School of Maternal, Neonatal & Reproductive Health
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- ItemOpen AccessAssessing partograph recordings and perinatal outcomes at Queen Elizabeth Central Hospital, Malawi(2016-12-01) Chisuse, Isabella ChikondiThe development of the partograph provides health professionals with a pictorial overview of labour progress, maternal and foetal condition and aids in early identification and management of complications such as poor progress of labour, prolonged labour, foetal distress, and, in the worst cases, obstructed labour and ruptured uterus. The aim of this study was to assess the documentation of the partograph recordings and perinatal outcomes during intrapartum period at Queen Elizabeth Central Hospital which is situated in the southern region of Malawi. A descriptive cross sectional study was conducted using a simple random sampling of 246 partographs. Using a checklist, recordings of observations on foetal, progress of labour and maternal parameters were assessed and given a grade as completely documented, adequately documented, inadequately documented and grossly inadequately documented. Results indicated that only 1.2% of the partographs were completely documented with observations on foetal, maternal and labour progress. Foetal heart rate monitoring was documented according to standard in only 2.4% of partographs and not recorded at all in 11.8% of the partographs. There was no association between recordings of foetal parameters (foetal heart rate, status of membranes and degree of moulding) and neonatal birth outcome (p = 0.713). The reviewed records showed 4 fresh still births and 21 newborns who were admitted to neonatal intensive care unit with Apgar score of less than 7 at 5 minutes within a period of one month. On labour progress, cervical dilatation was the only parameter that was more documented according to standard in 33.7% (n = 83) of the partographs as compared to the documentation of uterine contractions which was 4.5% (n = 11) and of descent of presenting part which was 5.9% (n = 14) of the partographs. On maternal parameters, blood pressure was not documented in 65.4% of the partographs reviewed and respirations were documented in only 3.3% of the partographs. On the maternal condition, the findings did not show a significant association between partograph recordings and immediate maternal outcomes. Though not statistically significant but very important, women experienced adverse outcomes such as pre-eclampsia (n = 4), uterine tears (n = 4) and postpartum haemorrhage (n = 13) were experienced by the women. There is need to investigate on possible explanations as to why the partographs were not documented according to World Health Organisation’s recommended guidelines.
- ItemOpen AccessAssessing quality of focused antenatal care provided to pregnant women at Bwaila Antenatal Clinic in Lilongwe District(2011-03-01) Lungu, Florence TamandaAlthough antenatal care coverage is high in Malawi (93%), worrying gaps exist in terms of its quality and ability to prevent, diagnose, or treat complications. According to Multiple-Indicator Cluster Survey (MICS, 2006), there is limited content of focused antenatal care services (FANC), indicating that pregnant women are not getting the quality care that would assist in the identification and management of complications. This contributes to the risk of maternal and neonatal mortality in Malawi which is currently 675 per 100, 000 live births and 33 per 1, 000 live births respectively (Malawi EmNOC Needs Assessment Report, 2010). The purpose of this study was to assess the quality of FANC services provided to pregnant women at Bwaila Antenatal Clinic in Lilongwe District. Specifically, the study identified the availability and functioning of the basic infrastructure and material resources necessary for offering quality FANC services. It also aimed at exploring the process of delivery of quality FANC services provided during antenatal consultation. Additionally, the study determined if provision of FANC services at Bwaila Antenatal Clinic met the required reproductive health standards as stipulated by Ministry of Health (MoH) in Malawi. A descriptive quantitative study was conducted on a convenience sample of 369 antenatal mothers. Following informed consent, these mothers were interviewed using a structured questionnaire to assess the perceived quality and content of FANC services provided during consultation. A checklist was used to assess structural quality and to determine if FANC services at Bwaila Antenatal Clinic met the required standards, as stipulated by Ministry of Health in Malawi. Descriptive statistics were computed using SPSS version 10.0. Study findings indicated proper structure for providing FANC services. Consultation rooms had basic equipment and essential drugs for providing FANC services. However there were inconsistencies in taking comprehensive history, incomplete physical examination, inadequate laboratory investigations and poor health education. There was lack of reagents for investigating Heamoglobin (Hb), and Syphylis. Only reagents for HIV test were readily available. Based on the national reproductive health standards; Bwaila Antenatal Clinic scored above standard on structural quality (87%) and below standard in performance (60%). It is recommended that community mobilization and training of health care providers be conducted in the district to promote awareness of the new approach in order to provide evidence based practice. The necessary material resources for providing FANC should be consistently supplied to provide an enabling environment for providing FANC services.
- ItemOpen AccessAssessing the level of burnout among maternity healthcare workers at Zomba Central Hospital, Zomba and Bwaila Maternity Unit, Lilongwe, Malawi(2017-10-01) Khangamwa, Fikile Lindiwe ThokozireBurnout is more prevalent in healthcare workers due to emotional strain of dealing with patients’ pain and suffering, accompanied by a poor working environment which leads to: poor quality of work, loss of self-confidence, negative attitudes, staff conflicts, absenteeism, anxiety and frustration. The rate and effects of burnout have not been properly investigated in the maternity facilities in Malawi. The main aim of the study was to assess the level of burnout among maternity healthcare workers by specifically determining the extent, describing the factors associated with it and exploring measures that can address burnout among maternity healthcare workers. A cross-sectional study was conducted among maternity healthcare workers at Zomba Central Hospital (ZCH) and Bwaila Maternity Unit (BMU) in June 2017.Data were collected using an adapted Maslach Burnout Inventory self-administered questionnaire which included demographic characteristics, job perceptions and burnout constructs: emotional exhaustion(EE), depersonalization(DP) and reduced personal accomplishment(PA). A total of 81 participants were enrolled in the study, 50 (62%) were from Bwaila Maternity Unit and 31(38%) from Zomba Central Hospital. The mean age was 31 years (SD: 6.2); 68 % (55) were female; 65% (52) were married. 21(26%) of the participants were from antenatal, 27(33%) from labour, 20(25%) from postnatal wards and 13 (16%) worked in all departments (antenatal, labour and postnatal wards). There was 75%, 28 % and 33 %burnout rates on EE, DP and reduced PA. In multivariate analysis, healthcare worker absenteeism (adjusted OR {P-value} 15.38(0.05) and low job satisfaction (adjusted OR {P-value} 17.72(0.02) were the only factors associated with EE.
- ItemOpen AccessAssessing the quality of information, education and communication during antenatal care at Chiradzulu District Hospital(2017-02-01) Lungu, Gaily GrayshamEvery pregnant woman attending antenatal care (ANC) is supposed to be informed, educated and communicated on various health areas regarding pregnancy and its outcomes. Information, education and communication (IEC) is considered as one of the major factors that help in reducing maternal mortality as it intends to develop positive attitudes towards behaviours in different cultures in order to support pregnant women accessing health services when required. This study aimed at assessing the quality of IEC offered during ANC at Chiradzulu District Hospital. The study had a descriptive design that employed quantitative methods of data collection and analysis. The sample size was 384 pregnant women who reported for ANC. Data was analysed using a Statistical Package for Social Sciences (SPSS) version 20.0. The researcher computed the statistics in form of frequency tables, pie charts and graphs to summarise the data. Results reveal that information necessary for pregnant women according to participant’s manual in integrated maternal and neonatal care for Malawi is not provided and some information is given in inadequate amount. The IEC is offered by both skilled (58.3%) and unskilled attendants using a few teaching and learning resources. However, majority of the respondents (45.6) reported that no teaching resources were used. In conclusion, IEC that is offered during antenatal care at Chiradzulu District Hospital, antenatal department is of poor quality. Quality IEC improves women’s ability to plan for various areas of care so as to meet the necessary needs during pregnancy. If IEC of good quality is provided to pregnant women, maternal and neonatal morbidity and mortality rates can be reduced.
- ItemOpen AccessAssessment of midwives and clinicians adherence to national obstructed labour management protocols at Thyolo District Hospital, Malawi(2019-03-01) Chamalawa Kamaliza, EsmieObstructed 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.
- ItemOpen AccessAssessment of quality of antenatal care that pregnant women receive during the initial visit at Kawale Health Centre in Lilongwe District(2017-02-01) Bandawe, Violet LoveAntenatal care is one of the strategies for the improvement of maternal health and the he reduction of maternal and neonatal morbidity and mortality. The initial antenatal care visit is the entry point for antenatal care and is the most significant visit since this is the visit where women are categorised into standard care or special care in accordance with the World Health Organization (WHO) guidelines. This study aimed at assessing the quality of antenatal care that pregnant women receive during the initial antenatal visit at Kawale Health Centre in Lilongwe District. Specifically, the study assessed the availability of resources necessary for the provision of quality antenatal care, nurse midwives’ knowledge and actual practice, and pregnant women’s knowledge of antenatal care and their satisfaction with the care that they receive during the initial visit. The study design was descriptive which used quantitative approach. Systematic random sampling was used to recruit 384 pregnant women who participated in the study. Data was collected using observation checklists and structured questionnaires for both pregnant women and nurse midwives. The study was guided by Donabedien’s Quality of Care Framework. Data collection was done in May and June 2015. Data analysis was done using SPSS version 16.0. Results of the study showed that the structure for providing antenatal care scored below the WHO standard at 46% and the process also scored below standard at 65%. Pregnant women lacked knowledge of antenatal care but showed satisfaction with the care received. Uninterrupted supply of material resources necessary for the provision of quality antenatal care, the use of stipulated guidelines, including health education and counselling to pregnant women is recommended for the improvement of quality antenatal care during the initial visit at Kawale Health Centre
- ItemOpen AccessCommunity members' view on banning of traditional birth attendants from conducting deliveries in rural areas of Ntcheu District(2017-03-01) Chimwenje, Sophie Cecilia KhumbizeniA Qualitative study was conducted to explore the views of the community members in Traditional Authorities, Masasa and Phambala in Ntcheu district on the banning of TBAs from conducting deliveries. The study objectives were to assess knowledge of community members on the availability and accessibility of maternal and neonatal care services; to assess perceived roles of TBAs before and after being banned from conducting deliveries; to describe community members perceptions about banning of TBAs and; to describe opinions of community members regarding accessibility and utilization of maternal and neonatal care services. Purposive sampling was used to select both the study areas and the study participants. Group Village Headman Mwenye and Masese were chosen from TAs Masasa and Phambala respectively. These were some of the areas with difficult accessibility to health facilities. Fourteen in-depth interviews from five women, five men and four chiefs were conducted and this was the point at which saturation was reached. Thematic content analysis was used to analyse the data and six key themes emerged, namely: access to maternal and neonatal health services; dangers of home delivery; experiences of giving birth at a TBA versus health facility; participants’ perceived trend of maternal and neonatal mortality; need for consultation with stakeholders; and health Worker- TBA Partnership. The study findings revealed that the community members welcomed the idea of banning TBA from conducting deliveries. However, the community members view implementation of the policy to be difficult because of prevalent factors affecting accessibility and utilization of safe delivery services. It is recommended that safe delivery services be made closer to them by constructing health facilities; deploying and retaining staff in non-functional health facilities; improving health worker attitude towards women of child bearing age and; community awareness on maternal and neonatal health issues.
- ItemOpen AccessCompliance with focussed antenatal care among pregnant women in Dowa district, Malawi(2017-02-01) Machika, Davison BesterAntenatal 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.
- ItemOpen AccessA descriptive study on the magnitude and factors associated with domestic violence against pregnant women in Nsanje District, Southern Malawi(2012-08-01) Chasweka, Robert JohnDomestic 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.
- ItemOpen AccessDeterminants of cervical cancer screening uptake among women of childbearing age in Mangochi District Malawi(2021-04-01) Mpachika, Felistas SungeniCervical 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.
- ItemOpen AccessDeterminants of postpartum disorders following early hospital discharge in Blantyre, Malawi(2020-09-01) Jere Lulaka, TiwongeSome mothers face various disorders after childbirth like postpartum haemorrhage, fatigue, sepsis, breast engorgement, sore nipple among others. However, it remains unknown as to what predisposes mothers to these disorders following early postnatal discharge. This current study aimed at establishing the determinants of postpartum disorders in mothers at home following early discharge. Specifically, the study identified the types of postpartum disorders following early postnatal discharge; determined the prevalence of mothers facing postpartum disorders following early discharge; investigated the demographic and socioeconomic factors which determine postpartum disorders after early discharge and assessed the existing support measures used to mitigate the postpartum disorders after early discharge. A cross-sectional study was conducted at Ndirande and Limbe Health Centres in Blantyre district with a sample size of 385 using systematic random sampling on mothers who had turned up at one-week postnatal check-up. Data was analyzed using descriptive statistics and logistic regression using statistical package for social sciences 20.0. The study results revealed that 52.7%mothers with a mean age of 25 years developed postpartum disorders. Out of those, 2.5% had life-threatening postpartum disorders (excessive vaginal bleeding)while the rest had non-life-threatening postpartum disorders like severe abdominal pains, painful legs, headache etc. The mothers with tertiary level of education (OR 27.5, 95% CI: 1.88-402.9, p = 0.015) and those with poor wealth quintile(OR 0.40, 95% CI: 0.21 – 0.77, p= 0.006. Postpartum disorders were the ones who developed the postpartum disorders. Mothers, husbands of the study participants were the primary caregivers at home to these new mothers. The study will enrich the body of knowledge in midwifery practice, education, research and policy making. In conclusion, the study determines that early discharge is not directly affecting the development of postpartum disorder but with other factors like poverty and high education.
- ItemOpen AccessEarly hospital discharge following childbirth: Mothers' experiences during the first week of the postpartum period at home in Mzuzu City, Malawi(2011-03-01) Kalale Chirembo, JudithThere has been a dramatic decrease in the length of time mothers remain in hospital following childbirth, which may affect the health outcome of the mother and neonate in the immediate postpartum period. This is because mothers may have health needs and concerns during the immediate postpartum period related to physical recovery from childbirth, neonatal care, and family relations that may need the midwife’s attention. Hence, a descriptive phenomenological qualitative study was conducted to explore mothers’ experiences during the first week of the postpartum period following early hospital discharge after childbirth in Mzuzu City, Malawi. In-depth interviews were conducted with 26 participants. All participants had given birth within six weeks prior to interviews and were discharged from the hospital within 24 hours after delivery. Data was tape-recorded and field notes were taken to complement the recorded data. Narratives were analysed following Collaizz’s technique. The results indicated that the majority of participants and their neonates experienced health problems during the first week of the postpartum period. Maternal problems included abdominal pains, excessive bleeding, breast problems and general medical health problems. Neonates experienced neonatal infections such as eye, skin, gastro-intestinal, and general health problems. Very few participants in this study sought medical care for the health problems they or their neonates experienced. However, almost all the participants attended the one-week scheduled postpartum check-up visit. Furthermore, the study revealed that the majority of participants received support from family members, specifically from their mothers, mothers-in-law, husbands, and neighbours during the first week of the postpartum period. The study further revealed that mothers were either satisfied or dissatisfied with early hospital discharge depending upon the extent of family support they received, the hospital environment, the amount of information they received and health assessment that was conducted in preparation for early hospital discharge, and their personal health status. The results further indicated suggestions for improving the practice of early hospital discharge. Suggestions included follow-up through home visits, telephone calls, scheduled postpartum check-up visits at the hospital and self-report to the hospital if any problem arises. The study adds insights into health problems that mothers experience during the first week of the postpartum period following early hospital discharge. Therefore, preparation for early hospital discharge should include a thorough health assessment of both mother and neonate to ensure that they are healthy before discharge. Midwives should also educate mothers on normal physiological changes during the postpartum period and that certain signs and symptoms indicate serious health problems. This information will help them to differentiate normal experiences from abnormal ones. There is a need for further research to explore the prevalence and types of maternal and neonatal health problems following early postpartum hospital discharge. Furthermore, exploration of the factors that contribute to postpartum health problems in the home during the early postpartum period is necessary. This knowledge will assist in guiding the care and education of mothers following childbirth.
- ItemOpen AccessAn examination of the management of infertility in Thyolo and Blantyre districts(2017-06-01) Nindi-Nyondo, AndaThe 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.
- ItemOpen AccessExperiences of antenatal mothers staying in a maternity waiting home at Malamulo Mission Hospital in Thyolo(2011-03-01) Sundu, SusanIn many areas of the world, and especially in Sub – Sahara Africa, utilization of maternal services is low. In low-resource settings, cost, distance, and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; one of these strategies is the maternity waiting homes (MWHs), but few studies have reported or evaluated the impact of the wide scale implementation of the strategy. This study was conducted to explore antenatal mothers’ experiences of staying in MWHs in Thyolo District. A qualitative, phenomenological study was conducted utilizing on audio-taped, semi-structured in-depth interviews (IDIs). A purposive sample selection of 15 antenatal mothers staying in MWHs was recruited. The lived experiences of these 15 mothers were revealed through IDIs. The findings on antenatal mothers’ experiences of staying in MWHs revealed several things including motivating factors, benefits, and challenges of staying in MWHs. Some of the motivating factors were proximity to the hospital, birth by skilled attendance, and availability of specialized care. The benefit of staying in MWHs was that the antenatal mothers had adequate time to rest, a thing which was rare at home. They enjoyed peace of mind because they did not have to worry about how they would get to the hospital if labour started, and they made new friends while in MWHs. Challenges that the antenatal mothers reported during their stay in MWHs were lack of privacy, poor sanitation, pests, congestion, poor attitude of midwives, and adverse cultural practices. Antenatal mothers who reside long distances from the hospital need to be encouraged to wait in MWHs for two to three weeks before the expected time of delivery where they can receive adequate medical care should complications arise. Health workers need education and training on interpersonal skills, ethics, and attitudes to address the issue of poor attitude of midwives. This could portray a better midwifery image to the community. However, further studies should be conducted on client – provider interaction to address the poor attitude of midwives. Additionally, the hospital management needs to improve the infrastructure in MWHs, and spray the buildings regularly with pesticides to eliminate mosquitoes, ants, and fleas. The findings indicate the need to address the challenges which will increase the utilization of MWHs. When the challenges are addressed, the number of antenatal mothers utilizing MWHs will increase leading to improved pregnancy outcome.
- ItemOpen AccessExperiences of male partners participating in Kangaroo mother care within the hospital and home settings in Dedza District, Malawi(2018-10-01) Katundu, YankhoLow Birth Weight which is mainly due to prematurity, contributes to high neonatal mortality rates. Kangaroo Mother Care is the main intervention for the babies to survive. Many studies on KMC experiences have focused on mothers and health care workers, hence the need to focus on men who also provide Kangaroo Mother Care. The objective of this study was to explore the experiences of male partners participating in Kangaroo Mother Care within the hospital and the home settings in Dedza district. A qualitative design method was used. The study was conducted at Dedza District Hospital in Malawi including data from home settings. Data were collected through face to face in-depth interviews using a semi-structured interview guide and a tape recorder. Data were analyzed using thematic analysis. The themes that emerged were: male partners’ perception of the experience with Kangaroo Mother Care, facilitators to male partners’ participation and barriers to male partners’ participation in Kangaroo Mother Care. The study revealed that most of the male partners had positive perceptions of their experience in participating in Kangaroo Mother Care at the hospital and at home such as perceiving it as a rewarding experience. However, there were barriers, such as health care worker attitude, hospital environment and lack of time. Health care worker support and community sensitization are key elements in ensuring male participation. The findings will give nurse midwives an insight that it is possible and essential to promote male partner participation in Kangaroo Mother Care and to develop more strategies that can enhance their participation.
- ItemOpen AccessExperiences of secondary school students in Mulanje District on parent-adolescent communication about sexual and reproductive health issues(2019-04-01) Likoya, Esnart VanessaThis 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.
- ItemOpen AccessAn exploration of midwives and clients experiences of emergency caesarian section at Bwaila Maternity Unit(2012-08-01) Mwale, Ruth CynthiaWorldwide 35.7 % of women suffer from major complications post caesarian section (Mukherjee, 2006). These include but are not limited to pelvic infection, generalized sepsis, deep vein thrombosis, and minor complications such as fever, urinary tract infections, and wound sepsis. Major complications are almost double in emergency caesarian sections compared to those in elective caesarian section. There is evidence that preoperative care rendered to mothers before emergency caesarean section helps to reduce complications postoperatively. A study was conducted at Bwaila maternity unit to determine midwives’ and clients’ experiences of preoperative care before emergency caesarean section. The objectives of the study were: to establish midwives’ perception of the components of standard preoperative care of clients undergoing emergency caesarian section; to assess midwives’ actions on components of standard preoperative care for emergency caesarian section; to determine clients’ perception of the preoperative teaching rendered to them prior to undergoing emergency caesarian section; to determine clients’ reaction to preoperative care they received prior to undergoing emergency caesarian section. to determine if there was an association between preoperative emergency care rendered and the incidence of postoperative complications. The study used a combination of retrospective and prospective designs using quantitative methodologies. A sample size of 87 clients and 28 midwives was obtained through convenient sampling. Data was collected using structured questionnaires and structured interview guides and a checklist was used to collect data from client chart review. The data obtained was analyzed using the statistical package for social science (SPSS Version 16.0). Data has been summarized using frequency tables, and bar charts and tables have been used to present the results. The Chi-Square test was used to determine the significant statistical association between the preoperative care rendered to the clients and the incidence of postoperative complications. Independent-samples t-test was used to examine statistically significant differences between the complications expressed by clients and those documented in the clients’ charts. Imogene King’s middle range theory of Goal Attainment guided this study. Chi-Square test showed a statistically significant association between preoperative teaching offered to the clients on deep breathing and coughing exercises, and the incidence of postoperative complications (P<0.05). Complications expressed by the clients (mean = 0.84, S.D. = 1.7) scored statistically significantly higher (p<0.05) than those documented in the clients’ charts. Although results showed that midwives were able to mention most of the components of basic preoperative care for clients undergoing emergency caesarean section, only 25% mentioned that they would check vital signs prior to emergency caesarean section, 28.6% mentioned that they would allow the client to ask questions, and 25% mentioned that they would answer client’s questions. Gaps were also noted between the mentioned components of care and those documented in the clients’ charts the least documented being vital signs (19.5%), psychological reassurance of the client (3.4%) and preoperative teaching of the client (1.1%). The main contributing factors were poor deployment of midwives to this hospital; lack of preoperative care guidelines; and lack of in-service training for the midwives in perioperative care.
- ItemOpen AccessExploring factors that influence adherence to exclusive breast feeding among HIV positive mothers at Bwaila Hospital in Lilongwe, Malawi(2018-02-01) Kandeya, BiancaCurrently, there are over 39 million people living with HIV worldwide. The burden is high in the sub-Saharan Africa where there are over 11 million people living with HIV. Malawi is one of the countries with a high HIV prevalence rate, with 8.8% of the population living with HIV. The total number of people living with HIV in 2016 was 1,000 000 of which more than 50% of these were women of the childbearing age. Transmission of HIV from mother to infant during postpartum is a far much bigger problem because not a lot of interventions have focused on the transmission of HIV postnatally. The rate of HIV transmission during postpartum globally is estimated at 8.9% whereas in Malawi, it is estimated at 2.4% (Van de Perre, Kankasa, Nagot, Meda, & Tumwine, 2017; Gumede-Moyo, Filteau, Munthali, Todd, & Musonda, 2017).The aim of this study was to explore factors that influence adherence to exclusive breastfeeding among HIV-positive mothers, which is important in promoting exclusive breastfeeding which may reduce the rates of HIV transmission. Despite that mixed feeding practices in exposed infants have shown an increase in transmission rates of HIV, it has not been easy to adhere to exclusive breastfeeding as an infant feeding practice. The study used descriptive qualitative research method to explore factors influencing adherence to exclusive breastfeeding among HIV-positive mothers at Bwaila Hospital in Lilongwe, Malawi. Purposively selected 15 HIV positive mothers with babies from 0-6 months of age were interviewed using a semi-structured interview guide. The data were analyzed manually using simple thematic analysis proposed by Braun & Clarke (2006). The results showed that knowledge of EBF, attitudes and perceptions towards EBF, availability of support from significant others, health facility influence, socioeconomic status and intention to protect are some of the factors that influence HIV positive women to adhere to EBF. In conclusion, there is need to intensify interventions that address several enabling factors, including; structural and social support, changing attitudes and subjective norms to provide the conditions conducive to EBF adherence.
- ItemOpen AccessFactors associated with alcohol and drug abuse among secondary school students in Lilongwe urban1917(Kamuzu College of Nursing, 1997) Nkhope, Saukira Louisa
- ItemOpen AccessFactors associated with antiretroviral therapy adherence under option B+ strategy among breastfeeding mothers at Mzuzu Health Centre, Malawi(2020-09-01) Kanyimbo, BeatriceART adherence among breastfeeding mothers is very essential in the PMTCT. Standard adherence rate of ≥ 95% sufficiently suppresses the virus and brings much more desirable outcomes, thus; it improves maternal health and reduces rate of vertical transmission of HIV. However, PMTCT remains a challenge after childbirth, with inadequate adherence among the breastfeeding mothers which needs greater attention. The aim of the study was to investigate factors associated with ART adherence by specifically determining social-demographic factors, assessing patient related factors, identifying the therapy related factors, assessing condition related factors, determining health care system factors associated with ART adherence and determining ART adherence rate among breastfeeding mothers on option B+ strategy at Mzuzu Health Centre Malawi. A quantitative cross-sectional descriptive study was conducted among all HIV positive mothers on ART with children breastfeeding from 6 weeks to 24 months, 18 years and above at Mzuzu Health Centre, Malawi in May to June 2019. Data were collected using a structured questionnaire (face to face interviews). A Statistical Package for Social Sciences (SPSS) version 23.0, bivariate and multivariate logistic regression was used for data analysis. A total of 323 participants were recruited in the study. The overall ART adherence rate among the breastfeeding mothers under option B+ strategy was 55.1%. The study showed that, forgetfulness [AOR 0.08; 95% CI :( 0.44, 0.14)], religious beliefs [AOR 0.49; 95% CI : (0.𝟤4, 1.0)], accessibility to ART clinic [AOR 2.53; 95% CI :( 1.13, 5.68)] and ART appointment dates [AOR 4.73; 95% CI :( 1.50, 14.98)], were significantly associated with ART adherence under patient related factors and health care system related factors respectively. The study showed that forgetfulness was the most significant variable which had the greatest effect on ART adherence rate. Therefore, efforts to improve ART adherence rate should focus on promoting strategies for reminders such as cell phones, alarm clocks and family members and other factors which showed significant association in ART adherence.
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