Psychosocial experiences of cancer survivors and their caregivers in sub-Saharan Africa: A synthesis of qualitative studies.

OBJECTIVE: To synthesize and examine current literature on survivorship experiences and psychosocial oncologic care programs of individuals affected by cancer in sub-Saharan Africa (SSA). METHODS: This was a systematic review guided by the PRISMA 2020 guidelines. We searched 6 databases for articles published from inception to 21 October 2021. Articles were appraised using the Johanna Briggs Institute's Checklist for Qualitative Research. For data synthesis, we used the World Health Organization (WHO) quality of life framework [WHOQOL] to organize experiences into 6 domains/themes. RESULTS: Twenty-five qualitative studies were included in the synthesis. Studies focused on psychosocial care of adults (>18 years) affected by cancer in SSA. The common WHOQOL domains were social relations, spirituality/religion/personal beliefs, and psychological. CONCLUSION: Findings echo need for individuals with cancer and their caregivers. Healthcare professionals are an essential resource for information and support services that can be tailored to individuals need. This synthesis highlighted caregiver stress and stressors from the community that could impact care of individuals with cancer. A holistic approach is needed that incorporates professional and social aspects of care.

Systematic review on the prevalence of perinatal depression in Malawi.

Background: Perinatal depression causes significant burden to women and their families during the perinatal period. However, there is no reliable national prevalence data on perinatal depression in Malawi. Aim: This systematic review aimed at establishing the pooled prevalence of perinatal depression. Setting: The study setting is Malawi. Methods: Two reviewers conducted the search, selection, quality evaluation and data abstraction. Appropriate terms were used to search the CINAHL, PsychINFO, PubMed and ScienceDirect databases. The relevance and the quality of the studies were assessed. The prevalence of prenatal depression was pooled using a random-effects model, which was used to synthesise the data. Results: The review included a total of eight articles of fair and good quality. This review found a pooled prevalence of antenatal depression of 17.1% (95.0% confidence interval [CI]: 12.5-22.2) and postnatal depression of 19.8% (95.0% CI: 4.6-42.1) with an overall pooled prevalence of perinatal depression of 18.9% (95.0% CI: 14.5-23.8). Conclusion: This systematic review provided a pooled prevalence of perinatal depression which may be used in the absence of national prevalence data on perinatal depression. Contribution: This systematic review found a high a pooled prevalence of perinatal depression in Malawi suggesting that mental health should be a key component of maternal health programmes, policies and activities in the local setting.

Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi.

BACKGROUND: Voluntary medical male circumcision (VMMC) is becoming more popular as an important HIV prevention strategy. Malawi, with a high HIV and AIDS prevalence rate of 8.8% and a low male circumcision prevalence rate of 28% in 2016, is one of the priority countries recommended for VMMC scale-up. This paper investigates the attitudes and key challenges to VMMC adoption in a traditionally circumcising community in Malawi where male circumcision is culturally significant. METHODS: A mixed design study using quantitative and qualitative data collection methods was carried out to determine the attitudes of 262 randomly selected males towards VMMC in a culturally circumcising community in Malawi. Statistical Package for the Social Sciences (SPSS) version 20 was used to analyse the quantitative data. To identify predictors of VMMC uptake, we used logistic regression analysis. To identify the themes, qualitative data were analysed using content analysis. RESULTS: The findings indicate that, while more males in this community prefer medical circumcision, traditional circumcision is still practised. Panic (63%) perceived surgical complications (31%), and cost (27%) in accessing VMMC services were some of the barriers to VMMC uptake. Age and culture were found to be statistically significant predictors of voluntary medical male circumcision in the logistic analysis. According to qualitative data analysis, the key challenges to VMMC uptake were the involvement of female health workers in the circumcision team and the incentives provided to traditional circumcisers. CONCLUSION: According to the findings of this study, VMMC services should be provided in a culturally competent manner that respects and considers existing cultural beliefs and practices in the community. Coordination between local leaders and health workers should be encouraged so that VMMC services are provided in traditional settings, allowing for safe outcomes, and increasing VMMC uptake.

Factors influencing implementation of simulation in nursing and midwifery training in Malawi.

Background: The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. Aim: This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. Setting: The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. Methods: Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. Results: Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. Conclusion: The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. Contribution: Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.

Systematic review of psychosocial interventions for adult cancer patients and their family caregivers in Sub-Saharan Africa.

Cancer is becoming a public health issue in the Sub-Saharan Africa (SSA). This systematic review aims to synthesise psychosocial interventions and their effects on the health outcomes of adult cancer patients and their family caregivers in SSA. We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included psychosocial interventions targeted adult cancer patients/survivors or their family caregivers in SSA. This review identified five psychosocial interventions from six studies that support adult cancer patients and their family caregivers in SSA. The interventions focused on providing informational, psycho-cognitive, and social support. Three interventions significantly improved quality of life outcomes for cancer patients and their caregivers. Significant gaps exist between the rapidly increasing cancer burdens and the limited psychosocial educational interventions supporting adult cancer patients and their families in SSA. The reviewed studies provide preliminary evidence on development and testing interventions that aim to improve patients' and caregivers' quality of life.

Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies.

Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA.

Health researchers and policy makers involvement in knowledge translation activities in Malawi.

PURPOSE: The purpose of this paper is to explore health researchers' involvement of policy or decision makers in knowledge translation activities in Malawi. DESIGN/METHODOLOGY/APPROACH: The case study collected quantitative through questionnaire from health researchers from the University of Malawi. The study used inferential statistics for the analysis of the quantitative data. Pearson χ2 test was used to establish the relationship between categorical data and determine whether any observed difference between the data sets arose by chance. The Kruskal-Wallis H test was used to determine if there were statistically significant differences between independent variable and dependent variables. Data has been presented in a form of tables showing means, standard deviation and p-values. FINDINGS: Health researchers sometimes involve policy or decision makers in government-sponsored meetings (M=2.5, SD=1.17). They rarely involve policy or decision makers in expert committee or group meetings (M=2.4, SD=1.20). Researchers rarely involve policy or decision makers in conferences and workshops (M=2.4, SD=1.31). Rarely do researchers involve policy or decision makers in formal private or public networks (M=2.4, SD=1.17). In events organised by the colleges researchers rarely involve policy or decision makers (M=2.3, SD=1.11); and rarely share weblinks with policy or decision makers (M=2.0, SD=1,17). On average, health researchers occasionally conduct deliberate dialogues with key health policy makers and other stakeholders (M=2.5, SD=1.12). The researchers rarely established and maintained long-term partnerships policy or decision makers (M=2.2, SD=1.20). They rarely involve policy or decision makers in the overall direction of the health research conducted by themselves or the Colleges (M=2.1, SD=1.24). RESEARCH LIMITATIONS/IMPLICATIONS: The study recommends that there should be deliberate efforts by health researchers and policy makers to formally engage each other. Individuals need technical skills, knowledge of the processes and structures for engaging with health research evidence to inform policy and decision making. At the institutional level, the use of research evidence should be embedded within support research engagement structures and linked persons. PRACTICAL IMPLICATIONS: Formal interactions in a form of expert meetings and technical working groups between researchers and policy makers can facilitate the use of health research evidence in policy formulation. SOCIAL IMPLICATIONS: In terms of framework there is need to put in place formal interaction frameworks between health researchers and policy makers within the knowledge translation and exchange. ORIGINALITY/VALUE: There is dearth of literature on the levels of involvement and interaction between health researchers and health policy or decision makers in health policy, systems and services research in Malawi. This study seeks to bridge the gap with empirical evidence.

Levels of research evidence in health policy assessment in Malawi.

PURPOSE: The purpose of this study is to examine levels of health research evidence in health policies in Malawi. DESIGN/METHODOLOGY/APPROACH: The study selected a typology of health policies in Malawi from 2002 to 2017. The study adopted the SPIRIT conceptual framework and assessed the levels of research evidence in health policy, systems and services research using the revised SAGE policy assessment tool. Documentary analysis was used to assess levels of health research evidence in health policies in Malawi. FINDINGS: In 29 (96.7 per cent) of the health policies, policy formulators including healthcare directors and managers used generic search engines such as Google or Google Scholar to look for heath research evidence. In 28 (93.3 per cent) of the health policies, they searched for grey literature and other government documents. In only 6 (20 per cent) of the heath policy documents, they used academic literature in a form of journal articles and randomised controlled trials. No systematic reviews or policy briefs were consulted. Overall, in 23 (76.7 per cent) of the health policy documents, health research evidence played a minimal role and had very little influence on the policy documents or decision-making. RESEARCH LIMITATIONS/IMPLICATIONS: The empirical evidence in the health policy documents are limited because of insufficient research citation, low retrievability of health research evidence in the policy documents and biased selectivity of what constitutes health research evidence. PRACTICAL IMPLICATIONS: The study indicates that unfiltered information (data from policy evaluations and registries) constitutes majority of the research evidence in health policies both in health policy, systems and services research. The study seeks to advocate for the use of filtered information (peer reviewed, clinical trials and data from systematic reviews) in formulating health policies. ORIGINALITY/VALUE: There is dearth of literature on the levels of health research evidence in health policy-making both in health policy, systems and services research. This study seeks to bridge the gap with empirical evidence from a developing country perspective.