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.

Guidelines for short-term medical missions: perspectives from host countries.

BACKGROUND: In the past decade, there has been increasing guideline development for short-term medical missions (STMMs) traveling from high-income to low- and middle-income countries for the purpose of supporting health care services. The ethics of STMMs is criticized in the literature and there is frequently a lack of host country collaboration. This typically results in guidelines which are developed through the lens of the sending (high-income) countries' staff and organizations. The aim of this paper is to evaluate an existing best practice guideline document from the perspective of host country participants with knowledge of STMMs from Honduras, Malawi, and the Philippines. METHODS: The guideline used for the evaluation consisted of nine best practice elements that were discerned based on literature and the experience of those working within the field. Semi-structured interviews were conducted in a cross-sectional study with participants (n = 118) from the host countries. Thematic analysis was conducted by two researchers and the results were assessed by working group members to confirm interpretations of the data. RESULTS: Overall, participants expressed a strong interest in having more structured guidance surrounding STMM practices. There was a positive response to and general acceptance of the proposed STMM guidelines, although participants found the 24-page document onerous to use; a companion checklist was developed. The key themes that emerged from the interviews included collaboration and coordination, care for hard-to-reach communities, capacity building, critical products and essential medical supplies, and opportunity and feasibility. CONCLUSIONS: Host input suggests that the guidelines provide structured regulation and coordination of the medical mission process and have the potential to improve the way STMMs are carried out. The guidelines have also proven to be a useful tool for the actual implementation of STMMs and can be a tool to strengthen links and trust between mission teams and local health staff. However, local contexts vary considerably, and guidelines must be adapted for local use. It is recommended that STMM teams work in conjunction with host partners to ensure they meet local needs, increase capacity development of local health workers, and provide continuity of care for patients into the local system.

ANTECEDENTES: En la última década, ha habido un incremento en el desarrollo de guías para las misiones médicas de corto plazo (STMM) que viajan desde países de ingresos altos a países en vías de desarrollo con el fin de apoyar los servicios de atención médica. La ética de las (STMM) es criticada en la literatura y hay una falta frecuente de colaboración entre los países anfitriones. Esto normalmente da como resultado directrices que se desarrollan a través de la lente del personal y las organizaciones de los países que envían (países de altos ingresos). El objetivo de este documento es evaluar un documento guía de mejores prácticas existente desde la perspectiva de los participantes del país anfitrión con conocimiento de las misiones médicas de corto plazo (STMM) de Honduras, Malawi y Filipinas. MéTODOS: la directriz utilizada para la evaluación consistió en nueve elementos de mejores prácticas que se discernieron en base a la literatura y la experiencia de quienes trabajan en el campo. Se realizaron entrevistas semiestructuradas en un estudio transversal con participantes (n = 118) de los países anfitriones. El análisis temático fue realizado por dos investigadores y los resultados fueron evaluados por miembros del grupo de trabajo para confirmar las interpretaciones de los datos. RESULTADOS: En general, los participantes expresaron un gran interés en tener una guía más estructurada en torno a las prácticas de las misiones médicas de corto plazo (STMM). Hubo una respuesta positiva y una aceptación general de las pautas de las misiones médicas de corto plazo (STMM) propuestos, aunque los participantes encontraron oneroso el uso del documento de 24 páginas y se desarrolló una lista de verificación complementaria. Los temas clave que surgieron de las entrevistas incluyeron colaboración y coordinación, atención a comunidades de difícil acceso, desarrollo de capacidades, productos críticos y suministros médicos esenciales, y oportunidad y viabilidad. CONCLUSIONES: Los comentarios del anfitrión sugieren que las directrices proporcionan una regulación y coordinación estructuradas del proceso de la misión médica y tienen el potencial de mejorar la forma en que se llevan a cabo las misiones médicas de corto plazo (STMM). Las pautas también han demostrado ser una herramienta útil para la implementación real de de las misiones médicas de corto plazo (STMM) y pueden servir para fortalecer los vínculos y la confianza entre los equipos de misión y los sistemas de salud locales. Sin embargo, los contextos locales varían considerablemente y las pautas deben adaptarse para el uso local. Se recomienda que los equipos de las misiones médicas de corto plazo (STMM) trabajen en conjunto con los socios anfitriones para garantizar que satisfagan las necesidades locales, aumenten el desarrollo de la capacidad de los trabajadores de salud locales y brinden continuidad de atención a los pacientes en el sistema local.

Exploring community support on safe motherhood: A case of Lilongwe District, Malawi.

BACKGROUND: Malawi is grappling with a high maternal mortality of 439 per 100 000 live births. It is estimated that 80% of maternal deaths can be prevented by actively engaging the community in the country. However, community support on safe motherhood remains unknown. AIM: This study, therefore, explored community support rendered to mothers and babies during antenatal, intrapartum and postpartum periods. SETTING: This study was conducted in the Lilongwe District, Malawi. METHODS: This was a qualitative study that collected data from 30 village health committee members through Focus Group Discussions (FGDs). Data were analysed using thematic analysis. RESULTS: This study found that community support on safe motherhood rendered to women varied. The following five themes emerged from FGDs data on community support on safe motherhood: antenatal support, intrapartum support, postpartum support, bylaws reinforced by chiefs in the community and safe motherhood support groups. Community members encourage pregnant women to attend antenatal care, escorted pregnant women to the hospital for delivery and assisted women to care for a child and go for postpartum checkups. Community bylaws were considered as a necessary tool for encouraging women to attend antenatal care, deliver at the health facility and attend postpartum checkups. CONCLUSION: This study suggests that community members play a crucial role in providing support to women and newborns during antenatal, intrapartum and postpartum periods.

Assessing the quality of postnatal care offered to mothers and babies by midwives in Lilongwe District.

BACKGROUND: The quality of care received by mothers and newborns in low-resource settings is often poor. This may partly explain the high rates of maternal deaths (60%) that occur during the postpartum period in Malawi. However, the quality of care provided to mothers and newborns in the country has not been adequately assessed. Therefore, this study aimed at assessing the quality of postnatal care services offered to mothers and babies by midwives in Lilongwe District. METHODS: This was a quantitative study that used a sample of 58 midwives to assess the quality of postnatal care at three selected health facilities. A structured questionnaire, an observation tool and a facility checklist were used to collect data. Descriptive statistics were used to analyse the data. The study received ethics approval from the relevant authority. RESULTS: The study found that the percentages reported by midwives regarding client monitoring varied and were below the 80% threshold. Midwives did not always follow the reproductive health standards on client examination so that less than 75% of midwives inspected perineal wounds (52.2%), checked vital signs of neonate (66.7%) and mother (62.2%), and inspected lochia drainage (30.4%). Most midwives (91.3%) never assessed the emotional state of the mother. Midwives covered a range of topics during health education and counselling. However, some topics, including immunisations (31.1%), were never taught. CONCLUSION: The study has suggested that the postnatal care offered by midwives at three health facilities was generally substandard and midwives do not always monitor, assess and counsel postnatal clients.