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

Extrinsic Motivation to Use mHealth Interventions in Maternal Healthcare in Rural Malawi

mHealth interventions have the potential to address the inequalities in accessing health information. In maternal healthcare, mHealth interventions provide information to pregnant women on how they can stay healthy during pregnancy, as well as on the danger signs in pregnancy that can contribute to maternal mortality. In this study we posit that extrinsic motivation could promote trialability of mHealth interventions. We employed qualitative research methods to investigate extrinsic factors that motivate maternal healthcare clients in rural Malawi to use mHealth interventions. Self-determination theory was used as the theoretical lens for the study. Data was collected using secondary data sources and semi-structured interviews with maternal clients who used the mHealth intervention. The study found that maternal healthcare clients were extrinsically motivated by incentives and the ability of the technology to suppress social-cultural norms. The study informs mHealth implementers on what they may focus on to bring in beneficiaries to try the intervention which eventually could lead to the adoption and use of interventions

Learning from the experience of maternity healthcare workers in Malawi:a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care

BACKGROUND: In Malawi there are too few maternity healthcare workers to enable delivery of high quality care to women. These staff are often overworked and have low job satisfaction. Skilled maternity healthcare workers are essential to improve outcomes for mothers and babies. This study focuses on understanding the working life experience of maternity staff at district hospitals in Malawi with the aim of developing relevant low-cost solutions to improve working life.METHODS: A qualitative study using semi-structured interviews was undertaken in three district hospitals around Malawi's Capital city. Thirty-one staff formed a convenience sample, purposively selected to cover each cadre. Interviews were recorded, transcribed and then analysed using Interpretative Phenomenological Analysis complemented by Template Analysis to elicit the experience of maternity staff.RESULTS: Staff describe a system where respect, praise and support is lacking. Many want to develop their skills, however, there are barriers to advancement. Despite this, staff are motivated; they are passionate, committed professionals who endeavor to treat patients well, despite having few resources. Their 'superdiverse' background and experience helps them build resilience and strive to provide 'total care'.CONCLUSIONS: Improving working lives can improve the care women receive. However, this requires appropriate health policy and investment of resources. There are some inter-relational aspects that can be improved with little cost, which form the ten recommendations of this paper. These improvements in working life center around individual staff (respecting each other, appreciating each other, being available when needed, performing systematic clinical assessments and communicating clearly), leadership (supportive supervision and leading by example) and the system (transparent training selection, training being need driven, clinical skills being considered in rotation of staff). To improve working lives in this way will require commitment to change throughout the health system. Thus, it could help address preventable maternal and newborn deaths.</p

Effective coverage of primary care services in eight high-mortality countries

Introduction: Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods: We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results: Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion: Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage

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

ABSTRACT Cervical cancer is a curable disease if diagnosed early. However, many women in Malawi seek treatment when the disease has reached an 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&apos; 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 of the signs and symptoms of cervical cancer and the merits of seeking early diagnosis and treatment

Working lives of maternity healthcare workers in Malawi: an ethnography to identify ways to improve care

BACKGROUND Maternal mortality in East Africa is high with a maternal mortality rate of 428 per 100,000 live births. Malawi, whilst comparing favourably to East Africa as a whole, continues to have a high maternal mortality rate (349 per 100,000 live births) despite it being reduced by 53% since 2000. To make further improvements in maternal healthcare, initiatives must be carefully targeted and evaluated to achieve maximum influence. The Malawian Government is committed to improving maternal health; however, to achieve this goal, the quality of care must be high. Furthermore, such a goal requires enough staff with appropriate training. There are not enough midwives in Malawi; therefore, focusing on staff working lives has the potential to improve care and retain staff within the system. OBJECTIVE This study aimed to identify ways in which working lives of maternity healthcare workers could be enhanced to improve clinical care. STUDY DESIGN We conducted a 1-year ethnographic study of 3 district-level hospitals in Malawi. Data were collected through observations and discussions with staff and analyzed iteratively. The ethnography focused on the interrelationships among staff as these relationships seemed most important to working lives. The field jottings were transcribed into electronic documents and analyzed using NVivo. The findings were discussed and developed with the research team, participants, and other researchers and healthcare workers in Malawi. To understand the data, we developed a conceptual model, “the social order of the hospital,” using Bourdieu's work on political sociology. The social order was composed of the social structure of the hospital (hierarchy), rules of the hospital (how staff in different staff groups behaved), and precedent (following the example of those before them). RESULTS We used the social order to consider the different core areas that emerged from the data: processes, clinical care, relationships, and context. The Malawian system is underresourced with staff unable to provide high-quality care because of the lack of infrastructure and equipment. However, some processes hinder them on national and local level, for example staff rotations and poorly managed processes for labeling drugs. The staff are aware of the clinical care they should provide; however, they sometimes do not provide such care because they are working with the predefined system and they do not want to disrupt it. Within all of this, there are hierarchical relationships and a desire to move to the next level of the system to ensure a better life with more benefits and less direct clinical work. These elements interact to keep care at its most basic as disruption to the “usual” way of doing things is challenging and creates more work. CONCLUSION To improve the working lives of the Malawian maternity staff, it is necessary to focus on improving the working culture, relationships, and environment. This may help the next generation of Malawian maternity staff to be happier at work and to better provide respectful, comprehensive, high-quality care to women

Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys.

OBJECTIVE: Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care. METHODS: We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random-intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider- and facility-level and subnational divisions). RESULTS: Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in higher-volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi. CONCLUSIONS: Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilities - along with promotion of respectful care in these facilities - should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns