Thesis & Dissertations

Permanent URI for this collection

http://41.70.64.5:4000/handle/20.500.12845/14

Browse

Recent Submissions

Now showing 1 - 5 of 15
  • Thumbnail Image
    Item
    Open Access
    Understanding factors that moderate the relationship between family poverty and depression among adolescents aged 10 to 16 years in rural districts of Balaka, Mchinji and Rumphi.
    (2022-03-01) Munthali, Denis, Edmond
    Adolescence is a critical stage in human development where physical, cognitive, and psychosocial growth takes place. Poverty is linked to adolescent depression. In Malawi, it is estimated that depression affects 16.9% of adolescents aged 10 to 16 years old. The objectives of the study were to assess the relationship between wealth index status and depression among adolescents and determine if this relationship is moderated by Adverse Childhood Experiences (ACEs) in the districts of Rumphi, Balaka and Mchinji. This study used cross-sectional secondary data collected in 2017 by Malawi Longitudinal Study of Families and Health-ACE (MLFSH-ACE). Logistic regression model was used to assess the relationship between wealth status and depression among adolescents. Odds ratios were generated to measure the association between wealth status and depression. ACEs factors were added to the model to test for moderation. The mean age in years was 13.2(±1.70) and 51% of the sample was female, 49% Male. School attendance among adolescents was at 91%. Adolescents from high wealth index households had lower odds of depression compared with adolescents from low wealth index households (aOR= 0.73, 95% CI: 0.56-0.95). Adolescents from a lower wealth index households have high odds of depression compared to adolescents from low wealth index households. In Developing countries, wealth index data can be used in identifying high risk households for adolescent’s depression and formulate appropriate interventions.
  • Thumbnail Image
    Item
    Open Access
    Spectrum of intestinal pathogens and their clinical presentation in HIV-positive patients with diarrhoea at Queen Elizabeth Central Hospital adult medical wards
    (2022-03-01) Nachipo, Patrick
    Diarrhoea is one of the most common conditions in people living with HIV (PLWHIV) in Malawi. However, there is limited data on the aetiology of diarrhoea and the specific clinical presentations in this population and setting. The aim of this study was to identify pathogens associated with diarrhoea in PLWHIV. Specifically, the study wanted to determine the prevalence of cryptosporidiosis and other enteric pathogens and to describe their clinical presentations This was a cross-section observational study at the Queen Elizabeth Central Hospital (QECH), a referral hospital in Blantyre, nested within a Phase 2A clinical trial of treatment of cryptosporidiosis in PLWHIV. Identification of the infectious agents in stool was done by Gastrointestinal (GI) TaqMan Array testing. We performed descriptive analyses on the prevalence of specific intestinal pathogens in PLWHIV presenting with diarrhoea comparing those with and without cryptosporidiosis. We also described the clinical presentations associated with the pathogens. We recruited 20 adults with diarrhoea caused by cryptosporidiosis and 10 controls without diarrhoea and cryptosporidiosis. The median CD4+ T-lymphocyte count was 21 cells/microlitre for the cases and 419 cells/microlitre for the controls (p<0001). The most common pathogens isolated among the cases were enteroaggregative Escherichia coli (EAEC)-65% (95% CI 40.78 to 84.6%), enterotoxigenic Escherichia coli (ETEC) (60%), Shigella spp. (60%) and Encephalitozoon bieneusi (40%). Among the controls, the most common pathogens isolated were Blastocystis in 87.5% (95% CI 47.35% to 99.68%), Shigella spp. in 75% (95% CI 34.91% to 96.81%), enteropathogenic Escherichia coli (EPEC) in 50 % (95% CI 15.70% to 84.30%) and ETEC in 50%. There was statistically significant difference in the prevalence of Blastocystis, being more common in the controls than the cases (87.5% and 30% respectively, p=0.0107). There was no statistically significant difference in the median number of pathogens isolated from one individual between the cases and the controls, 6.5 pathogens/person among the cases and 3.5 pathogens/person among the controls (p=0.2714). The most common clinical features identified were anorexia, nausea, abdominal pain and vomiting. 95% of the cases had used antibiotics prior to admission (95% CI 50.90 to 91.34). Our study showed that PLWHIV and diarrhoea with cryptosporidium, have low CD4 counts. They also have other enteric pathogens including EAEC, EPEC, ETEC, Shigella spp., E. bienuesi and Giardia. It also showed that Blastocystis is a common pathogen in HIV reactive patients, with and without diarrhoea. Anorexia, nausea, abdominal pain and vomiting were the common accompanying symptoms in patients with chronic diarrhoea. We also found that the use of antibiotics in chronic diarrhoea was prevalent.
  • Thumbnail Image
    Item
    Restricted
    Assessment of health worker’s knowledge and utilization of partograph to diagnose fetal distress during labor at Bwaila Hospital, in Lilongwe Malawi
    (2022-03-01) Chiwala, Luke
    World Health Organization recommended the partograph in management of women during labor to improve maternal and neonatal outcomes. Despite gains made in reducing maternal health, neonatal deaths from complications of labor and delivery persists. Quality of care and the use of the partograph in labor can help to avert deaths from labor complications. The way health workers use that partograph to diagnose fetal distress during labor needs to be investigated. This facility based cross-sectional study was conducted at Bwaila hospital using both qualitative and quantitative methods. A total of 911 partographs of births at Bwaila for the month of April and May 2020 were reviewed. Fifteen (15) midwives in the maternity ward were interviewed. Descriptive statistics and logistic regression were used to analyze quantitative data. Thematic analysis was applied to analyze data from in-depth interviews. Midwives had good knowledge about the partograph. Utilization of partographs and diagnosis of fetal distress was poor. Meconium-stained liquor (AOR=2.33; 95% CI =1.51-3.59, p<0.001), vacuum extraction (AOR=4.64; 95% CI= 1.61-13.58, p=0.004), Crossing alert line (AOR=1.70; 95% CI =1.09-2.66, p=0.020)., Male sex (AOR=1.75; 95% CI=1.17-2.62, p=0.006) and Birth Weight (AOR= 0.9992234; 95% CI= 0.9988441 - 0.9995922, p <0.001) were factors associated with birth asphyxia. Improving staffing levels, consistent supportive supervision, availability of equipment and supplies, in-service trainings on labor management and partograph, introduction of incentives, improving inter-professional collaboration, are necessary to improve quality. Partograph needs to be reviewed and modified to meet context needs. Electronic fetal monitoring should be used in busy setting.
  • Thumbnail Image
    Item
    Open Access
    Psychosocial care for road traffic injury patients: An exploration of service provision to patients attending Orthopaedic Clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi.
    (2022-03-01) Grace, Chigalu, Chingwalu
    Every year the lives of approximately 1.35 million people globally, are cut short as a result of a road traffic crash. Road traffic accidents are responsible for different types of injuries and disabilities which affect the individual’s quality of life as they may suffer limitations in physical, social and mental well- being. However, the nursing practice at QECH does not focus much on psychosocial wellbeing of patients. This study therefore, explored the provision of psychosocial services to patients with road traffic injuries attending Orthopaedic clinic at Queen Elizabeth Central Hospital in Blantyre, Malawi. Literature shows that psychosocial care in patients with orthopaedic injuries is important as it involves collaboration between health care professionals as well as multidisciplinary care. This was a qualitative study employing a phenomenological design which focused on nurses, caregivers and patients. A purposively selected sample of 20 adult patients, who were attending adult orthopaedic clinic at QECH were interviewed. The sample was selected from orthopaedic patients attending clinic at QECH. Data analysis was done manually by following principles of thematic content analysis. Psychosocial issues are not recognized and nurses focus their care on Bio-physiological issues. Over 75% of the participants felt that delay to go to theatre lengthened their stay in hospital which further affected the patients psychosocially since their financial resources became depleted more and more. Holistic approach to patients’ care is necessary to provide psychosocial care to orthopaedic trauma patients. There should be development of standardized guidelines which will include psychosocial care in dealing with orthopaedic trauma patients.
  • Thumbnail Image
    Item
    Open Access
    Perceptions of HIV positive women on integrated health service delivery’s efficiency: A review of public health facilities of Lilongwe district, Malawi
    (2019-05-15) Chauya, Ivy Violet
    The study reviews perceptions of HIV positive women on Integrated Health Service Delivery (IHSD) efficiency focusing on HIV integration with other health services. HIV/AIDS has proved to be a global health concern impacting more on poor countries and vulnerable populations like women and children. The study aimed at exploring perceptions of HIV positive women aged 18 and above on IHSD’s efficiency in public health facilities of Lilongwe district, Malawi. Specifically describing the nature of IHSD, examining their knowledge and perceptions of IHSD. This study used a cross-sectional qualitative in-depth study design where 18 HIV positive clients and 6 KIs from 6 health facilities were purposively sampled: 2 from rural, 2 urban and other 2 from peri urban. Three clients and 1 KI were interviewed in each health facility. Data collected was analyzed using themes. Codes were developed bearing in mind the purpose of the study. The researcher identified the themes by isolating data that was significant and interesting in relation to the study objectives. The results focused on whether IHSD is effectively and efficiently being implemented, focusing on the 4 conceptual models of PATH that include patient centeredness, health operations, the health system as well as inter-sectoral initiatives. It was revealed that the public health facilities of Malawi are not fully implementing effective and efficient IHSD as perception of clients in the 4 conceptual models proved inadequate to deliver quality IHSD. The challenges of inadequate resources i.e. trained staff, equipment, drugs, poor infrastructure forcing the health workers to refer clients to other departments/health facilities to access a service does not please most clients as it entails a waste of time and money. HIV positive women also perceive IHSD as a good and helpful service, however, they expressed dissatisfaction with delays in the delivery services due to late commencement of work and continuous referrals done for them to access a service. This is also attributed to inadequate resources as few health workers fail to adequately support the increased number of clients. There is need for government to provide effective governance to mobilize resources and improve on resource availability, enforce laws that protect the scarce resources and strengthen collaborations within and between sectors to ensure effective and efficient implementation of IHSD in the public health facilities of Malawi