Factors that contribute to delay in seeking cervical cancer diagnosis and treatment among women in Malawi

Cervical cancer is a curable disease if diagnosed early. However, many women in Malawi seek treatment when the disease has reached inoperable stage. This study was conducted to explore factors that contribute to delay in seeking early diagnosis and treatment of cervical cancer among women in Malawi. The study was exploratory and utilized qualitative data collection and analysis method. In-depth interviews were conducted using a semi-structured interview guide on a purposive sample of 24 women who were diagnosed of cervical cancer at the gynaecological wards of Zomba and Queen Elizabeth Central Hospitals in Malawi between July and September, 2011. Thematic content analysis was used to analyze the qualitative data. Two major themes (individual and health facility) emerged from the participants’ narratives as factors that contributed to their delay in seeking early diagnosis and treatment. The individual factors included;limited knowledge on symptoms and signs and limited financial resources. The health facilities factors included;limited accessibility and unavailability of cancer screening facilities in the health centres. Results show that there is a need to strengthen the screening of cervical cancer among women in the country. In addition, there is a need to create community awareness on the signs and symptoms of cervical cancer and the merits of seeking early diagnosis and treatment.

Experiences of women with the support they received from their birth companions during labour and delivery in Malawi

A study was conducted to describe the experiences of primiparous women with the support they received from their birth companions during labour and delivery in Malawi. The study design was descriptive and utilized qualitative data collection and analysis method on a sample of 20 primiparous women. The women were recruited from the postnatal ward of Bwaila hospital and were interviewed regarding their experiences on the support they received from their birth companions during labour and delivery using an open ended interview guide. Data was manually analyzed using content analysis. Primiparous women described the support they received from their birth companions as useful and beneficial. Birth companions provided advice, physical, emotional and spiritual support to the women during their labour and delivery. In addition, the birth companions were viewed as guardians of the women during labour and delivery. Results however, show that some women were not properly assisted by their companions because both the mothers and companions lacked knowledge on birth companionship. The results further show that birth companions play important roles during the birth and delivery of primiparous women and thereby improving birth outcomes. Therefore, there is a need to train the companions regarding support to a woman during labour and delivery. Primiparous women also need to be trained during antenatal care education so that they properly understand the roles of a birth companion as opposed to those of the midwives.

Birth preparedness and complication readiness among postnatal mothers in Malawi

This study was conducted to assess birth preparedness and complication readiness among postnatal mothers at Khombedza Health Centre in Salima District, Malawi. The study design was descriptive cross sectional and utilized qualitative data collection and analysis method on a random sample of 15 postnatal mothers. A semi structured questionnaire was used to assess birth preparedness and complication readiness among the postnatal mothers during their most recent pregnancy and child birth. The findings indicate that overall, all the mothers had attended antenatal care and were aware of the importance of seeking health facility delivery. The mothers were also conversant with the items to bring with them during labour and delivery. Results further show that the participants had some knowledge of danger signs during postpartum and also for the new born baby but had limited knowledge of danger signs during antenatal, labour and delivery. Although the mothers had planned to deliver at the hospital, they did not save money for transport. There is therefore a need to strengthen antenatal care education on birth preparedness and complication readiness. Such knowledge would assist pregnant mothers to identify danger signs during antenatal, labour and delivery and therefore seek emergency obstetric care on time to minimize maternal and neonatal mortalities.

Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi

This study examined factors that determine utilization of postpartum family planning services at Ntchisi District Hospital in Malawi. The study design was descriptive and utilized quantitative methods of data collection and analysis. A random sample of 383 postpartum women was interviewed using a structured questionnaire. Data were analysed using SPSS version 16.0. Chi-square tests were used to establish relationships between utilization of Post Partum Family Planning services and demographic variables. Knowledge about family planning services was almost universal at 94.3% among the women. About 75% of the women were using the contraceptives within the first year after delivery however they started taking the contraceptives after they had already resumed sex. There was a significant association (P < 0.05) between utilization of post partum family planning services and the following: clarity of family planning information given, level of education, period for resuming sex, husband’s approval of family planning method, counselling on fertility intention, duration of lactation amenorrhoea, maternal age and parity. There is therefore a need to promote these factors to increase uptake of postpartum services.

Attitude of Health Care Providers towards Adolescent Sexual and Reproductive Health Services in Developing Countries: A Systematic Review

The aim of the review was to synthesise the best available evidence regarding attitude of health care providers towards adolescent sexual and reproductive health services in developing countries. The review was conducted following qualitative research method. An online search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), EMBASE and MEDLINE databases was conducted to identify relevant studies for the review. There were nine studies that met the inclusion criteria and these were critically assessed by two independent reviewers using the standardised Joanna Briggs Institute (JBI) critical appraisal forms. Data were extracted using the standardised JBI data extraction forms. A narrative synthesis was done on the findings. Key findings from the review indicate that unprofessional attitude of health care professionals and lack of youth friendly reproductive health services, inhibit adolescents from gaining access to sexual and reproductive health services in developing countries. It is recommended that youth friendly reproductive health services be provided to increase uptake of re-productive health services by adolescents.

Comprehension of Risk Factors of Malaria during Pregnancy among Pregnant Women Attending Antenatal Care in Malawi

A study was conducted to determine the comprehension of pregnant women on malaria risk factors during pregnancy. Comprehension of Malaria risks is important to ensure compliance to prevention methods and treatment by the pregnant women and hence optimizes the pregnancy outcomes. The study was conducted in 2012 at three health facilities, Queen Elizabeth Central Hospital, Ndirande health Centre and St. Joseph Mission Hospital in Malawi. The study design was descriptive and utilized quantitative data collection and analysis methods on a random sample of 316 antenatal mothers. The study targeted antenatal mothers who were aged between 15 and 49 years, in the gestation period of 28 to 36 weeks and able to converse in English or vernacular language. A structured questionnaire was used to collect data which were analyzed using SPSS version 16.0. Most of the participants (79.4%, n = 251) knew the risk factors of malaria during pregnancy but very few (18.4%, n = 58) knew about intermittent prevention treatment despite taking SP as prescribed. The motivation factors for taking SP were husband support and the desire to protect their babies and themselves from Malaria. Although the comprehension of the intermittent prevention treatment among the women was low, the women were motivated to adhere to the treatment when instructed by the healthcare workers due to the desire for good health for themselves and their unborn babies. Husbands were the most significant other that motivated the pregnant women to adhere to treatment. Results show that there is a need for healthcare workers to facilitate comprehension of intermittent prevention treatment among pregnant mothers.

Stigma and Discrimination against People Living with HIV and AIDS in Malawi

A study was conducted to explore stigma and discrimination among people living with HIV and AIDS who were on home based care in the Lilongwe district of Malawi. The study design was descriptive through sectional and utilized qualitative data collection and analysis method. Fifteen people living with HIV and AIDS, aged between 15 and 60 years were purposively sampled from three organizations, which were: Light House, National Association for people living with HIV and AIDS in Malawi and Lilongwe Diocese. Qualitative data were collected using an open ended interview guide during in-depth face to face interviews with the participants. The data were analysed using ATLAS. ti 5.0. Results show that all the participants were facing stigma and discrimination because they were living with HIV and AIDS. Distant relatives were the main source of stigma and discrimination followed by friends and church members. Most participants indicated that they felt they were discriminated because HIV infection is associated with bad behaviours such as prostitution or promiscuity. However some of them complained that they contracted the virus from their married partners and hence they did not deserve to be stigmatized or discriminated against. Results show that there is a need for creation of awareness among community members on the transmission of HIV and the need for home based care for the chronically ill people living with HIV and AIDS.

Midwives’ Adherence to Preoperative Care Guidelines Prior to Emergency Caesarean Section at Bwaila Maternity Hospital in Malawi

A study was conducted to describe midwives’ adherence to preoperative care during emergency caesarian section at Bwaila Maternity Wing in 2012 in Malawi. The study utilized a descriptive prospective and retrospective design. A structured questionnaire was administered to all 28 midwives who were directly involved in the preparation of clients for emergency caesarean section. Clients charts were also reviewed using a standard checklist to determine adherence to preoperative care. Data were analyzed using SPSS version 16.0 and descriptive statistics in the form of frequencies and percentages were computed for the dataset. A midwife was supposed to score at least 80% on each component of preoperative care guidelines to be compliant to the stipulated pre-operation standards. The midwives scored above 80% on only four of the 14 preoperative care guidelines which were;bladder catheterization (100%, n = 14), obtaining informed consent (92.9%, n = 12), administration of IV (96.4%, n = 13) and administration of preoperative antibiotics (82.1%, n = 11). Midwives however scored less than 80% on preoperative procedures that dealt with vital signs (28.6%, n = 4): BP check (28.6%, n = 4);Pulse rate check (25%, n = 3.5);respiration check (25%, n = 3.5) and temperature check (25%, n = 3.5). The midwives scored further below standard on blood specimen collection (78.6%, n = 11). Psychological support to clients was also below standard at 60.7%, n = 8. Other components of psychological support such as surgery information (57.1%, n = 8), allowing clients ask questions (28.6%, n = 4) and answering clients’ questions (25%, n = 3.5) were also scored below standard. Overall the standard of preoperative care was below standard at the facility. Most of the midwives were new graduates, who had never received any in-service training on preoperative care. Therefore in service training it is recommended for the midwives to provide good quality of care.

Associative Factors for Birth Asphyxia at Queen Elizabeth Central Hospital—Malawi

Background: Birth asphyxia is one of the major causes of neonatal deaths worldwide. Queen Elizabeth Central Hospital (QECH) neonatal ward records indicate that 36.5% of neonates admitted in the ward from April to September 2012 had birth asphyxia. This study was conducted to explore associative factors for birth asphyxia at QECH. Methodology: The study design was descriptive cross sectional that employed quantitative methods of data collection and analysis. Data sources were case notes of neonates and their mothers.? Sample size was 87 neonates with birth asphyxia and 87 neonates admitted with conditions other than birth asphyxia as controls. Data were collected from November to December 2013. Statistical Package for Social Science (SPSS) version16.0 was used to analyze data. Results: Findings revealed that there were no maternal associative factors for birth asphyxia, however, foetal distress, prolonged first and second stage of labour were significant associative factors for birth asphyxia. Conclusion: Associative factors for birth asphyxia at QECH are Foetal distress, prolonged first and second stage of labour. These factors can be prevented if quality care is provided to women in labour through close monitoring of foetal heart, appropriate use of the partograph, prompt decision making and early interventions.

Factors Promoting and Hindering Performance of Unit Nurse Managers at Kamuzu and Queen Elizabeth Central Hospitals in Malawi

Unit nurse managers in Malawi experience many challenges in the course of performing their roles. This affects their performance and service delivery including the quality of nursing care to patients. This study was conducted to determine the factors that hindered performance of unit managers in relation to expected quality of nursing services at two referral facilities (Kamuzu and Queen Elizabeth Central hospitals) in Malawi. These two central hospitals have the same structural settings and both offer specialized tertiary health services. A quantitative descriptive design was used to guide the planning and implementation of the study. Purposive sampling was used to select the two major hospitals in Malawi and all available 37 unit nurse managers during the time of the study at the two hospitals participated in the study. Data were collected using semi-structured questionnaires after seeking consent from the participants and were analyzed using SPSS version 16.0. The major roles identified by the unit managers were supervision (75.6%, n = 28) and coordination (70.3%, n = 26). Other roles such as team leader, liaison officer, research allocator, monitor and facilitator were rated by very few participants. Findings of the study showed that performance of unit nurse managers was affected by inadequate material (86.4%, n = 32) and human resources (94.5%, n = 35) and lack of managerial skills (5.4%, n = 2). In addition, the unit managers perceived their role to be stressful (38.9%, n = 14) and challenging (47.2%, n = 17). Therefore, there is a need to provide adequate material and human resources to the wards of the two central hospitals to enable the unit managers perform their duties efficiently.

Experiences of Community Members on Reporting Community Maternal Deaths in Mangochi District of Malawi

The purpose of this study was to explore and describe the experiences of community stakeholders on reporting community maternal deaths to relevant authorities in Mangochi District of Malawi. The study employed qualitative hermeneutic phenomenology approach to data collection, analysis and interpretation. It was conducted in three health zones of Mangochi district which are Monkey-bay, Mangochi boma and Namwera zones. Purposive sampling was used to select major community stakeholders on issues of safe motherhood and these were;Village heads, Health Surveillance Assistants (HSAs), safe motherhood volunteers and members of village health committees (VHCs). A total of eighteen in-depth interviews and three focus group discussions were conducted. Descriptive statistics were computed for the demographic variables and the qualitative data were analysed using modified Colaizzi (1978) method based on Heideggerian and Gademerian philosophy. Findings showed that community maternal deaths were not always reported because there were no records in the district. Most participants lacked knowledge on the process and their role in reporting community maternal deaths despite knowing the importance of reporting such deaths. However, findings indicated a positive perception of participants towards reporting community maternal deaths to authorities. The study recommends that health education be offered to community members and Health Surveillance Assistants regarding reporting maternal deaths to improve the situation.

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi

A study was conducted to determine midwives adherence to guidelines on management of birth asphyxia at Queen Elizabeth Central Hospital in Blantyre district, Malawi. The study design was descriptive cross sectional using quantitative data analysis method on 75 midwives that were working in the maternity unit of the hospital. A structured questionnaire was used to collect data on participant’s demographic characteristics and midwives’ comprehension of birth asphyxia and an observational check list was used to observe midwives’ adherence to WHO resuscitation guidelines. In addition midwives were observed on their adherence to the Integrated Maternal and Neonatal Health guidelines that were developed by the Malawi Ministry of Health. The findings indicate that the midwives had knowledge of birth asphyxia in general. However, there were gaps in their ability to identify warning signs of birth asphyxia through partograph use. In addition the midwives did not adhere to 9 out of the 21 steps of the resuscitation guideline. Generally there was substandard adherence to guidelines on identification of warning signs of birth asphyxia and neonatal resuscitation. On the other hand, the facility did not have adequate resuscitation equipment and supplies. The results are discussed in relation to the importance of adhering to resuscitation guidelines in the management of birth asphyxia for babies that do not breathe at birth. Training of the midwives on partograph use and resuscitation to improve neonatal outcomes is recommended. It is recommended further that the health facility should have adequate resuscitation equipment and supplies.

An Audit of Admissions to Intensive Care Unit at Kamuzu Central Hospital in Malawi

Results are presented of a retrospective audit of admissions to the Intensive Care Unit (ICU) of Kamuzu Central Hospital in Lilongwe, Malawi, which is a tertiary referral facility. The audit was conducted for a period of one year spanning from January to December, 2012. The objectives of the audit were to: describe the profile of admissions and treatment outcomes of the admissions and identify main causes of mortality in ICU of the facility. The admission book and patients’ records were reviewed retrospectively guided by a data extraction form which was specifically designed for this study. The extracted data included age, sex, referring unit, diagnosis, treatment outcome and length of stay. The data were analyzed using STATA version 10.0. A total of 253 patients were admitted to the ICU over the one year period of study. About a third of the patients (33.6% n = 85) were admitted due to postoperative surgery. There were 154 deaths representing an overall mortality of 60.9%. Sepsis was the commonest cause of death and accounted for 39.6%, n = 61 of the deaths. Younger age of less than 40 years and increased patients’ length of stay in the unit were significantly and positively associated with mortality (P < 0.05). The high mortality rates among patients admitted to ICU reflects numerous challenges at various levels of critical care service delivery in the country. There is therefore a need to strengthen critical care services to improve treatment outcomes for patients admitted to ICU of the facility.

Compliance of state registered nurses to nursing standards during practice in tertiary facilities in Malawi

The aim of this study was to describe the quality of practice offered by nurses to patients who underwent surgical incision into the abdomen (post-laparotomy) at tertiary hospitals (Kamuzu, Mzuzu, Queen Elizabeth and Zomba) in Malawi. The study design was descriptively cross sectional and utilized a quantitative data collection and analysis method. All available 48 registered nurses in the surgical ward of four central hospitals and 100 patients that were admitted in the ward during the time of study were recruited. A 3-point scale rating consisting of compliance (C = 1), partial compliance (C 1.0-0.5) and non compliance (C 0.5-0.0) was used to describe the nurse midwives compliance with the process standards of care. Results show that nurses in all the 4 central hospitals partially complied with assessment and planning standards. During assessment, the nurses assessed the physical aspects of care but did not assess the psychological, spiritual and cultural aspects of care. At planning the nurses assigned and delegated tasks based on the knowledge and skills of the provider selected but did not comply with factors related to safety, effectiveness and cost of care. All the facilities fully complied with implementation standard because they implemented care in a safe and appropriate manner and communicated with patients/ significant others and other health care providers. However, regarding systematic and ongoing evaluation of patients’ condition only Mzuzu Central hospital partially complied while the rest of the facilities were not compliant. All the facilities did not comply with documentation standard of care because the patient records were not legible and did not precisely depict comprehensiveness of care nor bore signatures of the implementers of the care. Results are discussed by relating the level of compliance to standards and the quality of patient care.

Factors That Influence Anti-Retroviral Therapy Adherence among Women in Lilongwe Urban Health Centres, Malawi

Introduction: Sub-SaharanAfricaremains most severely affected, with nearly1 inevery 20 adults (4.9%) living with HIV and this is accounting for 69% of the people worldwide. Although the regional prevalence of HIV infection is nearly 25 times higher in sub-Saharan Africa than in Asia, almost 5 million people are living with HIV in South, South-East and East Asia combined. Purpose: The purpose of this study was to find out the factors that influence anti-retroviral therapy adherence among women in Lilongwe Urban,Malawi. Methods: a descriptive cross-sectional design was used to study multi sites using quantitative methods. The sites were ART clinics at Area 18 health centre, and Area 25 health centre. A questionnaire was used to a convenient sample of 118 HIV positive women. Quantitative data from close-ended questions were coded and analyzed using the Statistical Package for Social Science (SPSS), version 16. Logistic regression model was used to execute the potential covariates. Findings: ART adherence among women is influenced by knowledge levels on: perceived importance and consequences for not adhering to ART;Short waiting time;good relationships with the next of kin and service providers;trust and effective coping mechanisms to stressful events. Source of information was highly associated with adherence in the logistic regression OR ≤ 2.89;CI (1.66 ± 5.38);p (0.039). Moreover, Short waiting time of the women at the hospital during the ARV refill period is highly associated with ART adherence level OR ≤ 4.11;CI (2.05 ± 6.12);p (0.021). On the other hand, factors that contribute to non-adherence are reduced knowledge level p0.002;Side effects of ART;bad relationships with service providers and relationship with the next of kin as well as occupation of the clients (women). Conclusion: Despite stressful events to HIV positive living women, this study revealed that the majority of these participants would continue taking ART if the factors are very minimal. Encouraging the women who stop taking ART particularly in urban health centres due to such factors like religious beliefs that God is superior and will heal them would influence the ART survival rate in Malawi.