Knowledge and perceptions of preconception care among health workers and women of reproductive age in Mzuzu City, Malawi: a cross-sectional study.

BACKGROUND: Preconception care is one of the preventive strategies in maternal and new-born health as recommended by WHO. However, in sub-Saharan Africa there is poor preconception care practices. This study examined knowledge and perceptions of preconception care among health workers and women of reproductive age group in Mzuzu City, Malawi. METHODS: A descriptive cross-sectional study was conducted using a mixed methods approach. Selection of respondents was done through a multistage and purposive sampling techniques respectively. A total of 253 women of reproductive age from nine townships of Mzuzu City responded to the questionnaire and 20 health workers were interviewed. RESULTS: A total of 136 (54%) respondents had heard of preconception care. About 57.7% (n = 146) demonstrated a good level of knowledge of preconception care while 42.3% (n = 107) had poor knowledge. About 72% (n = 105) of those with good of knowledge of preconception care, lacked awareness on possibilities of talking to a health care provider on intentions of getting pregnant. About 74.7% (n = 189) of women had a positive perception towards preconception care. Knowledge of preconception care was a good predictor of positive perception (AOR = 2.5; 95% CI 1.2-5.0), however its predictability was influenced by the academic level attained. Those with secondary (AOR = 10.2; 95% CI 3.2-26.2) and tertiary (AOR = 2.3; 95% CI 1.1-4.9) were more likely to have good knowledge of preconception care than those with primary school education level. About 95% (n = 19) of health workers lacked details about preconception care but they admitted their role in preconception care. CONCLUSION: Preconception care practice among health workers and women of reproductive age in Mzuzu City was low. However there was positive perception towards preconception care in both parties. There is an opportunity in existing platforms for implementation of interventions targeting identified predictors for increased knowledge and uptake of preconception care.

World health organization defines preconception care as the provision of biomedical, behavioral and social interventions to women and couples before the occurrence of conception. In sub-Saharan Africa, there is poor preconception care practices which has resulted into high infant and maternal mortalities. This study examined the knowledge and perceptions of preconception care among health workers and women of reproductive age in order to provide evidence based outcomes for tailored interventions and policy direction. A semi-structured questionnaire and structured interviews were used to assess the knowledge level and perceptions of preconception care among women of reproductive age and health workers respectively. Of the 253 women, 57.7% showed good level of knowledge of preconception care while 42.3% had poor knowledge. Most (72%) women with good knowledge level lacked awareness that they can talk to a health worker before getting pregnant. Most (74.7%) women showed a positive perception towards preconception care which was strongly linked to having good knowledge based on the academic level attained. Those with secondary and tertiary backgrounds were more likely to have good knowledge than those with primary school level education. The majority (95%) of health workers were unable to explain well about preconception care but they admitted their role in preconception care.

Prevalence and correlates of comprehensive HIV/AIDS knowledge among adolescent girls and young women aged 15-24 years in Malawi: evidence from the 2015-16 Malawi demographic and health survey.

BACKGROUND: HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct knowledge of two major ways of preventing the sexual transmission of HIV and rejection of three misconceptions about HIV) is a key component of preventing new HIV infections among AGYW. Therefore, the aim of this study was to identify the correlates of comprehensive HIV/AIDS knowledge among AGYW in Malawi. METHODS: The study was based on cross-sectional data from the 2015-2016 Malawi Demographic and Health Survey. It involved 10,422 AGYW aged 15-24 years. The outcome variable was comprehensive HIV/AIDS knowledge. Data were analysed using descriptive statistics, bivariate and multivariable logistic regression model. All the analyses were performed using complex sample analysis procedure of the Statistical Package for Social Sciences to account for complex survey design. RESULTS: Approximately 42.2% of the study participants had comprehensive HIV/AIDS knowledge. Around 28% of the participants did not know that using condoms consistently can reduce the risk of HIV and 25% of the participants believed that mosquitoes could transmit HIV. Multivariable logistic regression model demonstrated that having higher education (AOR = 2.97, 95% CI: 2.35-3.75), belonging to richest households (AOR = 1.24, 95% CI: 1.05-1.45), being from central region (AOR = 1.65, 95% CI:1.43-1.89), southern region (AOR = 1.65, 95% CI: 1.43-1.90),listening to radio at least once a week (AOR = 1.27, 95% CI: 1.15-1.40) and ever tested for HIV (AOR = 1.88, 95% CI: 1.68-2.09) were significantly correlated with comprehensive HIV/AIDS knowledge. CONCLUSIONS: The findings indicate that comprehensive HIV/AIDS knowledge among AGYW in Malawi is low. Various social-demographic characteristics were significantly correlated with comprehensive HIV/AIDS knowledge in this study. These findings suggest that public health programmes designed to improve comprehensive HIV/AIDS knowledge in Malawi should focus on uneducated young women, those residing in northern region and from poor households. There is also a need to target AGYW who have never tested for HIV with voluntary counselling and testing services. This measure might both improve their comprehensive HIV/AIDS knowledge and awareness of their health status.

Uptake and correlates of HIV testing among men in Malawi: evidence from a national population-based household survey.

BACKGROUND: HIV testing is one of the key strategies in the HIV/AIDS prevention and control programmes. However, studies examining utilization of this service by men in Malawi are limited. The aim of this study was to assess the uptake and determinants of HIV testing among men in Malawi. METHODS: Secondary data analysis was conducted on cross-sectional household data for 7478 men aged 15 to 54 years drawn from the 2015-16 Malawi Demographic and Health Survey. Descriptive statistics, bivariate and multivariable logistic regression analyses were performed to identify the socio-demographic, behavioral and health service related factors that are associated with HIV testing service utilisation by men in Malawi. All analyses were performed using the complex sample analysis procedure of the Statistical Package for the Social Sciences version 22.0 to account for the multistage sampling used in Demographic Health Survey. RESULTS: Overall, 69.9% of the participants had ever been tested for HIV. The results indicate that age, region of residence, marital status, covered by health insurance, education and age at first sexual debut are significant predictors of HIV testing among men in Malawi. In particular, men who were in the age group 30-39 years (AOR = 3.00; 95% CI = 2.35-3.82), married (AOR = 3.03; 95% CI = 2.51-3.65), those with secondary or above education (AOR = 3.02; 95% CI = 2.33-3.91), and those who had health insurance (AOR = 1.66; 95% CI = 1.05-2.63) were likely to utilise HIV testing service than their counterparts. CONCLUSION: The findings suggest that HIV testing services and programmes need to target younger unmarried men aged 15-19, men with low level or no education and expand HIV testing services to the central and southern regions of Malawi. Targeting the undiagnosed men living with HIV in a timely manner is a crucial and necessary step not only for achieving the UNAIDS' 90-90-90 targets but for individuals to benefit from antiretroviral treatment and to sustainably reduce population-level HIV transmission.

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.

Factors associated with contraceptive use among young women in Malawi: analysis of the 2015-16 Malawi demographic and health survey data.

BACKGROUND: Although Malawi is one of the countries with highest Contraceptive Prevalence Rate (CPR) in Sub-Saharan Africa, pregnancies and fertility among young women remain high. This suggests low up take of contraceptives by young women. The aim of this study was to investigate the factors associated with contraceptive use among young women in Malawi. METHODS: This is a secondary analysis of household data for 10,422 young women aged 15-24 years collected during the 2015-16 Malawi Demographic and Health Survey (MDHS). The sample was weighted to ensure representativeness. Descriptive statistics, bivariate and multivariate logistic regressions were performed to assess the demographic, social - economic and other factors that influence contraceptive use among young women. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with their corresponding 95% confidence intervals (95% CI) were computed using the Statistical Package for the Social Sciences version 22.0. RESULTS: Of the 10,422 young women, 3219 used contraception representing a prevalence of 30.9%. The findings indicate that age, region of residence, marital status, education, religion, work status, a visit to health facility, and knowledge of the ovulatory cycle are significant predictors of contraceptive use among young women in Malawi. Women who were in the age group 20-24 years (AOR = 1.93; 95% CI = 1.73-2.16), working (AOR = 1.26; 95% CI = 1.14-1.39), currently married (AOR = 6.26; 95% CI = 5.46-7.18), knowledgeable about their ovulatory cycle (AOR = 1.75; 95% CI = 1.50-2.05), and those with primary education (AOR = 1.47; 95% CI = 1.18-1.83) were more likely to use contraceptives than their counterparts. CONCLUSION: This study has demonstrated that several social demographic and economic factors are associated with contraceptive use among young women in Malawi. These findings should be considered and reflected in public health policies to address issues that could be barriers to the use of contraception by young women. Strengthening access to family planning information and services for young women is highly recommended to reduce pregnancies among young women in Malawi.

Documentation of the partograph in assessing the progress of labour by health care providers in Malawi's South-West zone.

BACKGROUND: There is some evidence that appropriate use of partograph in monitoring the progress of labour could decrease delivery related complications. The documentation of parameters of partographs is however, poorly understood. The aim of the present study was to determine the extent to which health care workers are making use of the partograph in monitoring the progress of labour through checking the documentation of the parameters of the partographs. METHODS: A hospital-based descriptive study involving retrospective review of partographs for births that occurred in 2016 was conducted in Malawi's South-West zone. A total of 1070 partographs that were used to monitor labour in two public hospitals were reviewed to determine the documentation of the parameters of partographs and descriptive statistics were computed using statistical package for the social science software version 22.0. RESULTS: Of the total 1070 partographs reviewed, 58.6% (n = 627) of the partographs had no recording of maternal blood pressure and 65.3% (n = 699) of the partographs had no temperature documentation. Moulding was not recorded in 25.4% (n = 272) of the partographs, foetal heart rate was not recorded in 14.9% (n = 159) of the partographs and descent of the foetal head was not recorded in 12.0% (n = 128) of the partographs. CONCLUSION: There is poor documentation of vital parameters of the partographs. This suggests insufficient monitoring of the progress of labour, which may lead to adverse pregnancy outcomes. To improve the accurate documentation of parameters of the partograph, there is a need to understand the problem and provide tailor-made solutions to address them and ultimately improve pregnancy outcomes. In the meantime, in-service refresher courses on partograph use to health care workers need to be conducted regularly. Supportive supervision to obstetric care providers and regular partograph audit could also improve documentation.

Induced and Spontaneous Abortion and Risk of Uterine Fibroids.

BACKGROUND: The relationship between abortion and uterine fibroids has received little attention. The aim of the present study was to explore the association between number of induced and spontaneous abortions and the risk of uterine fibroids in middle-aged and older Chinese women. METHODS: A total of 14,595 retired female employees from the Dongfeng-Tongji cohort study were included in our analysis. Information on induced and spontaneous abortions was collected by trained interviewers through face-to-face interviews. Diagnosis of uterine fibroids was based on ultrasound or self-reported physician diagnosis of uterine fibroids. Logistic regression models were used to explore the associations between number of induced and spontaneous abortions and the risk of uterine fibroids. RESULTS: The prevalence of uterine fibroids was 15.1% among all participants. Higher number of induced abortions was associated with an increased risk of uterine fibroids (1 induced abortion: odds ratios [ORs] = 1.32, 95% confidence interval [CI] 1.18-1.48; 2 induced abortions: OR = 1.45, 95% CI 1.28-1.64; and ≥3 induced abortions: OR = 1.62, 95% CI 1.39-1.90). Compared with women without induced abortion, ORs for women with 1, 2, and ≥3 were 1.17 (95% CI 1.03-1.32), 1.21 (95% CI 1.06-1.39), and 1.36 (95% CI 1.15-1.61), respectively, after adjustment for potential confounders. No association was observed between the number of spontaneous abortions and the risk of uterine fibroids. CONCLUSION: The findings of this study showed that induced abortion may be an independent risk factor for uterine fibroids in middle-aged and older Chinese women.

Parity and risk of ovarian cysts: Cross-sectional evidence from the Dongfeng-Tongji cohort study.

Little is known about the association between parity and the risk of ovarian cysts. The aim of this study was to examine the association between parity and the risk of ovarian cysts among a population of Chinese women. A total of 20 502 women aged 45-86 years from the Dongfeng-Tongji Cohort study completed baseline questionnaires, medical examination and provided baseline blood samples. Participants were categorized into four groups according to parity (one, two, three, and four or more live births). Logistic regression models were used to investigate the association between parity and the risk of ovarian cysts. The prevalence of ovarian cysts in the study population was 4.0% (816/20 502). Increasing parity was associated with decreasing risk of ovarian cysts without adjustment for any covariates and after age-adjusted model (P<0.001). After adjusting for potential confounders, women who had had four or more live births had lower risk of ovarian cysts (OR: 0.51; 95% CI: 0.27-0.96) compared with women who had had one live birth. There was a consistent but non-significant decreased risk of ovarian cysts for women who had had two, and three live births (OR: 0.85; 95% CI: 0.68-1.05) and (OR: 0.84; 95% CI: 0.59-1.20) respectively compared with women who had had one live birth. It was concluded that higher parity was associated with decreasing risk of ovarian cysts in this population of Chinese women. These findings could be helpful in decision making in clinical practice for gynecologists when evaluating women suspected to have ovarian cysts.

Understanding the mechanisms through which women's group community participatory intervention improved maternal health outcomes in rural Malawi: was the use of contraceptives the pathway?

BACKGROUND: Women's group intervention is a community based initiative through which rural women form groups, meet regularly to discuss maternal health issues affecting them, and come up with locally available solutions. This intervention has been associated with reduced maternal and neonatal mortality in limited resource settings. Nevertheless, the mechanisms through which women's groups influence maternal health outcomes are uncertain. Because contraception reduces the risk of maternal mortality and women's groups also tackled this issue, we speculated that contraceptive use might be the pathway. Consequently, this study investigated whether participation in women's groups was associated with contraceptive use in Malawi. DESIGN: We examined the use of contraceptives between women who participated in women's groups and those who did not through a community-based cross-sectional study in Mchinji, Malawi. The study involved 3,435 women of reproductive age (15-49 years) who were recruited using a multistage sampling approach. Members (treated) and non-members (control) of women's groups were matched on observed covariates using propensity scores and the counterfactual for the treated individuals was estimated. RESULTS: Crude analysis revealed that women's groups improved uptake of contraceptives by 26% (odds ratio (OR)=1.26; 95% confidence interval (CI)=1.03-1.56; p=0.024). However, using the matched data, uptake of contraceptives was almost the same among members and non-members of women's groups. More precisely, the likelihood of using contraceptives was not significantly different between the members and non-members of women's groups (OR=1.00; 95% CI=0.81-1.24; p=0.991). CONCLUSIONS: There is insufficient evidence of an association between participation in women's groups and contraceptive use among rural Malawian women. The implication is that contraception was not the mechanism through which women's groups contributed to reduced maternal mortality in Malawi. Because the effects of community interventions are usually comprehensive and sometimes difficult to demonstrate, ethnographic studies should be considered in the evaluation of women's groups and other related interventions.

Parity and the risk of cataract: a cross-sectional analysis in the Dongfeng-Tongji cohort study.

AIMS: Epidemiological evidence showed that prevalence rates of cataract were higher in women than in men. Female reproductive factors were hypothesised to be linked with this sex difference. In this study, we explored possible effects of parity and reproductive factors on the risk of cataract. METHODS: Women (14 337 total; aged 45-86 years) were recruited from the Dongfeng-Tongji cohort study. All subjects completed baseline questionnaires and medical examinations and provided baseline blood samples. Cataract was diagnosed by the ophthalmologist in the ocular examination. Logistic regression models were used to evaluate the association between parity and the risk of cataract. RESULTS: The prevalence rate of cataract in the study population was 6.8% (972/14 337). After adjustment for potential confounders, women who had undergone two, three, and four or more live births had 1.52 times (95% CI 1.13 to 2.04), 1.67 times (95% CI 1.27 to 2.29) and 1.72 times (95% CI 1.22 to 2.42), respectively, higher risk of cataract compared with women who had undergone one live birth. The risk increased by an estimated 11.3% for each additional live birth. Women who had undergone hormone replacement therapy (OR 1.61; 95% CI 1.05 to 2.47), had diabetes mellitus (OR 1.33; 95% CI 1.11 to 1.58) and/or had the habit of drinking alcohol (OR 1.51; 95% CI 1.08 to 2.10) had a higher risk of cataract. Neither menopause status nor history of contraceptive use was associated with cataract. CONCLUSIONS: The findings suggested that parity was an independent risk factor for the development of cataract in Chinese women.