Utilization of the Teaching Strategies among Nurse Tutors in Malawi Nursing Colleges

Background: There are numerous teaching strategies that suit the pedagogical learning, but not all can yield the desired outcome and be properly applied by nurse tutors in both classroom and clinical area. Therefore, identifying the utilization of the teaching strategy for nurse tutors is very detrimental in nursing education. Methods: Descriptive exploratory design which utilized both qualitative and sequential quantitative methods was applied to Iterated Purposive Probability Sampling (IPPS) of 10 nursing colleges in Malawi. This was done to 129 student and 82 nurse tutors in two structured questionnaires, 40 in-depth interviews and 10 focus groups. There were 56 variables for the teaching strategy under five ranked Likert scale and the Cronbach’s Alpha was found to be 0.964 without standardisation and it was 0.963 after standardisation. Results: Direct teaching strategies like the lecture method are very common although nurse tutors prefer to combine with other interactive instructions. There is statistical association of use of role play and group discussion methods and nurse tutor work experience with odds ratios of OR ≤ 1.624;CI(0.576 ± 4.579);p ≥ 0.359 and OR ≤ 1.397;CI(0.882 ± 2.306);p ≥ 0.147 respectively. The ability to use different teaching strategies competently is still very limited among nurse tutors in Malawi nursing colleges. This compromises quality of learning among nursing students in the colleges. Conclusion: Developing a new teaching strategy that could combine the different attributes in the variety of the teaching instructions can promote the quality of nursing education in Malawi.

Where Is the Grade Coming from? Problems and Challenges in Evaluating the Clinical Performance of Nursing Students

Evaluating the clinical performance of nursing students effectively and fairly is a challenge which continues to confront nurse education and there is evidence of both faculty and student concerns. This paper reports part findings of a hermeneutic phenomenological study which explored the clinical learning experience of Malawian undergraduate student nurses. The study took place at a University Nursing College in Malawi, using a purposive sample of thirty student nurse participants. Conversational interviews were conducted to obtain participants’ accounts of their clinical learning experience and a framework developed by modifying Colaizzi’s procedural steps guided the phenomenological analysis. Several issues emerged from this study, but for this paper the assessment issues which the study revealed were discussed. It revealed concerns of unfairness and lack of objectivity during the evaluation of the clinical performance of nursing students. It also revealed that interpersonal relationships significantly influenced the evaluation process. Consequently, nursing students become preoccupied with building relationships with qualified nurses knowing the impact of such relationships on the clinical grade. The findings reveal that students employ various strategies in order to obtain good grades and this illustrates students’ overall preoccupation with “making the grade”. It is argued that the evaluation of the clinical performance of nursing students is a vital component of nursing education and it must be conducted in a manner that enables nurse educators to effectively determine the clinical proficiency of nursing students.

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.

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.

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.

Sources of Stress among Undergraduate Nursing Students during Clinical Practice: A Malawian Perspective

Purpose: The purpose of this study was to explore undergraduate nursing students’ perceptions of their clinical learning experience, and the reported findings emerged from narratives of their experience. Design: This was a hermeneutic phenomenological study which took place at a university nursing college in Malawi. Participants for the study were purposively selected from third- and fourth-year undergraduate nursing students and the data were collected through in-depth interviews. A framework developed by modifying Colaizzi’s procedural steps guided the phenomenological analysis. Findings: The study reveals factors which cause stress among undergraduate nursing students during their clinical practice. The following themes emerged from the study: lecturer/nurse interaction with students: stress associated with patient care and stress associated with objective structured clinical examination (OSCE). The lecturer is perceived to significantly induce stress, and this is common when the student perceives that the lecturer’s interaction is in a “policing” manner. The primary stressors associated with patient care include lack of life-saving medication which sometimes leads to death of a patient, taking care of critically ill patients unsupervised, and fear of contracting infections such as HIV and tuberculosis, and death of a patient. Factors associated with stress during OSCE include use of examiners whom students are not familiar with and the conduct of OSCE in the skills lab which has better resources than the clinical settings where students practice. Conclusions: The study reveals sources of stress during nursing students’ clinical practice and its effects on their learning and motivation. Consistent with existing literature, these findings confirm that nursing students experience considerable levels of stress during clinical practice. Recommendations: The study suggests that nursing education can be quite a stressful experience to the learners. It is therefore essential that nurse educators should address the various sources of stress which the study has revealed to enhance students’ clinical learning and provide the student nurses with the needed care.

A qualitative study of childbirth fear and preparation among primigravid women:The blind spot of antenatal care in Lilongwe,Malawi

Objectives:This study aimed to explore childbirth fear and childbirth preparation among primigravid women in the late pregnancy from 36 to 40 weeks gestation.Methods:We purposively recruited 18 primigravid women into in-depth interviews,21 birth companions,and 13 health workers into focus group discussions.Participants were recruited from two community hospitals'maternity waiting homes in Lilongwe,Malawi.Semi-structured interview guides were used to collect data that were analyzed using content analysis.NVivo11 computer software was used to organize the data.Results:The four categories developed were:"ambivalent pregnancy feelings","dependence on traditional childbirth counseling","inadequate prenatal childbirth instruction"and"inconsistent roles of a birth companion".The findings suggest that primigravid women who were mainly exposed to traditional childbirth mentoring rather than professional care providers,experienced childbirth fear,and lacked proper psychosocial childbirth preparation.Conclusions:Childbirth fear among primigravid women emanate from personal;family;ineffective traditional counseling;and inadequate antenatal childbirth instruction.Birth companions may increase childbirth stress.However,our findings highlight birth companions as readily available psychosocial support resources among primigravid women.We recommend that professional childbirth instruction during antenatal care should be strengthened to surpass traditional childbirth counseling.Appropriateness and effectiveness of birth companions need to be carefully assessed.

Undergraduate Students’ Perceptions of the Role of the Nurse Educator during Clinical Placements in Malawian

In this article we reported selected findings of a hermeneutic phenomenological study which explored the clinical learning experience of undergraduate nursing students in Malawi. The setting for the study was a university nursing college and the sample was selected purposively, consisting of thirty participants. Conversational interviews were conducted and a framework developed by modifying Colaizzi’s procedural steps guided the phenomenological analysis. The study findings reflect students’ perspectives on what the ideal role of a nurse educator in Malawi should entail. Contrary to most of the literature from western countries, the findings strongly indicate the need for nurse educators to teach students during clinical placements by engaging in hands-on-care. Additionally, the study also indicates the need for educators to view their role holistically by focusing on both academic and personal aspects of the students’ life. The study illustrates the need for connected educator-student relationships.

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.

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.

Beliefs and practices of young women on utilization of prevention of mother to child transmission of HIV services in Malawi

This study explored beliefs and actual practices of young women on utilization of Prevention of Mother to Child Transmission (PMTCT) of HIV services in Balaka district of Southern Malawi. The study design wascross sectional which utilized qualitative data collection and analysis methods. In-depth interviews were conducted on 12 young mothers of 15 to 24 years old. The respondents were drawn from 6 health centres in the district during their visits to either the under-five clinic, HIV and AIDS support groups or HIV follow up clinics. Data were analyzed using thematic analysis approach. Overall the respondents had positive beliefs on utilization of PMTCT services. They believed that adherence to PMTCT guidelines such as condom use, taking of Nevirapine (NVP) and exclusive breastfeeding protected the baby from contracting the virus. Nevertheless, all respondents believed that HIV testing was mandatory and that early weaning caused malnutrition and death of babies. Actual practice was very low. Very few young mothers breastfed exclusively, weaned their babies abruptly and took NVP as recommended. Not all positive beliefs translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. Culture was also a major barrier because traditionally babies are expected to be breastfed and supplements are fed to babies too. Therefore, there is a need to mobilize communities on PMTCT of HIV. Education programmes in HIV should emphasize behavior change interventions and should focus on both men and women and significant others. There is also need to intensify monitoring and evaluation of health workers’ activities to ensure that beliefs translate into positive behavior.

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.

Overcoming Barriers to Uptake of Voluntary Medical Male Circumcision in a Traditionally Circumcising Community in Machinga District, Malawi

Introduction: Voluntary medical male circumcision (VMMC) reduces chances of contracting HIV during heterosexual intercourse in males, and risk of cervical cancer in their female sexual partners. However, its uptake among traditionally circumcising communities, where male circumcision carries a cultural significance, has not been studied. Previous research has focused on barriers to uptake of VMMC in non-circumcising communities. This study was conducted to determine socio-cultural barriers to VMMC uptake in order to identify culture-sensitive and evidence-based interventions to increase its uptake. Methodology: This exploratory mixed methods cross-sectional study generated quantitative data from 262 randomly sampled sexually active men;and qualitative data through four focus-group discussions with 58 purposely selected male participants and 10 key informants. Results: The study established that only 6.3% (n = 15) of those circumcised (90.8%, n = 238) were circumcised in clinical setting. Limited access to VMMC services, cost, pain, being attended to by female providers and cultural influences were the major hindrances to uptake of VMMC. Conclusion: Although there is a paradigm shift of preference from traditional male circumcision to VMMC in this community, its uptake is low. The study recommends that besides introducing mobile VMMC services, the Ministry of Health should collaborate with traditional circumcisers and local leaders to provide gender-and-culture-sensitive safer medical male circumcision services.

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.

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.

Nurses’ Knowledge and Attitudes towards Pain Management in Children Admitted in the Paediatric Department of Queen Elizabeth Central Hospital, Blantyre, Malawi

Background: Inadequate pain management is a problem in hospitalized children. Objectives: To explore knowledge and attitudes of nurses in management of pain in children. Methods: A descriptive design using qualitative methods was used to conduct the study. 17 nurses with prior pain management training were interviewed using a semi-structured interview guide. Ethical approval was obtained from College of Medicine Research and Ethics Committee. Data were analysed using thematic content analysis. Results: Nurses had some knowledge of pain assessment methods, treatment and use of morphine. Gaps, however, existed on how to use pain assessment scales, analgesics to use at each step of the WHO analgesic ladder, and how to effectively use morphine for pain relief. Although most nurses had positive attitudes towards children’s pain and use of morphine, negative attitudes were evident in some nurses regarding administration of morphine to neonates or acutely ill children. Conclusion and Implications: The study has revealed knowledge and attitude gaps which may reflect deficiencies in the pain education nurses received, non-availability of pain scales and lack of support for nurses to link theory with practice. Nurse leaders are challenged to provide repeated comprehensive education for nurses on pain assessment and management. Furthermore, user friendly pain scales should be developed, and nurses educated and demonstrated on their use. In addition, opportunities for supportive supervision with nurses in the clinical setting should be created for linkage of theory and practice.

Comparison of Nurses’ and Families’ Perception of Family Needs in Critical Care Unit at Referral Hospitals in Malawi

This study compared needs of family members as perceived by nurses and the family members themselves. The study design was descriptive and utilized quantitative data collection and analysis method. Nurses (n = 62) working in the Intensive Care Units (ICU) and High Dependency Units (HDU) of three tertiary health facilities in Malawi at the time of the study consented to participate in the study. In addition, family members (n = 62) who were looking after a critically sick relative in the ICU and HDU in the same tertiary facilities consented and participated in the study. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory for a period of 7 days. STATA version 10 was used to analyze data. The rank correlation between the mean scores of perceived needs across major need categories of support, comfort, information, proximity and assurance between the nurses and family members was significantly different from zero (r = 0.97, p = 0.005). Nurses and family members, respectively ranked assurance (90% and 92%) as the highest priority need, followed by information (78% and 85%) and comfort (78% and 84%) and then support (70% and 73%) and proximity (66% and 69%). The ranking however between the 2 groups on 16 out of 45 individual needs were significantly different (p < 0.05). Among the nurses, the rankings by registered nurses were significantly higher (p < 0.05) from those of nurse midwife technicians. There were also significant differences (p < 0.05) in the mean scores between the gender of family members with men demanding more “comfort” than females. Results show a need for facility authorities to formulate ICU policies and strategies that ensure provision of friendly services to family members of critically ill patients.

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.

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.

Pregnancy decisions of married women living with HIV during wide access to antiretroviral therapy in southern Malawi

Availability of antiretroviral therapy and prevention of mother to child transmission of HIV programmes have increased childbearing decisions in people living with HIV. However, pregnancy decisions of married women living with HIV have not been adequately reported in Malawi. In order to provide information to inform the development of antiretroviral and family planning services targeted to the unique needs of women living with HIV, this study explored pregnancy decisions of women living with HIV in rural southern Malawi. Twenty in-depth interviews on married women living with HIV selected purposively were conducted in two antiretroviral clinics of patrilineal Chikhwawa and matrilineal Chiradzulu districts in 2010. With their pregnancy and child rearing experiences, the women who got pregnant after a positive HIV diagnosis decided to never get pregnant again. Their lived experiences of motherhood when living with HIV play a major role in their pregnancy decisions despite free access to antiretroviral therapy, which has improved the quality of their life’s and survival. Societies in Malawi must accept this behavioural change by married women living with HIV and their needs for family planning. Health care workers must be knowledgeable and sensitive about it and assist women living with HIV who are willing to adapt their pregnant decisions based on living experiences.