Factors Influencing Women's Choice of Place of Delivery in Rural Malawi -An Explorative Study

This explorative study was conducted in the Mangochi area in Malawi with the aim of investigating the individual, community and health facility level factors influencing women's choice of place of delivery. In depth interviews and non-participating observation were the methods used. Three major issues were revealed. First, sub optimal quality of care including communication, attitudes and cooperation within the health care system was identified as a main factor. Secondly, cultural aspects such as influence from decision makers, perceptions of danger signs and traditional views on pregnancy and delivery were important. Finally, an unsatisfactory availability to skilled delivery care in terms of distance, transport and costs was shown. We conclude that the barriers to use of professional obstetric care in Malawi partly can be attributed to the health care system itself, and that a more individualized maternity care is needed. African Journal of Reproductive Health Vol. 10 (2) 2006: pp. 66-7

Process evaluation of HIV prevention peer groups in Malawi: a look inside the black box

This paper reports the process evaluation of a peer group intervention for human immunodeficiency virus (HIV) prevention which had positive outcomes for three target groups in Malawi: rural adults, adolescents and urban hospital workers. The six-session intervention was delivered to small groups of 10–12 participants by 85 trained volunteer peer leaders working in pairs. A descriptive, observational mixed methods design was used with a convenience sample of 294 intervention sessions. Using project records and a conceptually based observation guide, we examined five aspects of the implementation process. The context was favorable, but privacy to discuss sensitive issues was a concern for some groups. In study communities, program reach was 58% of rural adults, 70% of adolescents and nearly all hospital workers. Session records confirmed that all peer groups received the intended six sessions (dose delivered). The dose received was high, as evidenced by high participant engagement in peer group activities. Peer leaders were rated above the median for three indicators of peer group content and process fidelity: session management skills, interpersonal facilitation skills and whether more like a peer group than classroom. Documenting that this HIV prevention peer group intervention was delivered as intended by trained peer volunteers supports widespread dissemination of the intervention