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

HIV prevention awareness and practices among married couples in Malawi

In this study we explored the level of awareness and practice on HIV prevention among married couples from selected communities in Malawi. Methods We carried out the study from October to December, 2008 in four communities, two each from Chiradzulu and Chikhwawa districts of Malawi. We conducted face-to-face in-depth interviews with 30 couples in each district using a semi-structured interview guide. The interviews lasted approximately 60-90 minutes. The husbands and wives were interviewed separately. The interviews were audio taped using a digital recorder. We wrote field notes during data collection and later reviewed them to provide insights into the data collection process. We computed descriptive statistics from the demographic data using SPSS version 16.0. We analyzed qualitative data using Atlas ti 5.0 computer software. The coded data generated themes and we present the themes in qualitative narration. Results The couples’ ages ranged from 20 to 53 years, the majority (52%) being in the 20-31year age group. Most of the couples (67%) attained only primary school education and 84% had been married only to the current partner. Most couples (83%) depended upon substance farming and 47% had been married for 3 to 9 years. The number of children per couple ranged from 1 to 10, most couples (83%) having between 1 and 5 children. All couples were aware of HIV prevention methods and talked about them in their marriages. Both wives and husbands initiated the discussions. Mutual fidelity and HIV testing were appropriate for couples to follow the HIV prevention methods. For most couples (54) there was mutual trust between husbands and wives, and members of only a few couples (6) doubted their partners’ ability to maintain mutual fidelity. Actual situations of marital infidelity were however detected among 25 couples and often involved the husbands. A few couples (5) had been tested for HIV. All couples did not favor the use of condoms with a marriage partner as an HIV prevention method. Conclusion The level of HIV prevention awareness among couples in Malawi is high and almost universal. However, there is low adoption of the HIV prevention methods among the couples because they are perceived to be couple unfriendly due to their incompatibility with the socio-cultural beliefs of the people. There is a need to target couples as units of intervention in the adoption of HIV prevention methods by rural communities

Parenting experiences of couples living with human immunodeficiency virus: A qualitative study from rural Southern Malawi

The advent of antiretroviral therapy (ART) has allowed couples living with human immunodeficiency virus (HIV) to live longer and healthier lives. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV (PLWH) to have children. However, little is known about the parenting experiences of couples living with HIV (CLWH). The aim of this qualitative study was to explore and describe parenting  experiences of seroconcordant couples who have a child while living with HIV in Malawi. Data were collected using in-depth interviews with 14 couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa  communities from July to December 2010. The research findings shows that irrespective of kinship organization, economic hardships, food insecurity, gender-specific role expectations and conflicting information from health institutions and media about sources of support underpin their parenting roles. In addition, male spouses are directly involved in household activities, childcare and child feeding decisions, challenging the existing  stereotyped gender norms. In the absence of widow inheritance, widows from patrilineal communities are not receiving the expected support from the deceased husband relatives. Finally, the study has shown that CLWH are able to find solutions for the challenges they encounter. Contrary to existing belief that such who have children depend solely on public aid. Such claims without proper knowledge of local social cultural contexts, may contribute to stigmatizing CLWH who continue to have children. The study is also relevant to PLWH who, although not parents themselves, are confronted with a situation where they have to accept responsibility for raising children from their kin. We suggest the longer-term vision for ART wide access in Malawi to be broadened beyond provision of ART to incorporate social and economic interventions that support the rebuilding of CLWH social and economic lives. The interventions must be designed using a holistic multi-sector approach.Keywords: Malawi, couples, experiences, HIV and AIDS, parentingL’ave`nement de la the´rapie antire´trovirale a permis couples vivant avec le VIH de vivre plus longtemps et en meilleure sante´. La re´duction de la transmission du VIH de la me`re a` l’enfant a encourage´ certaines personnes vivant avec le VIH ont deux enfants. Cependant, on sait peu sur les expe´riences parentales des  couples vivant avec le VIH. Le but de cette e´tude qualitative e´tait d’explorer et de´crire des expe´riences  parentales des couples se´roconcordants qui ont un enfant tout en vivant avec le VIH au Malawi. Les donne´es  ont e´te´ collecte´es abuser des entrevues en profondeur avec des quatorze couples dessein e´chantillonne´s dans les communaute´s matriline´aires et patriline´aires Chiradzulu, Chikhwawa de Juillet jeu. De´cembre 2010.  Les re´sultats de recherche montrent que, inde´pendamment de l’organisation de la parente´, les difficulte´s  e´conomiques, l’inse´curite´ alimentaire, le roˆle des attentes spe´cifiques de genre et des informations  contradictoires des institutions de sante´ et les me´dias au sujet des sources de soutien angoisse leur roˆle  parental En outre, les conjoints de sexe masculin sont directement implique´s dans les activite´s de me´nage,  garde d’enfants et les de´cisions de l’alimentation des enfants, contestant la norme de genre ste´re´otype´s existant. En l’absence de l’he´ritage des veuves, veuves des communaute´s patriline´aires ne rec¸oivent pas le  soutien attendu de la famille du mari de´funt. Enfin, l’e´tude a montre´ que les couples vivant avec le VIH sont  a` l’aise pour trouver des solutions aux de´fis qu’ils rencontrent. Contrairement deux croyance existante que ce  qui ont des enfants de´pendent uniquement sur l’aide publique. Ces revendications sans la connaissance de  contextes socioculturels locaux, peut contribuer a` stigmatiser les couples vivant avec le VIH qui continuent deux  ont des enfants. L’e´tude est e´galement pertinent pour les personnes vivant avec le VIH qui, bien que non les  parents themelves, sont confronte´s a` une situation ou` ils doivent accepter la responsabilite´ d’e´lever les enfants de leurs parents. Nous sugge´rons la vision a` long terme de la the´rapie antire´trovirale large acce`s au Malawi a` eˆtre e´largi au-dela` de la fourniture d’un traitement antire´troviral deux interventions sociales et e´conomiques Incorporer qui soutiennent la reconstruction des couples vivant avec le VIH vie sociale et  e´conomique. Les interventions doivent eˆtre conc¸ues utilisation excessive d’une approche multi-sectorielle  globale.Mots cle´s: Malawi, les couples, les expe´riences, le VIH et le SIDA, la parentalite

An unusual “venous circle” of the internal mammary vein encountered during microvascular anastomosis and implications for practice

The internal mammary vessels are commonly used for anastomosis in breast reconstruction. The anatomy when using the 2nd ICS has been shown to be predictable and hence preferentially used by the senior author. We present an unusual case of internal mammary vein bifurcation and immediate confluence forming a ‘venous circle’

Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

Background: In 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies. Methods: 4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies. Results: 44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father’s age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner’s age and mother’s education level. The effect of mother’s education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies. Conclusion: A simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This information can be used to target family planning services to those most at risk of unplanned pregnancies, particularly women with a history of depression or who are experiencing intimate partner violence

Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies?

Background:  The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV.Methods:  A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly,data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis.Results: Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed nonprescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services.Conclusion: This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi

Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Background: The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. Methods: A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. Results: The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). Conclusions: Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions

Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. In this report, we describe the case of a 63-year-old patient who, whilst receiving chemotherapy for metastatic breast cancer, presented with an infected polytetrafluoroethylene mesh 15 years after pedicled TRAM flap immediate breast reconstruction. This necessitated mesh removal to treat the infection. Following a thorough review of the English literature, this is the longest recorded presentation of an abdominal prosthetic mesh infection. The mechanism and aetiology of such a late complication are discussed

Reassessing Pregnancy Intention and Its Relation to Maternal, Perinatal and Neonatal Outcomes in a Low-income Setting: a Cohort Study

BACKGROUND: It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations, calling the findings into question. This research was designed to overcome these limitations and assess the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country. METHODS: The pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi, was measured using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). Women were re-interviewed postnatally to assess pregnancy outcome. Postnatal depression was assessed using the WHO's Self-Reporting Questionnaire. Multivariable regressions were conducted, with the choice of confounders informed by a pre-existing conceptual epidemiological hierarchy. RESULTS: Planned pregnancies are associated with a reduced risk of any (adjusted RR 0.90 [95%CI 0.86, 0.95]) or high symptoms of depression (adjusted RR 0.76 [95%CI 0.63, 0.91]) compared to unplanned pregnancies in rural Malawi. There was no relationship between pregnancy intention and the composite measure of miscarriage, stillbirth, low birthweight and neonatal death. There was some evidence that greater pregnancy intention was associated with reduced adjusted risk of stillbirth (0·93 [95%CI 0·87, 1·00]). CONCLUSION: Our study is the first to use a psychometrically valid measure of pregnancy intention, and to do so antenatally. As pregnancy intention increases, the risk of postnatal depression and, possibly, stillbirth decreases. This suggests a new, clinical use for the LMUP; identifying women antenatally who are at risk of these adverse pregnancy outcomes