High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Burnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience.</p> <p>Methods</p> <p>In the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout.</p> <p>Results</p> <p>In terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment.</p> <p>Conclusions</p> <p>Based on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting.</p

HIV-related stigmatization: Experiences from women enrolled in a mother-to-child transmission of HIV prevention program in Malawi

Abstract Title: HIV-related Stigmatization: Experiences from women enrolled in a Mother-to-child of HIV Prevention Program in Malawi Researcher: Viva Combs Thorsen Supervisors: Johanne Sundby, MD, MPH (Professor, University of Oslo) Francis Martinson, MD, PhD (Country Director, UNC Project) Introduction: Despite two decades into the epidemic (first HIV diagnosis in Malawi in 1985) and its pervasiveness in Malawi, stigma insidiously continues to overshadow HIV, resulting in negative attitudes and reactions towards people living with HIV/AIDS (PLWHA). This has in turn impeded preventive efforts such as prevention of mother-to-child transmission (PMTCT). Fear of being stigmatized deter pregnant women from being tested, enrolling in PMTCT programs, and disclosing serostatus to significant others. The impetus for this study was HIV/AIDS-related stigma negatively impacts on the wellbeing of PLWHA, prevention efforts, and service delivery. Overall Objective of the Study: The proposed study aims to broaden the understanding of HIV-related stigmatization in the context of prevention of mother-to-child transmission of HIV in Lilongwe, Malawi. Specific Objectives were to: Identify and describe the forms of stigmatization HIV+ pregnant women and new mothers experience Investigate the context in which stigmatization is manifested Explore HIV+ pregnant women s responses to stigmatization Explore the dimensions of stigmatization that may influence HIV+ pregnant women s decisions to participate in efforts to prevent the transmission of HIV to their (unborn) child Investigate how healthcare workers may mitigate or perpetuate stigmatization in the MTCT prevention program Study Design and Methods: Qualitative methods of interviews and non-participant observations were employed. Newspapers were also reviewed to assess socio-cultural and political tones of HIV/AIDS in Malawi. Conclusion: Felt stigma influenced the women s decision to adhere to PMTCT recommendations. However, it was more an issue of how to comply without inadvertently disclosing their HIV status. Therefore, stigmatization was not the major contender; poverty and gender inequality were. They are most influential in the women s decision to adhere to PMTCT. Therefore, any anti-stigmatization campaigns must take these larger socio-cultural and political contextual factors into consideration. Recommendations: The PMTCT should consider participating in the following seven activities: Increase number of anti-stigmatization activities Expand the scope of hospital staff training and counselling Reduce involuntary disclosure caused by incentives Integrate the PMTCT perspective into development initiatives Optimize infrastructure and supplies Modify PMTCT terminolog

Maternal Mortality and Morbidity in Malawi and the Gambia - Malawi, 2011

A descriptive retrospective case study design of 32 maternal death cases that occurred at a secondary and tertiary maternity unit in the District of Lilongwe, Malawi between January 1, 2011 and June 30, 2011. The in-depth investigation entailed interviewing 34 healthcare workers, 23 family members, and four traditional birth attendants. In addition, 101 healthcare workers were surveyed to assess their level of burnout using the Maslach Burnout Inventory (MBI)

Easier said than done!: methodological challenges with conducting maternal death review research in Malawi

Background Maternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi. Methods Critical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation. Results Challenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses. Conclusion Conducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized

Culture clash of female Somali adolescents and sexual and reproductive health services in Oslo, Norway

Objective Culture influences an individual’s perception of health needs. The influence of culture also applies to Somali individuals’ perception of their sexual and reproductive health (SRH) and uptake of related services. An understanding of female Somali adolescents’ SRH needs is vital to achieve inclusive health coverage. No research has, however, been conducted to explore the SRH needs of this population group in Oslo; hence, the aim of this qualitative study was to minimise the knowledge gap. Methods Fourteen young women aged 16–20 years were recruited using the snowball technique with purposive sampling. In-depth interviews using a semi-structured interview guide were used to collect data, and thematic analysis was applied. Results Participants perceived SRH as a very private matter and open discussion of SRH was extremely limited owing to certain Somali cultural beliefs and values. As the participants intend to practise chastity before marriage, they believed that existing SRH services were largely irrelevant and inappropriate. Where they felt the need to access SRH services, participants wished to do so in a way they considered culturally appropriate. Conclusion Somali culture markedly influences individuals’ perceptions of SRH services. It is recommended to modify existing SRH services by increasing confidentiality and anonymity in order to take into account the cultural requirements of female Somali adolescents

Piecing together the maternal death puzzle through narratives: the three delays model revisited.

BACKGROUND: In Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi. METHODS: Retrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds). RESULTS: Sixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement

Postrape care services to minors in Kenya: are the services healing or hurting survivors?

Abstract: Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors’ rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors’ rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused minors in Kenya require amendment

Direct & Indirect Causes and Frequencies of Maternal Deaths.

<p>Based on chart notes and two independent reviews, the cause of death for each maternal death was determined, confirmed, tallied, and grouped according to whether the cause contributed directly or indirectly to the death.</p