DNA-PCR after six weeks of age. The participants were recruited from the study population using purposive sampling method. The sample size for the study was 15 and data saturation was the guiding principle in the sample size. Data were collected using a Chichewa translated interview guide for individual interviews. Data were recorded through audio-taping and field notes were taken. Data were analysed manually using thematic analysis. The findings of the study will facilitate early infant diagnosis of HIV as stipulated in the guidelines for policy implementation. The findings may also add knowledge to child health nursing practice and influence change and policy development in care of exposed infants. Ethical approval to conduct the study was obtained from the College of Medicine Research and Ethics Committee. Thereafter, permission to conduct the study was obtained from Mchinji District Hospital. The findings of the study showed that fear of stigma and discrimination, denial of one’s HIV status, home deliveries, laziness, and migration to and from neighboring countries affected early infant diagnosis of HIV. These findings are to be disseminated through meetings at Mchinji District Hospital which was the study setting. A written report is to be submitted to the study site, Kamuzu College of Nursing and College of Medicine Research and Ethics Committee.
Open Access
Experiences of Blantyre urban primary school teachers in identifying and reporting child physical abuse
(2020-08-01) Nyirenda Kayange, Tauncio
Child physical abuse is a serious public health problem because of its association with poor child health outcomes. Effective identification and reporting of child physical abuse is critical to break cycles of physical abuse and for developing a well-functioning child protection system. Teachers among other professionals are uniquely positioned to identify and report child abuse cases because of their daily contact with children. However, little is known about the experiences of teachers in identifying and reporting child abuse cases in their schools. This study explored the experiences of primary school teachers in identifying and reporting of child physical abuse cases in Blantyre urban. A descriptive qualitative study, with purposive sampling technique, was employed. The sample size was 10 key informants and 59 primary school teachers. In-depth interviews and focus group discussions were used to collect data with the aid of a semi structured interview schedule. Thematic data analysis using six steps of Braun and Clarke was employed to analyze data. The findings of the study revealed that teachers were aware of their responsibility to detect suspected child physical abuse and also to report the suspected cases but faced challenges such as lack of knowledge and skills, large classes, inadequate time and lack of clear guidelines for dealing with child physical abuse. It was also noted that some teachers were culprits of perpetrating child physical abuse and many had supportive attitudes towards the utilisation of corporal punishment as a means of child discipline. It was, therefore, suggested that there should be professional development for both primary school managers and teachers on handling child physical abuse cases and on alternative and effective strategies of disciplining students. With regards to safety concerns raised by the teachers and effective response to child physical abuse cases, the study further recommends a multiple disciplinary approach to the issue of child physical abuse with clear reporting lines and guidelines.
Open Access
Experiences of caregivers of children receiving palliative care at Mzuzu Central Hospital, Malawi
(2015-12-01) Chaputula, Bertha Mwandida
The number of children with life threatening and limiting illnesses requiring children palliative care is increasing each and every year. In response to the rising number of children requiring palliative care, family involvement in care giving has expanded. Caregivers play a major role in caring for children with life-limiting or threatening illnesses on palliative care at home as well as in hospital. However, for them to adequately provide the care, they require adequate support.This study reports on the caregivers’ experiences of caring for children receiving palliative care at Mzuzu Central Hospital Palliative Care Clinic. The study was aimed at exploring the caregivers’ experiences of caring for children receiving palliative care. A descriptive qualitative research method was used. The target group was caregivers of children with life threatening or limiting illnesses receiving palliative care at the clinic. A total of 30 caregivers were recruited for the study using purposive sampling technique. Qualitative data was collected using semi structured interview guide for in-depth interviews and a tape recorder while analysis was done using thematic analysis. Findings revealed that caregivers play a major role in caring for their children receiving palliative care. They provide assistance with activities of daily living and health care management in additional to their usual daily chores. The needs of the children receiving palliative care included transportation, finances, information, health care and daily needs. Family members and community members formed part of the caregivers’ support systems. Caregivers of children receiving palliative care reported facing financial, social, physical, and psychological and health service challenges. Proper assessment and availability of adequate support would positively influence the caregiver’s experiences of caregiving and the child’s quality of life. Hence, there is need to develop practical interventions that will lessen the caregivers’ challenges.
Open Access
Experiences of caregivers of children with hydrocephalus at Queen Elizabeth Central Hospital
(2018-04-01) Chidziwisano, Cynthia
The impairment of cortical connectivity involving the afferent and efferent pathways in hydrocephalus usually leads to cortical pathway dysfunction. Consequently, in most of the affected children the dysfunction is permanent causing both motor and cognitive deficits and behavioral difficulties. This causes the affected child to entirely depend on the caregiver for all daily functions. Therefore parents are responsible for helping the child in all the activities of daily living. Understanding parents’ experiences has the potential to improve parent–professional collaboration and the management of the child’s condition. To explore parents’ experiences of living with a child with hydrocephalus and their responsibility of having to care for a growing child who is entirely dependent on them. Design and methods: A descriptive qualitative method was undertaken, and twenty caregivers were interviewed using an in depth interview guide. Six themes were identified; strange illness, financial constraint, work overload, social stigmatization and support system. The identified themes were all from the parent’s verbalized experiences, the caregivers referred to hydrocephalus as a strange disease which they have never heard or seen. Financial constraint is a major challenge arising from their failure to work or do business and from frequent hospitalization. Social stigmatization was another major challenge which was deterring the caregivers form participating in important community events. Furthermore support system involved the support the caregivers received from their friends and relatives, health professionals and the organizations. Therefore, caregivers of children with such a condition must cope tremendous emotional, physical and economic burdens, although in the course of this, they gain a vast experience on care management approaches of the affected child. Therefore collaboration with parents requires health professionals to listen to parents’ concerns and value their experiences.
Open Access
Experiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth Central Hospital
(2016-03-01) Joshua Gondwe, Mtisunge
The bubble Continuous Positive Airway Pressure (bCPAP) is a form of oxygen treatment given to children with severe respiratory distress. The bCPAP treatment might be stressful to caregivers caring for their sick infants. As such, caregivers may need continuous psychological support and adequate information for them to understand treatment better. This was a descriptive study that utilized qualitative method to explore experiences of caregivers of infants who have been on bCPAP at QECH. Data was collected from a purposive sample of twelve caregivers from Chatinkha and Paediatric nursery wards through in-depth interviews using a semi- structured interview guide. Qualitative data was analyzed using Colazzi’s framework which resulted in identifications of 3 themes; information about bCPAP, perception of caregivers and psychological support. The study found that information given about bCPAP was inadequate and not standardized for caregivers to understand bCPAP treatment. Most caregivers perceived bCPAP as a good treatment that saved lives of their infants. The caregivers were more stressed due to interrupted parent infant interaction and bCPAP machine as they prevented them to be in physical contact with their infants. The family members, friends and religious beliefs were among preferred source of psychological support rather than the healthcare workers. Therefore, the results have shown that there are gaps in providing support to caregivers of infants on bCPAP at QECH in terms of giving information and psychological care. As such, it is recommended that specific interventions be developed to minimize psychological distress and promote psychological health of caregivers with sick infants on bCPAP at QECH.
Open Access
Experiences of caregivers on healthcare and psychsocial services available for Celebral Palsy children in Mangochi District
(Kamuzu University of Health Sciences under the CHEER Project, 2023-06-01) Chiundira, Felistas; Masese, Ruth; Matenje, Anania; Kaonga, Mavuto; Chilemba, Winnie; Maleta, Maureen; Laher, Beverly; Manong'a, Chifundo
This was a cross sectional phenomenological qualitative study. Children with Cerebral Palsy (CP) require multidisciplinary and holistic care in order to comprehensively manage their medical needs as well as maximize their developmental and educational potential. 1. In addition, many children with Cerebral Palsy have complex limitations in self-care functions which renders them completely reliant on their caregivers. 2. The provision of such care may therefore be detrimental and stressful to both the physical health and the psychological well-being of parents of children with Cerebral Palsy3. Exploring experiences of caregivers on healthcare and psychosocial services available for children with Cerebral Palsy is key in addressing gaps existing in provision of quality health care and psychosocial services both at community and hospital settings. The study utilized qualitative research design which was cross sectional and phenomenological in nature. The study was conducted at Mangochi District Hospital and targeted caregivers of children with Cerebral Palsy. The duration of the study was 10 months; between December 2021 to September 2022. Convenient sampling was used with a sample size of 12 caregivers. Data collection was done using face to face in depth interviews with the aid of interview guide. Tape recorder was used and the information provided by the participants was transcribed. Data was presented in themes and subthemes. Study findings: The findings of the study showed that majority of participants reported that their children received good physiotherapy services, health care workers were friendly and welcoming and they had short waiting time to receive the services. However, some of the participants received inadequate information related to etiology of CP, prognosis of CP, alternative treatments and on child care at home. There was also lack of follow up of CP children and lack of home visits by health care workers. Majority of participants received informal psychosocial support from their relatives and friends. However, majority of formal psychosocial services were lacking for example there was lack of counselling services, no visits by counsellors or social workers, unavailability of support groups and lack of assistive devices at home. Challenges which caregivers encountered were related to financial support resulting in their inability to meet basic needs for CP children and transport challenges to take their children to the hospital for monthly physiotherapy services. The study recommends that health care workers should be trained in order to provide evidence based CP information and psychosocial counselling services. CP children and their caregivers should also be followed up by community healthcare workers for support and continuity of services. There is need to engage non-governmental organization existing within Mangochi district to support caregivers in terms of basic needs and psychosocial support. All in all, there is need for multisectoral collaboration in order to manage CP children comprehensively. The study findings has been sent to COMREC, has been disseminated at RDC conference and will be disseminated at MOH conference and other upcoming national and international conferences, stakeholder and professional review meetings, seminars. Soft copies of research documents have been made available to Ministry of Health, Kamuzu University of Health Sciences and Mangochi DHO. The study findings will also be published in paediatric journals.