Theses & Dissertations

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    Open Access
    Hypertension service delivery capacity assessment in Malawi: Results from Malawi longitudinal study of families and health in Balaka, Machinga, Mchinji and Rumphi health care facilities
    (Kamuzu University of Health Sciences, 2020-12-31) Mbulaje, Lucia Davie Ambajilyn
    Management of hypertension has challenges due to different factors. These include unavailability of drugs, poor infrastructure, inexperienced personnel, insufficient diagnostic tools, and high treatment costs. Malawi adopted a Package for Essential Non-communicable (PEN) and was incorporated in Malawi Standard Treatment Guidelines (MSTG) for the management of various diseases including hypertension in 2015. Since the inception of the MSTG, the service delivery capacity for hypertension care in some health care facilities has not been well researched. We conducted this cross-sectional study to assess health service capacity to deliver comprehensive hypertension care. Data were extracted from the parent study of Health Care Facility questionnaire of the Malawi Longitudinal Study of Families Health. Descriptive statistics were analyzed using Stata version 14. Of the facilities managers’ qualifications, 53.6% or they were Medical Assistants and 45.8% of them had 2 years of post-secondary education. Most of the managers 82.1% did not have in-service training or update on topics specific to the diagnosis and/or management of hypertension. In 57.1% of the facilities, copies of protocols and guidelines for the or management of hypertension were not available. Aspirin was the most available drug (89.3%) and Calcium Channel Blockers were not available in 69.7% of the health care facilities. We have found gaps in health facilities capacity to deliver comprehensive hypertension care. Future interventions should aim in targeting the highlighted gaps to improve capacity.
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    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.
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    Exploring HIV services needs of people at Lilongwe Central Market, Malawi
    (Kamuzu University of Health Sciences, 2020-12-01) Jere, James H.C.
    Reaching all people with HIV services, including those in the informal economy, is critical to meeting the UNAIDS goals of 95-95-95. However, people who sell in the market, prioritise their business over attendance at health facilities, inevitably limiting the services they can access if these services are not in their place of business. An exploratory qualitative study design was used to explore market traders' preferences for the type and delivery methods of HIV services at Lilongwe Central Market, Malawi. We conducted four Key informant interviews (KIIs), three with officers responsible for planning HIV services at both the District and Council levels, and one with a market chairman. Sixteen In-depth interviews (IDIs) were conducted with traders in different businesses at Lilongwe Central market. All interviews were face-to-face and were audio-recorded and later transcribed. Data were analysed thematically and was guided by the Differentiated Services Delivery framework. HIV services preferred by market traders include HIV testing, Antiretroviral Therapy, HIV awareness campaigns, and Condom’s dispensation. These services could be offered when the market is less crowded via a temporary shelter or mobile vans. Service providers can be both trained peers and health professionals depending on the service. To mitigate the stigma associated with HIV-specific services these HIV services should be offered in an integrated care setting. Therefore, to accelerate the achievement of UNAIDS 95-95-95 goals by 2030, HIV services should be available to all those who require them at times and locations that are convenient for them, through providers they have chosen and provided in an integrated manner to mitigate stigma. This necessitates the development of new approaches to closing gaps and the inclusion of under-served groups, such as traders, in markets.
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    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.
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    Evaluating the impact of mandatory folic acid fortification programme on the prevalence of Spina Bifida in Southern Region of Malawi: A central hospital based secondary data study
    (Kamuzu University of Health Sciences, 2020-12-01) Chapweteka, Blessings
    Without evidence, we can not know if a Malawian fortification programme of 2015 has been effective. We conducted the study to evaluate the impact of folic acid fortification programme on the prevalence of spina bifida in the southern region of Malawi. We used a pre post case-control quasi experimental comparative study design. We assessed the total number of births for the southern region, Mw in 2014. Then we reviewed case notes of spina bifida patients who presented to QECH from the southern region, Mw in that year (2014). We did the same for 2018. Spina bifida cases were defined as a documented confirmed case note diagnosis of spina bifida, myelomeningocele or meningocele. The control group comprised of case notes of patients who presented to QECH from the southern region with conditions like sepsis, malaria and diarrhea. To obtain prevalence, we divided the number of cases with the total number of births, expressed per 10,000 live births. The prevalence for 2014 and 2018 were compared to assess the programme’s impact. We performed logistic regression to assess the odds of spina bifida before and after the programme using; gender, birth weight; tribe; maternal age at delivery; number of children by mother; district of residence; pre-natal use of folic acid and use of chronic medications. The before and after odds were compared to assess for accuracy of prevalence. We used Z test to assess the significance of the odds at 95% confidence interval and 0.05 marginal error. SPSS software version 20 was used. The prevalence increased by 13.6% from the pre-fortification to the post-fortification period. Occurrence of spina bifida was statistically associated with female gender (OR 2.51 (1.019-6.198) p= 0.45), absent history of spina bifida (OR 0.191 (0.41-.884) p=0.034), mean birth weight of 2850g, family size 72% ≤3 children and maternal age 77% ≤ 30 years. The study showed that the mandatory folic acfortification programme in Malawi might have not been effective in reducing the prevalence of spina bifida.