Labour and birth information needs of first time mothers in Malawi and satisfaction with information received

Giving labour and birth information to first time mothers is one of the challenges facing the midwives in Malawi. There are many underlying health and soeioeconomic problems facing the people of Malawi particularly mothers in the child bearing age because of inadequate human and material resources in the health sector. This thesis presents findings of a study carried out in Malawi to explore labour and birth information given to first time mothers at hospitals and in the communities. Maternal satisfaction with the information received was determined. In addition labour and birth information needs of first time mothers in Malawi were determined from the mother\u27s perspective. A descriptive-correctional design was used in this study. One hundred and fifty first time mothers who had given birth to a live full term infant within 8 weeks of the postpartum period participated in the study. The findings of the quantitative results were analysed using SPSS for Windows. Responses to open ended questions were analysed using content analysis. The findings indicated that first time mothers believe that they are not given adequate labour and birth information in the hospital settings. The findings also indicated that labour and birth information given in the community is culturally based and mainly comprises cultural beliefs and taboos of childbirth. First time mothers in Malawi also expressed satisfaction with some of the information given during pregnancy, labour and birth but were not satisfied overall with the amount of information they received in preparing them for childbirth. The findings of the study have implications for improving how and what labour and birth information is given to first time mothers in Malawi. Recommendations are presented for nurse/midwifery practice, education, management and research

The development and evaluation of a childbirth education program for Malawian women

Childbirth education provided to women is an Integral aspect of the childbirth experience. In Malawi, midwives face a major challenge because one of their major roles is to provide childbirth information to women. However, there are no existing Childbirth Education Programs to facilitate this process. The purpose of this study was, therefore, threefold. First, it explored childbirth Information needs of Malawian mothers from the perspectives of both mothers and midwives, as well as strategies that would be appropriate to disseminate this childbirth information to Malawian women. Second, it developed a Childbirth Educational Program (CEP) to meet the specific needs of Malawian women as previously identified. Third, the CEP was implemented and evaluated for it’s effectiveness in increasing Malawian women’s knowledge of childbirth. The study was conducted in three phases. In Phase One, childbirth information needs of Malawian women were determined using findings from previous studies, focus groups and individual interviews of Malawian midwives. In Phase Two, data obtained from Phase One was used to develop a CEP as well as pretest/posttest questionnaire. In Phase Three, a quasi-experimental study using sequential sampling was conducted to implement and evaluate the CEP. Participants Included pregnant women who attended antenatal clinics at the Ndirande and Limbe Health Centres in Blantyre (Malawi). Following informed consent, 125 women from the Ndirande Health Centre were Invited to participate in the study and recruited to a control group. Another 125 women were also recruited to an intervention group at Limbe Health centre. A pretest was administered to both groups of women to determine their childbirth knowledge prior to implementation of the study. Women In the control group were exposed to routine antenatal education from both hospital and traditional non-hospital sources. Therefore, an increase in childbirth knowledge was anticipated. Additionally, women in the intervention group were exposed to both routine antenatal education as well as a systematic and comprehensive CEP. It was anticipated the degree to which knowledge increased in this group would be higher than in the control group, thus demonstrating the effectiveness of the CEP

Early Paleogene planktic foraminifera in thin-sections : an experiment on isolated specimens from the Fore-Magura Thrust Sheet (Polish Outer Carpathians)

This paper describes results of an experiment aimed mainly at obtaining random thin-sections of isolated specimens of planktic foraminifera determined to a species level. Twenty species of uppermost Paleocene-Middle Eocene planktic foraminifera from pelagic variegated marls of the Fore-Magura Thrust Sheet have been chosen for this experiment. These planktic foraminifera belong to the genera Chiloguembelina, Turborotalia, Acarinina, Morozovella, Muricoglobigerina, Subbotina and Parasubbotina. Their SEM images, stereomicroscope photos of isolated specimens, and the experimental thin-sections along with their systematics and stratigraphic ranges are presented

Evidence on Populations and Programs to Support Contraceptive Service Design, with special reference to Adolescents in Sub Saharan Africa : Tsogolo Langa Desk review

The government of Malawi has committed to improving the Sexual and Reproductive Health Rights and Family Planning (SRHR/FP) across the country, including for adolescents. However, challenges to contraceptive uptake and access to FP services prevail. To address the modest fall in age-specific fertility seen among adolescents in Malawi in recent years with its related adverse social and health consequences, all available relevant evidence that could inform programming is needed. This desk review focused on two main objectives with a specific focus on adolescents: 1. Evidence on factors that underlie reproductive health decision making and specifically contraceptive use amongst adolescents including vulnerable sub-groups such as young people with disabilities in Sub Saharan Africa 2. Review of scientific papers and programme reports that contain analytical findings about contraceptive service delivery An electronic search was undertaken using a formal search strategy. Working papers and reports that may contain relevant studies from Tsogolo Langa partners were also sought. In response to objective 1, the literature review identified 388 potentially related sources of which 29 were found to be informative. The review identified evidence falling into three key thematic areas: cultural belief systems including prevalent gender norms, lack of confidentiality and shame, and influencers of contraceptive use. To address the second objective, 2,341 potential sources were identified from the search. An initial review of titles and abstracts resulted in 241 sources retained, and of these 38 were reviewed in detail. Main findings • There are a number of powerful disincentives for adolescents in Malawi to access and use contraceptives, including cultural beliefs that prevail about fertility, masculinity and misconceptions about fertility linked to contraceptive use, alongside issues related to confidentiality and shame regarding accessing services. These are compounded by influencers, including parents, partners and peers, and traditional initiation practices. Furthermore, providers’ unwillingness to provide contraceptive services to unmarried adolescents also hinder the contraceptive uptake by this age-group. As such, the Malawian context for adolescents accessing SRHR/FP demands further research. • In terms of effective platforms from which to engage adolescents, there were a number of key findings to consider. A lesson from peer education and schoolbased intervention studies is that only modest impact can be expected when educational strategies do not include access to services. Post abortion care is an important setting for providing contraception to adolescents. In addition, according to published evidence, in Malawi the use of Health Surveillance Assistants to drive community-based provision may not be an ideal approach. • Through the desk review, specific knowledge gaps were identified and should be considered for examination. - The SRHR/FP experience of adolescents living with disabilities and those of boys and young men; interventions targeting adolescents with disabilities. - Lower use of emergency contraception (EC) in Malawi than other countries resulting in preventable unintended pregnancy. - Concentration of information about EC pertains to urban/educated adolescents with little to no information on rural populations. - As national policy for Pre Exposure Prophylaxis for HIV prevention (PrEP) extends to AGYW, strategies for integration with other SRHR/FP services is a key priority. Conclusion To drive effective evidence based SRH programming that addresses the needs of adolescents (male and female), exploration of their wider needs for health services, including optimal access points and the mix of services is needed. Social networks need to be explored as channels for accessing information about services and spreading correct understanding about non contraceptive benefits of method use, to dispel misconceptions and myths. A special focus on LARC is needed so that longer acting methods can be made fully accessible to adolescents, in parallel with ready access to EC

Childbirth information feeds for first time Malawian mothers who attended antenatal clinics

Childbirth information received by mothers during antenatal period influences their satisfaction with the care during perinatal period. It is important for the midwives to know the type of information that satisfies their clients. This study found that the childbirth information that mothers received during antenatal period did not satisfy them. On the other hand, although some of the information received at home was useful, some information had potential to cause fear, anxiety and ill health on the mothers. The information needs of the clients were taken into account when designing a childbirth program for Malawi. Aim The specific objective of the study was to identify childbirth information needs of Malawian women as perceived by Malawian mothers and midwives in order to design a childbirth education program. Methods An exploratory, descriptive qualitative design was used to determine Malawian women’s childbirth information needs. A total of 150 first time mothers who attended antenatal clinics at selected central, district and mission hospitals were interviewed.Four focus group discussions were conducted with four different types of midwives to identify their perceptions of the childbirth information needs of Malawian women. These discussions were complimented by individual interviews with experienced midwives who held key positions in government and non governmental health organizations. Results The content of the childbirth education program for pregnant mothers should include; care during pregnancy, danger signs during pregnancy, labor and after birth, the labor process and the postnatal care for the mother and the baby. Regarding cultural beliefs and taboos of childbirth, it was recommended that they should not be presented as a stand alone topic but be incorporated in other topics such as self care. Cultural beliefs and taboos vary with regions and tribes hence rather than generalizing, midwives should address specific issues prevalent in their work areas. The training manual should be translated into the vernacular language in view of the high illiteracy rate in the country. Conclusion The education program should address self-care during pregnancy, nutrition during pregnancy, common discomforts of pregnancy, danger signs of pregnancy, sexually transmitted diseases and preparation for delivery. The program should also address the labor process, possible complications during labor and birth, caesarean birth and non pharmaceutical pain relief measures in labor. It was also evident that the program should deal with self-care during postnatal period, exclusive breast feeding, care of the newborn baby, danger signs of puerperium, care of the newborn baby and family planning

Manufacture and properties of fluoride cement

This research work aimed at characterising composition, hydration and physical properties of fluoride cement, by studying samples of the cement obtained from Malawi, and comparing them to ordinary Portland cement. By confirming the suitable characteristics of fluoride cement through this work, the results of the research work provide a good basis for the wider adoption of fluoride cement as an alternative to ordinary Portland cement, especially in developing economies. Numerous accounts have been cited regarding the production and use of fluoride cement. Since there have not been conclusive agreement as to its properties, this study was limited to the theories of successful incorporation of fluoride compounds in the manufacture of fluoride cement. Hence, the properties and characteristics reported in this study relate to the cement currently manufactured in Malawi, and, on a comparative basis only, to that manufactured in other parts of the world. Samples of the fluoride cement used in the study were obtained by synthetic manufacture of the cement using common raw materials for the manufacture of fluoride cement that is limestone, silica sand, and fluorspar. These samples were subjected to several comparative tests used to characterise cements including examination under x-ray diffractometer, scanning electron microscopy and tests for setting time and compressive strength. Under similar laboratory conditions, it was possible to prove that fluoride cement hardens more rapidly than ordinary Portland cement. Also observed during the experimental work is that fluoride cement develops higher compressive strengths than ordinary Portland cement. The hardening and setting times are significantly different between the two cements. Also the nature of the hydration products, that is the microstructural development is significantly different in the two cements. The differences brought about between the two cements are because of the presence of fluorine during the clinkering process. It was observed in the laboratory simulated production of fluoride cement, that the clinkering temperature is much lower (around 1 170 °C) compared to that for the production of ordinary Portland cement. The other observed differences were attributed to the different mineralogical composition as a result of fluoride incorporation into the cement. While fluorine content is very minimal in fluoride cement, not more than 2 %, the resulting cementitious products are altered significantly as was observed from the study. Part of the experimental results has been used as reference material in the preparation of a draft Malawi Standard on fluoride cement. This draft standard will be submitted to the Malawi Bureau of Standards for further processing before it can be officially endorsed as a Malawi Standard

Application of the Lalonde (horizontal-only scar) breast reduction technique for correction of gynaecomastia in dark skinned patients

Surgical correction of gynaecomastia correction sometimes necessitates skin reduction in addition to resection of glandular tissue and liposuction of the fat deposits. Many skin reduction techniques have been described but all suffer from very noticeable and often poor scars that can manifest as hypertrophic or keloid scars in patients with dark skin. Three large gynaecomastia patients undergoing a modification of the Lalonde “no vertical scar” breast reduction technique designed to reduce the extent of scarring were reviewed. The Lalonde “no vertical scar” technique was successfully applied to three patients of African extraction with acceptable postoperative scarring. A description of the technique and the cosmetic results are presented. The Lalonde technique of female breast reduction can be applied to the treatment of male breast enlargement in patients at high risk of scar complications. It provides an alternative to the more widely used concentric skin reduction techniques. To our knowledge, this is the first report in literature of the application of the Lalonde “no vertical scar” surgical technique to the treatment of gynaecomastia in patients with darkly pigmented skin

Cretaceous (Aptian/Albian-?Cenomanian) age of "black flysch" and adjacent deposits of the Grajcarek thrust-sheets in the Małe Pieniny Mts. (Pieniny Klippen Belt, Polish Outer Carpathians)

Several sections record the relation between the "black flysch" and Upper Cretaceous red shales in the Grajcarek thrust-sheets. In all the sections studied the "black flysch" appears in the core of imbricated folds or thrust-sheets, whereas the limbs are composed of Upper Cretaceous deposits. The transitional beds between the "black flysch" and the Upper Cretaceous red shales are composed of green and black bituminous shales, green and red radiolarites and cherty limestones. Biostratigraphical investigations have revealed a similar type and sequence of microfauna assemblages in all the sections studied and significant redeposition of Jurassic calcareous benthic foraminifera, calcareous nannoplankton, molluscs, sponge spicules and crinoid elements. The Cretaceous age (Aptian/Albian-Cenomanian) of the "black flysch" is shown by the presence of agglutinated foraminifera and microfacies data. These deposits are underlain by a Kimmeridgian-Aptian radiolarite/limestone condensed succession and overlain by Turonian-Campanian hemipelagic red shales and Maastrichtian/Lower Paleocene conglomerates and thick-bedded silicilastic turbidites of the Jarmuta Formation. Such a sequence of deposits is typical of the Outer Carpathian basins and records the global Mid/Late Cretaceous phenomena in the world ocean, followed by the Cretaceous Oceanic Red Beds