The Implication of Using NVivo Software in Qualitative Data Analysis: Evidence-Based Reflections

For a long time, electronic data analysis has been associated with quantitative methods. However, Computer Assisted Qualitative Data Analysis Software (CAQDAS) are increasingly being developed. Although the CAQDAS has been there for decades, very few qualitative health researchers report using it. This may be due to the difficulties that one has to go through to master the software and the misconceptions that are associated with using CAQDAS. While the issue of mastering CAQDAS has received ample attention, little has been done to address the misconceptions associated with CAQDAS. In this paper, the author reflects on his experience of interacting with one of the popular CAQDAS (NVivo) in order to provide evidence-based implications of using the software. The key message is that unlike statistical software, the main function of CAQDAS is not to analyse data but rather to aid the analysis process, which the researcher must always remain in control of. In other words, researchers must equally know that no software can analyse qualitative data. CAQDAS are basically data management packages, which support the researcher during analysis

Factors that Affect Maternal Care Seeking Behaviour and the Choice of Practitioner(s) during Complications: the Case of Mang’anja Tribe in Malawi

Despite the high prevalence rate of maternal mortality coupled with under-utilisation of health services, little attempt has been made in Malawi to explore and document people’s understanding and beliefs about causes and appropriate treatment of the major complications that are medically believed to be the causes of maternal deaths. Any difference between the insider’s and the biomedical perceptions of what is a serious maternal complication is dangerous because it may delay seeking of lifesaving care. This study was therefore, designed to elicit and explore the local explanatory associated with the major biomedical cause of maternal mortality (haemorrhage) among Mang’anja tribe in Malawi and how these influence care seeking behaviour. Descriptive qualitative research design was adopted and data was collected using Kleinman’s ‘explanatory model interview guide’ from 25 respondents. The findings generally suggest that being aware of maternal danger signs is not enough to provoke a trip to the appropriate healer. Since it is the cause not the effect of the maternal complications that determines care seeking, a shift in approach of health education provided to pregnant women is recommended. Keywords: Malawi, maternal health, explanatory model, care seeking, haemorrhag

A Multimethod Examination of the Motives and Effects of Herbal Medicine Use During Pregnancy

Background There are suggestions that the use of herbal medicine during pregnancy is associated with adverse pregnancy outcomes. However, the extent of use, the reasons for use and the link between use and poor outcomes have not been rigorously studied. So, my PhD research examined associations between the use of herbal medicine during pregnancy and adverse maternal and neonatal outcomes. It also explored the socio-cultural explanations of the pregnancy-related problems and how this influences the use of herbal medicine. Methods The PhD research project comprised of four sub-studies. The first was a systematic review and meta-analysis of the effectiveness, safety and prevalence of herbal medicines during pregnancy at global and regional (sub-Saharan Africa) levels. The second was a secondary analysis of Cluster-randomised controlled trial data from Malawi. For this analysis, I examined the link between herbal medicine use and adverse pregnancy outcomes amongst 32,254 births recorded from 2005 to 2010 in Mchinji. The other two sub-studies were part of a field-based ‘exploratory sequential mixed-methods study’ in Malawi. I first conducted a qualitative study involving semi-structured interviews with women who had recently (<24 months) given birth (n=10) and focus group discussions with grandmothers or traditional birth attendants (n=2) and community health workers (n=2). This was followed by a hospital-based case-cohort study with 1,830 women (15-49 years old) who had just given birth. The motives for herbal medicine use and the associations between herbal medicine use and pregnancy outcomes were assessed. Results Multiple explanations of pregnancy complications were identified, and most of them are grounded in cultural beliefs. Specifically, most pregnancy problems were attributed to witchcraft and associated supernatural forces. The findings further show that the explanations of pregnancy problems influence the choice of practitioners and care-seeking practices, including the use of herbal medicine. Herbal medicine use during pregnancy is high in both Malawi and other sub-Saharan countries. I also found that some of the herbal medicines were associated with adverse maternal and neonatal outcomes (e.g. pre-labour rupture of membranes and neonatal death) while others were not. Conclusion There appear to be mixed-effects of herbal medicines during pregnancy. Some were associated with adverse pregnancy outcomes whereas others were not. Because it is not yet clear as to which herbal medicines are safe or not, the key recommendation from this thesis is that where possible all herbal medicines of unproven safety should be avoided during pregnancy

Residential energy efficiency interventions: A meta-analysis of effectiveness studies

BACKGROUND: The residential sector releases around 17% of global greenhouse gas emissions and making residential buildings more energy efficient can help mitigate climate change. Engineering models are often used to predict the effects of residential energy efficiency interventions (REEI) on energy consumption, but empirical studies find that these models often over-estimate the actual impact of REEI installation. Different empirical studies often estimate different impacts for the same REEI, possibly due to variations in implementation, climate and population. Funding for this systematic review was provided by the evaluation function at the European Investment Bank Group. OBJECTIVES: The review aims to assess the effectiveness of installing REEIs on the following primary outcomes: energy consumption, energy affordability, CO2 emissions and air quality indices and pollution levels. SEARCH METHODS: We searched CAB Abst, Econlit, Greenfile, Repec, Academic Search Complete, WB e-lib, WoS (SCI and SSCI) and other 42 databases in November 2020. In addition, we searched for grey literature on websites, checked the reference lists of included studies and relevant reviews, used Google Scholar to identify studies citing included studies, and contacted the authors of studies for any ongoing and unpublished studies. We retrieved a total of 13,629 studies that we screened at title and abstract level, followed by full-text screening and data extraction. SELECTION CRITERIA: We included randomised control trials, and quasi-experimental studies that evaluated the impact of installing REEIs anywhere in the world and with any comparison. DATA COLLECTION AND ANALYSIS: Two independent reviewers screened studies for eligibility, extracted data and assessed risk of bias. When more than one included study examined the same installation of the same type of REEI for a similar outcome, we conducted a meta-analysis. We also performed subgroup analyses. MAIN RESULTS: A total of 16 studies were eligible and included in the review: two studies evaluated the installation of efficient lighting, three studies the installation of attic/loft insulation, two studies the installation of efficient heat pumps, eight studies the installation of a bundle of energy efficiency measures (EEMs), and one study evaluated other EEMs. Two studies, neither appraised as having a low risk of bias, find that lighting interventions lead to a significant reduction in electricity energy consumption (Hedges' g = −0.29; 95% confidence interval [CI]: −0.48, −0.10). All the other interventions involved heating or cooling, and effects were synthesizised by warmer or colder climate and then across climates. Four studies examined the impact of attic/loft insulation on energy consumption, and two of these studies were appraised as having a low risk of bias. Three studies took place in colder climates with gas consumption as an outcome, and one study took place in a warmer climate, with the electricity consumption (air conditioning) as the outcome. The average impact across all climates was small (Hedges' g = 0.04; 95% CI: −0.09, 0.01) and statistically insignificant. However, two of the studies appear to have evaluated the effect of installing small amounts (less than 75 mm) of insulation. The other two studies, one of which was appraised as low risk of bias and the other involving air conditioning, found significant reductions in consumption. Two studies examined the impact of installing electric heat pumps. The average impact across studies was not statistically significant (Hedges' g = −0.11; 95% CI: −0.41, 0.20). However, there was substantial variation between the two studies. Replacing older pumps with more efficient versions significantly reduced electricity consumption in a colder climate (Hedges' g = −0.36; 95% CI, −0.57, −0.14) in a high risk of bias study. However, a low risk of bias study found a significant increase in electricity consumption from installing new heat pumps (Hedges' g = 0.09; 95% CI, 0.06, 0.12). Supplemental analyses in the latter study indicate that households also used the heat pumps for cooling and that the installed heat pumps most likely reduced overall energy consumption across all sources—that is, households used more electricity but less gas, wood and coal. Seven studies examined bundled REEIs where the households chose which EEMs to install (in five studies the installation occurred after an energy audit that recommended which EEMs to install). Overall, the studies estimated that installing an REEI bundle is associated with a significant reduction in energy consumption (Hedges' g = −0.36; 95% CI, −0.52, −0.19). In the two low risk of bias studies, conducted with mostly low-income households, installed bundles reduced energy consumption by a statistically significant amount (Hedges' g = −0.16; 95% CI, −0.13, −0.18). AUTHORS' CONCLUSIONS: The 16 included studies indicate that installing REEIs can significantly reduce energy consumption. However, the same type of REEI installed in different studies caused different effects, indicating that effects are conditional on implementation and context. Exploring causes of this variation is usually not feasible because existing research often does not clearly report the features of installed interventions. Additional high quality impact evaluations should be commissioned in more diverse contexts (only one study was conducted in either Asia or Africa—both involved lighting interventions—and no studies were conducted in South America or Southern Europe)

PROTOCOL: Residential energy efficiency interventions: An effectiveness systematic review

This review aims to identify, appraise and synthesise the evidence available on the effectiveness of energy efficiency measure installations, including those bundled with behavioural interventions. The synthesis will estimate the overall impact of these interventions as well as examine possible causes of variation in impacts. We will also attempt to assess the cost-effectiveness of residential energy efficiency interventions

Associations between the use of herbal medicines and adverse pregnancy outcomes in rural Malawi : a secondary analysis of randomised controlled trial data

BACKGROUND: The use of herbal medicines during pregnancy is very high globally and previous studies have pointed out possible associations with adverse pregnancy outcomes. Nevertheless, the safety of herbal medicines in pregnancy is under-explored in low-income countries experiencing high maternal and neonatal complications. We investigated the associations between self-reported use of Mwanamphepo (a group of herbal medicines commonly used to induce or hasten labour) and adverse maternal and neonatal outcomes in rural Malawi. METHODS: We conducted a cross-sectional analysis of secondary household data relating to 8219 births that occurred between 2005 and 2010 in Mchinji district, Malawi. The data were collected as part of a cluster-randomised controlled trial (RCT) that evaluated community interventions designed to reduce maternal and neonatal mortality. Data were gathered on maternity history, demographic characteristics, pregnancy outcomes and exposure to Mwanamphepo. Associations between self-reported use of Mwanamphepo and maternal morbidity as well as neonatal death or morbidity were examined using mixed-effects models, adjusted for relevant covariates. All analyses were also adjusted for the clustered nature of the survey. RESULTS: Of the 8219 births, Mwanamphepo was used in 2113 pregnancies, representing an estimated prevalence of 25.7%. The self-reported use of Mwanamphepo was significantly associated with increased occurrence of maternal morbidity and neonatal death or morbidity. Specifically, the odds of maternal morbidity were 28% higher among self-reported users than non-users of Mwanamphepo (AOR = 1.28; 95% CI = 1.09-1.50) and the probabilities of neonatal death or morbidity were 22% higher (AOR =1.22; 95% CI = 1.06-1.40) among neonates whose mother reportedly used Mwanamphepo than those who did not. CONCLUSION: The use of Mwanamphepo was associated with adverse pregnancy outcomes in rural Malawi. Thus, herbal medicines may not be safe in pregnancy. Where possible, pregnant women should be discouraged from using herbal medicines of unconfirmed safety and those who report to have used should be closely monitored by health professionals. The study was limited by the self-report of exposure and unavailability of data relating to some possible confounders

Effectiveness and safety of herbal medicines for induction of labour : a systematic review and meta-analysis

OBJECTIVE: The use of herbal medicines for induction of labour (IOL) is common globally and yet its effects are not well understood. We assessed the efficacy and safety of herbal medicines for IOL. DESIGN: Systematic review and meta-analysis of published literature. DATA SOURCES: We searched in MEDLINE, AMED and CINAHL in April 2017, updated in June 2018. ELIGIBILITY CRITERIA: We considered experimental and non-experimental studies that compared relevant pregnancy outcomes between users and non-user of herbal medicines for IOL. DATA EXTRACTION AND SYNTHESIS: Data were extracted by two reviewers using a standardised form. A random-effects model was used to synthesise effects sizes and heterogeneity was explored through I2 statistic. The risk of bias was assessed using 'John Hopkins Nursing School Critical Appraisal Tool' and 'Cochrane Risk of Bias Tool'. RESULTS: A total of 1421 papers were identified through the searches, but only 10 were retained after eligibility and risk of bias assessments. The users of herbal medicine for IOL were significantly more likely to give birth within 24 hours than non-users (Risk Ratio (RR) 4.48; 95% CI 1.75 to 11.44). No significant difference in the incidence of caesarean section (RR 1.19; 95% CI 0.76 to 1.86), assisted vaginal delivery (RR 0.73; 95% CI 0.47 to 1.14), haemorrhage (RR 0.84; 95% CI 0.44 to 1.60), meconium-stained liquor (RR 1.20; 95% CI 0.65 to 2.23) and admission to nursery (RR 1.08; 95% CI 0.49 to 2.38) was found between users and non-users of herbal medicines for IOL. CONCLUSIONS: The findings suggest that herbal medicines for IOL are effective, but there is inconclusive evidence of safety due to lack of good quality data. Thus, the use of herbal medicines for IOL should be avoided until safety issues are clarified. More studies are recommended to establish the safety of herbal medicines

The quality and diagnostic value of open narratives in verbal autopsy: a mixed-methods analysis of partnered interviews from Malawi

Background Verbal autopsy (VA), the process of interviewing a deceased’s family or caregiver about signs and symptoms leading up to death, employs tools that ask a series of closed questions and can include an open narrative where respondents give an unprompted account of events preceding death. The extent to which an individual interviewer, who generally does not interpret the data, affects the quality of this data, and therefore the assigned cause of death, is poorly documented. We aimed to examine inter-interviewer reliability of open narrative and closed question data gathered during VA interviews. Methods During the introduction of VA data collection, as part of a larger study in Mchinji district, Malawi, we conducted partner interviews whereby two interviewers independently recorded open narrative and closed questions during the same interview. Closed questions were collected using a smartphone application (mobile-InterVA) and open narratives using pen and paper. We used mixed methods of analysis to evaluate the differences between recorded responses to open narratives and closed questions, causes of death assigned, and additional information gathered by open narrative. Results Eighteen partner interviews were conducted, with complete data for 11 pairs. Comparing closed questions between interviewers, the median number of differences was 1 (IQR: 0.5–3.5) of an average 65 answered; mean inter-interviewer concordance was 92 % (IQR: 92–99 %). Discrepancies in open narratives were summarized in five categories: demographics, history and care-seeking, diagnoses and symptoms, treatment and cultural. Most discrepancies were seen in the reporting of diagnoses and symptoms (e.g., malaria diagnosis); only one pair demonstrated no clear differences. The average number of clinical symptoms reported was 9 in open narratives and 20 in the closed questions. Open narratives contained additional information on health seeking and social issues surrounding deaths, which closed questions did not gather. Conclusions The information gleaned during open narratives was subject to inter-interviewer variability and contained a limited number of symptom indicators, suggesting that their use for assigning cause of death is questionable. However, they contained rich information on care-seeking, healthcare provision and social factors in the lead-up to death, which may be a valuable source of information for promoting accountable health services