Patients’ satisfaction with reproductive health services at Gogo Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi

Patient satisfaction is an individual’s state of being content with the careprovided in the health system. It is important for reproductive health care providers to get feedback from women regarding satisfaction with reproductive health services. There is a dearth of knowledge about patientsatisfaction in Malawi.AimThe specific objective of the study was to determine the extent to whichwomen are satisfied with the care they receive when they come to deliverat the Queen Elizabeth Central Hospital maternity unit. MethodsA cross sectional study of postpartum women using interviewer administered semi-structured questionnaires was conducted betweenNovember 2008 and May 2009. The questionnaires captured mainly quantitative data.Results1562 women were interviewed. Most women were housewives (79%) whowere referred from Health Centres within the city. Ninety five percent delivered a live baby. The majority of women (97.3%) were satisfied withthe care they received from admission through labour and delivery andthe immediate postpartum period. Most women cited doctors’ and nurses’reviews (65%) as what they liked most about the care they received duringtheir stay in the unit. Most women expected to receive efficient and definitive care. The women’s knowledge on patient’s rights was extremely low (16%) and equally very few women were offered an opportunity to give an opinion regarding their care by the doctors and nurses in the maternity unit.ConclusionMost women who deliver at the hospital are satisfied with the care offered.This satisfaction is mainly due to the frequent reviews of patients by nurses and doctors in the unit. There is a great need to educate both thepopulation of women served and the health workers that serve them onpatient’s rights

Intrapartum Antibiotic Exposure and Early Neonatal, Morbidity, and Mortality in Africa

Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants

HIV-Specific Antibodies Capable of ADCC Are Common in Breastmilk and Are Associated with Reduced Risk of Transmission in Women with High Viral Loads

There are limited data describing the functional characteristics of HIV-1 specific antibodies in breast milk (BM) and their role in breastfeeding transmission. The ability of BM antibodies to bind HIV-1 envelope, neutralize heterologous and autologous viruses and direct antibody-dependent cell cytotoxicity (ADCC) were analyzed in BM and plasma obtained soon after delivery from 10 non-transmitting and 9 transmitting women with high systemic viral loads and plasma neutralizing antibodies (NAbs). Because subtype A is the dominant subtype in this cohort, a subtype A envelope variant that was sensitive to plasma NAbs was used to assess the different antibody activities. We found that NAbs against the subtype A heterologous virus and/or the woman's autologous viruses were rare in IgG and IgA purified from breast milk supernatant (BMS) – only 4 of 19 women had any detectable NAb activity against either virus. Detected NAbs were of low potency (median IC50 value of 10 versus 647 for the corresponding plasma) and were not associated with infant infection (p = 0.58). The low NAb activity in BMS versus plasma was reflected in binding antibody levels: HIV-1 envelope specific IgG titers were 2.2 log10 lower (compared to 0.59 log10 lower for IgA) in BMS versus plasma. In contrast, antibodies capable of ADCC were common and could be detected in the BMS from all 19 women. BMS envelope-specific IgG titers were associated with both detection of IgG NAbs (p = 0.0001)and BMS ADCC activity (p = 0.014). Importantly, BMS ADCC capacity was inversely associated with infant infection risk (p = 0.039). Our findings indicate that BMS has low levels of envelope specific IgG and IgA with limited neutralizing activity. However, this small study of women with high plasma viral loads suggests that breastmilk ADCC activity is a correlate of transmission that may impact infant infection risk

The obstinate maternal mortality ratio for Malawi: beyond the Obstetrician

No Abstract. Malawi Medical Journal Biology Vol. 19 (1) 2007: pp. 9-1

'I don't want all my babies to go to the grave': perceptions of preterm birth in Southern Malawi

Objective: to investigate perceptions of preterm birth, infections in pregnancy and perinatal mortality among women, men and health-care providers in Namitambo, Southern Malawi. Design: a qualitative study using focus-group discussions, critical incidence narrative and key informant interviews. The framework approach to qualitative analysis was used. Setting: Namitambo, a rural area in southern Malawi. Participants: women who have experienced preterm delivery, groups of mothers, fathers and grandmothers, healthcare providers, traditional birth attendants and heaters. Findings: four key inter-related themes grounded in community interpretative frameworks emerged: (1) community conceptualisations of preterm birth (the different terminologies used); (2) perceived causes of preterm birth (i.e. both 'modern' and 'traditional; illnesses, violence, witchcraft, ideas relating to impurity, heavy work, inadequate food and inappropriate use of medicine); (3) perceived strategies to prevent preterm birth (i.e. using format health services, treatment for sexually transmitted infections, using condoms and stopping violence); and (4) barriers to realising these strategies, such as lack of food, money and women's autonomy in health seeking. Key conclusions: similarities and differences exist in understanding between healthcare providers and the community. Additional dialogue and action is needed within the health sector and community to address the problem of preterm births. This includes strategies to enable health-care providers and community members to reflect on their perceptions and practices (e.g. through action research and interactive drama); identify and build on areas of common concern (i.e. poor pregnancy outcome) and enter into partnerships with non-format providers. Action is also needed beyond the health sector (e.g. in campaigns to reduce gender-based violence). (c) 2006 Elsevier Ltd. All rights reserved