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1.
BMC Pregnancy Childbirth ; 21(1): 790, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819018

RESUMO

BACKGROUND: HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS: A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS: Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS: HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

2.
Qual Health Res ; 31(13): 2528-2541, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34581657

RESUMO

Public health scholars describe "culture of quality" in terms of desired values, attitudes, and practices, but this literature rarely includes explicitly stated theories of culture formation. In this article, we apply Fredrik Barth's transactional model to demonstrate how taking a theory-centered approach can help to identify what would be necessary to foster "cultures of quality" outlined in the public health literature. We draw on data from a study of the Republic of Malawi's Performance and Quality Improvement for Reproductive Health initiative. These data were generated in 2017-2018 through a 6-month organizational ethnography in three facilities selected to represent a range of districts with differing social and economic contexts. Our analysis revealed facility-level organizational cultures in which staff valued providing care, but responded to structural constraints by normalizing divergence from quality-of-care protocols. These findings indicate that sustaining a quality-oriented organizational culture requires addressing underlying conditions that generate routine experiences and practices.

3.
Adv Med Educ Pract ; 12: 557-563, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34093051

RESUMO

Purpose: Malawi trains registered nurses as clinical preceptors to facilitate quality clinical teaching to nursing students. The concept of preceptorship is new in Malawi, and as such data about its contribution and challenges are scanty. It is for this reason that this study was undertaken to explore the challenges that preceptors face as they teach students. Methods: This exploratory-descriptive qualitative study was conducted at Malawi's four major referral hospitals utilised by nursing training institutions as clinical sites. A sample of 12 participants was purposively selected to provide data regarding challenges encountered during preceptorship activities. In-depth interviews were conducted in order to collect data on challenges experienced by these facilitators. The data were later categorised and analysed into themes. Results: From the analysed data, three key themes emerged including preceptorship as time-consuming, lack of support from faculty members and lack of teamwork among preceptors. Conclusion: The study concluded that preceptors face several challenges that affect the quality of clinical teaching. The study recommends that there should be an improvement in the working relationship among those involved in clinical teaching to enhance clinical learning experiences among student nurses. It also recommends that more registered nurses should be trained as preceptors to improve the student-preceptor ratio.

4.
Adv Neonatal Care ; 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34138793

RESUMO

BACKGROUND: Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of these mothers as both care providers and mothers. PURPOSE: The purpose of this study was to explore the experiences of mothers during the hospitalization of the infant. The goal was to increase knowledge of their primary concerns about the hospital stay. METHODS: This was a descriptive qualitative study conducted at Queen Elizabeth Central Hospital in Malawi. Mothers were interviewed prior to their infant's discharge. We used the directed content analysis approach to analyze our data. RESULTS: Twenty mothers of preterm or full-term infants were interviewed. The primary concerns were perinatal experiences, the infant's condition and care including breastfeeding, support from family members, and support and care from healthcare providers. Additionally, mothers of preterm infants were concerned about the burdens of kangaroo mother care. IMPLICATION FOR PRACTICE: In hospitals that provide limited nursing support to mothers and their infants, it is important to identify a support system for the mother and provide mothers with information on infant care. IMPLICATIONS FOR RESEARCH: Future research should identify specific supports and resources in the community and hospital settings that are associated with positive hospital experiences.

5.
HRB Open Res ; 4: 1, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095749

RESUMO

Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. Exclusively breastfeeding infants for the first six months would lead to the largest infant mortality reduction. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund (UNICEF), which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) is an extension of the BHFI's 10 th step of the Ten Steps to Successful Breastfeeding and of the BFHI overall. Its focus is on community-based breastfeeding supports for women. There have been no known attempts to synthesise the overall body of evidence on the BFHI in recent years, and no synthesis of empirical research on the BFCI. This scoping review asks the question: what is known about the implementation of the BFHI and the BFCI globally? Methods and analysis: This scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria will follow the Population, Concepts, Contexts approach. A data charting form will be developed and applied to all the included studies. Qualitative and quantitative descriptive analysis will be undertaken. In order to address equity of access to the BFHI/BFCI, the Levesque et al. (2013) access to health care framework will be used as a lens to analyse the charted data in relation to this aspect of the review. An already established group of stakeholders with experience of infant feeding policy and implementation in Malawi will be consulted, to obtain expert views on the findings of the scoping review. Conclusion: This review will establish gaps in current evidence which will inform areas for future research in relation to this global initiative.

6.
Pilot Feasibility Stud ; 7(1): 32, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33494838

RESUMO

BACKGROUND: Depression is often underdiagnosed by treating health professionals. This is a situation in Malawi where there is no routine screening of depression at antenatal clinics. Recently, a Screening Protocol for Antenatal Depression (SPADe) that can be used by midwives to screen for antenatal depression was developed in Blantyre District. SPADe proposes multistage screening of antenatal depression by midwives which may enable early detection and treatment of pregnant women with depression. Proper treatment of antenatal depression can assist in achieving Sustainable Development Goals (SDGs). However, utilisation of SPADe in clinical practice to screening for depression in antenatal clinics has not been established yet. Therefore, the primary aim of this study is to assess feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. The secondary aim was to assess acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. METHODS: This will be a feasibility study which will consist of scientific investigations that will support movement of evidence-based, effective health care approach, SPADe, from the clinical knowledge base into routine use. This study will consist three phases: phase 1 will introduce SPADe in antenatal clinics in Blantyre District where screening of depression is almost none existent; phase 2 will implement screening of depression using SPADe in antenatal clinics in Blantyre District; and phase 3 will evaluate the screening of antenatal depression using SPADe to establish its feasibility, acceptability and fidelity in antenatal clinics in Blantyre District. DISCUSSION: This study will establish and document feasibility, acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. It is expected that midwives will develop more confidence in detecting and dealing with antenatal depression. Consequently, there will be increased numbers of pregnant women detected with depression by midwives and increased accessibility to mental health care by pregnant women in antenatal clinics.

7.
Int J Gynaecol Obstet ; 153(1): 154-159, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33098114

RESUMO

OBJECTIVE: To examine whether group prenatal care (PNC) increased key services and educational topics women reported receiving, compared with individual PNC in Malawi and Tanzania. METHODS: Data come from a previously published randomized trial (n=218) and were collected using self-report surveys. Late pregnancy surveys asked whether women received all seven services and all 13 topics during PNC. Controlling for sociodemographics, country, and PNC attendance, multivariate logistic regression used forward selection to produce a final model showing predictors of receipt of all key services and topics. RESULTS: In multivariate logistic regression, women in group PNC were 2.49 times more likely to receive all seven services than those in individual care (95% confidence interval [CI] 1.78-3.48) and 5.25 times more likely to have received all 13 topics (95% CI 2.62-10.52). CONCLUSION: This study provides strong evidence that group PNC meets the clinical standard of care for providing basic clinical services and perinatal education for pregnant women in sub-Saharan Africa. The greater number of basic PNC services and educational topics may provide one explanatory mechanism for how group PNC achieves its impact on maternal and neonatal outcomes. ClinicalTrials.gov: NCT03673709, NCT02999334.


Assuntos
Cuidado Pré-Natal/métodos , Educação Pré-Natal/métodos , Adulto , Feminino , Humanos , Modelos Logísticos , Malaui , Projetos Piloto , Gravidez , Gestantes , Tanzânia , Adulto Jovem
8.
BMJ Open ; 10(11): e037000, 2020 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-33191250

RESUMO

OBJECTIVES: The objective of this study was to investigate the role stressors, sociodemographic characteristics and job tasks of health surveillance assistants (HSAs) and to explore major predictors of role stressors and job satisfaction of HSAs in Malawi. SETTING: Data were collected from health centres and hospitals of three Malawi districts of Mangochi, Lilongwe and Mzimba. PARTICIPANTS: Respondents were 430 HSAs. 50.20% of them were male, while 49.8% were female. DESIGN: A cross-sectional study of the observational correlational design was carried out. MAIN OUTCOME MEASURES: Respondents perceptions of job tasks, role stressors and job satisfaction. RESULTS: The key findings of this study were role ambiguity and role overload were significantly negatively related to job satisfaction, while role conflict was insignificantly related to job satisfaction. Additionally, the clinical tasks of the HSAs and some of the sociodemographic variables were associated with the role stressors and job satisfaction of the HSAs in Malawi. CONCLUSIONS: Since the HSAs clinical tasks were significantly related to all role stressors, there is need by the government of Malawi to design strategies to control the role stressors to ensure increased job performance and job satisfaction among HSAs. Furthermore, studies may be required in the future to assist government to control role stressors among HSAs in Malawi.


Assuntos
Agentes Comunitários de Saúde , Satisfação no Emprego , Estudos Transversais , Feminino , Grupos Focais , Humanos , Malaui/epidemiologia , Masculino , Gravidez , Pesquisa Qualitativa
9.
Syst Rev ; 9(1): 237, 2020 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-33038930

RESUMO

BACKGROUND: Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The 'Care Group model' is an approach primarily used in international development settings, whereby social and behaviour changes are promoted through supported peer-to-peer (mostly mother-to-mother) knowledge sharing. The aim of most Care Groups is to promote improved infant nutrition, improve hygiene and increase the number of children who are fully vaccinated and exclusively breastfed for the first 6 months. The behavioural changes promoted by Care Groups (such as safe infant feeding, frequent hand washing, consistent mosquito net usage, providing suitable complementary foods from 6 months old) have the potential of averting preventable deaths particularly among children under five. While a variety of approaches are used to promote improved health and nutrition for children under five, the Care Groups model was best known and frequently referenced during our discussions with key stakeholders regarding the delivery at community level of Malawi's National Multi-Sector Nutrition Policy 2018-2022. A better understanding of how Care Groups achieve their social and behaviour change results and how community-based efforts are sustained can potentially help to ensure more effective planning and budgeting for Care Group interventions and enable greater sustainability and increased coverage of infant feeding support countrywide. This realist review is designed to improve our understanding of how, why, to what extent and under what circumstances Care Groups improve infant feeding practices in low- and middle-income countries (LMICs). METHODS AND ANALYSIS: A realist review is a theory-driven approach to evidence synthesis. To undertake this realist review, we will gather evidence by conducting peer-reviewed and grey literature database searches in order to find peer reviewed articles, programme guidelines and evaluation reports, among other texts, associated with the implementation of Care Groups in low- and middle-income countries. Our review process has five key steps: (1) locating existing theories; (2) searching for evidence in literature; (3) selecting articles and other suitable evidence; (4) extracting data, identifying configurations of context-mechanism-outcomes; and (5) synthesising the evidence, drawing conclusions. DISCUSSION: The results of this realist review will be written up according to RAMESES guidelines and disseminated through a stakeholder workshop in Malawi, through conference presentations and peer-reviewed publications. It is intended to improve the understanding of the potential and limits of working through Care Groups globally and among relevant Malawi Ministry of Health staff and the donor and NGO community, both internationally and within Malawi. This systematic review protocol has been submitted for registration on the PROSPERO database (receipt number: 170261).


Assuntos
Países em Desenvolvimento , Pobreza , Criança , Humanos , Lactente , Revisões Sistemáticas como Assunto
10.
Int J Womens Health ; 12: 187-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256123

RESUMO

Introduction: Globally, magnesium sulfate (MgSO4) has been recognized as the drug of choice for preventing and controlling fits among women with severe pre-eclampsia and eclampsia, respectively. Improper use of magnesium sulfate has been reported globally. Therefore, actionable findings for improving magnesium sulfate use are needed. This study aims at understanding the views of midwives towards MgSO4 use to inform an intervention whose objective is to improve MgSO4 use among the midwives. Methods: An exploratory qualitative study was conducted from July to September 2018. We conducted 10 in-depth interviews and a focus group discussion with midwives. All the interviews were audio taped and transcribed verbatim. Data were managed by NVivo version 10.0 and analyzed thematically. Results: We identified one overarching theme: "Inadequate governing approaches on management of clients on MgSO4" with corresponding subthemes; in adequate preparation on magnesium sulfate administration; inconsistent formula, regimen and guidelines/protocols on magnesium sulfate use and lack of resources. Conclusion: Midwives perceived MgSO4 use as a demanding activity due to inadequate training, inconsistent tools, and lack of resources. While periodic in-service training should be intensified to improve MgSO4 use, necessary resources should be provided, such as blood pressure machines, more midwives, and protocols.

11.
BMC Public Health ; 20(1): 205, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32039721

RESUMO

BACKGROUND: Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes. METHODS: Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. DISCUSSION: This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.


Assuntos
Saúde do Lactente , Saúde Materna , Avaliação de Resultados em Cuidados de Saúde , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Malaui , Gravidez
12.
BMC Pregnancy Childbirth ; 20(1): 48, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964346

RESUMO

BACKGROUND: In resource-limited settings, childbirth remains a matter of life and death. High levels of childbirth fear in primigravid women are inevitable. To date, few studies have explored interventions to reduce childbirth fear in primigravid women. This study aimed to evaluate the efficacy of companion-integrated childbirth preparation (C-ICP) during late pregnancy for reducing childbirth fear and improving childbirth self-efficacy, birth companion support, and other selected pregnancy outcomes in primigravid women. METHODS: A quasi-experimental study was carried out using a non-equivalent control group design to recruit a sample of 70 primigravid women in hospital maternity waiting homes in the intervention and control groups, with 35 in each group. The primigravid women and their birth companions in the intervention group received two sessions of companion-integrated childbirth preparation, whereas the control group received routine care. A questionnaire that incorporated the childbirth attitude questionnaire (CAQ), the childbirth self-efficacy inventory (CBSEI), the birth companion support questionnaire (BCSQ), and a review checklist of selected pregnancy outcomes was used to collect data. Pretest and post-test data were analyzed using simple linear regression. Beta coefficients were adjusted at a 95% confidence interval with statistical significance set at a P-value of < 0.05 using Statistical Package for the Social Sciences version 25. RESULTS: At pretest, mean scores were similar in the intervention and control groups. At post-test, being in the intervention group significantly decreased childbirth fears (ß: = - .866, t (68) = - 14.27, p < .001) and significantly increased childbirth self-efficacy (ß: = .903, t (68) = 17.30, p < .001). In addition, being in the intervention group significantly increased birth companion support (ß: = - 0.781, t (68) = 10.32, p < .001). However, no statistically significant differences regarding pregnancy outcomes were observed between the study groups (Mann-Whiney U test, p > .05). CONCLUSION: The findings of our study suggest that C-ICP is a promising intervention to reduce childbirth fear while increasing childbirth self-efficacy and maternal support. We recommend the inclusion of C-ICP for primigravid women during late pregnancy in resource-limited settings.


Assuntos
Parto Obstétrico/psicologia , Medo/psicologia , Número de Gestações , Parto/psicologia , Educação Pré-Natal/métodos , Autoeficácia , Adulto , Ansiedade/prevenção & controle , Depressão/prevenção & controle , Feminino , Seguimentos , Humanos , Gravidez , Resultado da Gravidez , Gestantes/psicologia , Autoimagem
13.
Malawi Med J ; 31(2): 138-143, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31452847

RESUMO

Background: There are no critical care nurse training programs in Malawi despite the high burden of diseases which culminate in critical illness. This paper presents contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi. The qualitative findings presented are part of a larger mixed methods study which explored learning needs of critical care nurses as a way of informing the development of a training program for the critical care nurses in Malawi. Methods: Interpretive descriptive design was used. Data were gathered through 10 key informant interviews with nurse leaders (n=8) and anaesthetists (n=2); and two focus group discussions with registered nurses and nurse midwife technicians working in intensive care and adult high dependency units at two tertiary hospitals. Transcribed data were analyzed manually and through the use of NVivo data management software utilizing Thorne's steps of analysis1. Results: Being unprepared to work in intensive care and high dependency units was a dominant theme. Factors that contributed to this sense of unpreparedness were lack of educational preparation, organisational factors and workforce issues. The consequences of nurses' perceptions of being unprepared were fearfulness, a change of nurses' attitudes and elevation of risk to patients. The nurses managed unpreparedness by relying on other health professionals and learning on the job. Conclusion: The findings illuminated contextual issues to be considered when developing programs for upskilling nurses in hospitals within Malawi and contributes to the developing body of knowledge related to nursing education and practice development within developing countries.


Assuntos
Competência Clínica , Enfermagem de Cuidados Críticos , Cuidados Críticos/organização & administração , Estado Terminal , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Enfermagem de Cuidados Críticos/educação , Enfermagem de Cuidados Críticos/organização & administração , Educação em Enfermagem , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Liderança , Malaui , Masculino , Pesquisa Qualitativa
14.
Malawi Med J ; 31(2): 164-168, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31452853

RESUMO

Introduction: Malawi is experiencing slow progress in postnatal care of mothers within the first 48 hours after childbirth. Malawi Demographic and Health Survey (MDHS) 2015-16 reported a slow progress in postnatal care of mothers in the first 48 hours at 42% from 41% in 2010 despite a high number of institutional births. This is a critical period as a large proportion of maternal deaths occur during this period, currently at 439 per 100,000 live births. During postnatal care the mother is given important information to assist in caring for herself and her baby. The lack of well documented guidelines and funding to employ more midwives to manage mothers in postnatal ward contributes to poor quality of postnatal care. Methods: This is an evidence-based policy brief that was prepared to inform policy makers, health workers, clients, community and other stakeholders to consider the available evidence about the impact of the suggested options in order to improve postnatal care. Results: Several factors that contribute to low utilization of postnatal care among mothers after childbirth were identified. Factors included lack of clear guidelines on postnatal care, shortage of skilled health workers and inadequate resources. Conclusion: Implementation of the identified policy options may improve postnatal care.


Assuntos
Medicina Baseada em Evidências , Política de Saúde , Serviços de Saúde Materna/organização & administração , Cuidado Pós-Natal/normas , Qualidade da Assistência à Saúde , Parto Obstétrico , Humanos , Tocologia
15.
PLoS One ; 14(6): e0217102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211776

RESUMO

PURPOSE: This study was conducted to explore the perceptions of perinatal women and key maternal care health workers about perinatal depression and the health service needs required to inform development of a culturally sensitive and acceptable psychosocial intervention. METHODS: This qualitative study used a descriptive exploratory design; it is the first phase of a larger mixed methods study aimed at adapting a psychosocial intervention for perinatal depression. We conducted in-depth interviews with 22 women who screened positive for depression using a locally validated Chichewa version of the Edinburgh Postnatal Depression Scale at antenatal and postnatal clinics in 1 rural and 1 urban health care setting in Lilongwe District, Malawi. We also conducted 10 key informant interviews with maternal care health workers. Informed consent was obtained from all participants. An interview guide was used to guide enquiry about perceptions of perinatal depression and health service needs. Interviews were transcribed, translated and analysed using content analysis approach. RESULTS: Perinatal depression was recognized as a common mental health problem that affected self-care activities and functioning of women in the perinatal period. Financial difficulties, relationship problems (polygamy, lack of support, neglect, and infidelity), traumatic events (intimate partner violence and loss) and fear of birth outcomes were identified as causes of depression. All study participants acknowledged the need for support and an intervention that will address the identified challenges. Additionally, they viewed strengthening the health delivery system as crucial to effectively address their needs and gaps identified in the system. CONCLUSION: The results of this study support plans to develop a family focused intervention for perinatal depression in Malawi addressing relationship, psychosocial and economic issues. It also highlights the importance of strengthening the health delivery system especially at primary care level where the majority of women access care in Malawi and across Sub-Saharan Africa.


Assuntos
Cultura , Depressão/etnologia , Depressão/terapia , Conhecimentos, Atitudes e Prática em Saúde , Complicações na Gravidez/etnologia , Complicações na Gravidez/terapia , Pesquisa Qualitativa , Adulto , Agentes Comunitários de Saúde/psicologia , Atenção à Saúde/estatística & dados numéricos , Depressão/psicologia , Família , Feminino , Humanos , Malaui/etnologia , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/psicologia , Resultado da Gravidez , Apoio Social , Adulto Jovem
16.
Nurs Ethics ; 26(5): 1361-1372, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29627999

RESUMO

BACKGROUND: Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. OBJECTIVE: The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. METHOD: Analysis of moral competence concept was done using Walker and Avant's strategy of concept analysis. RESULTS: Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. CONCLUSION: Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi.


Assuntos
Formação de Conceito , Princípios Morais , Enfermeiras e Enfermeiros/psicologia , Humanos , Malaui
17.
BMC Pregnancy Childbirth ; 18(1): 497, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558572

RESUMO

BACKGROUND: Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness. METHODS: An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis. RESULTS: We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care. CONCLUSION: Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.


Assuntos
Educação não Profissionalizante , Poder Familiar/psicologia , Cuidado Pré-Natal , Educação Pré-Natal , Cônjuges , Adulto , Estudos Transversais , Educação não Profissionalizante/métodos , Educação não Profissionalizante/normas , Feminino , Grupos Focais , Humanos , Malaui/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Enfermeiras Obstétricas/normas , Parto/psicologia , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Educação Pré-Natal/métodos , Educação Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Cônjuges/educação , Cônjuges/psicologia
18.
Malawi Med J ; 30(3): 146-151, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30627347

RESUMO

Background: Few studies have assessed the effectiveness and acceptability of male partner involvement in antenatal education. Yet, male involvement in antenatal care including antenatal education has been proposed as a strategy to improve maternal and neonatal outcomes. We conducted this study to add to the body of knowledge on acceptability of male partner involvement in antenatal education following an intervention. Methods: This was a cross sectional qualitative study using 18 in-depth interviews with 10 couples, 5 women from the couples group and 3 nurse-midwife technicians. Participants were purposively selected and interviewed between July and November, 2017. The study setting was South Lunzu and Mpemba Health Centres and their catchment areas. All interviews were audiotaped, transcribed verbatim and translated from Chichewa into English. Data were coded in Nvivo 10.0 and analyzed thematically. Findings: We identified three themes: benefit of content received; organization of couple antenatal education appropriate for male partner involvement; and delivery of couple antenatal education incentive for male involvement and learning. However, some improvements were suggested regarding content, organization and delivery of the education sessions. Conclusion: Couple antenatal education was acceptable to the couples and the facilitators in terms of content received, organization and delivery. Nevertheless, adding naming the baby to the list of topics, creating a special day for couples to attend antenatal education and providing a readable leaflet are likely to make couple antenatal education more user friendly.


Assuntos
Pai/educação , Mães/educação , Gestantes , Cuidado Pré-Natal/métodos , Cônjuges , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Humanos , Malaui , Masculino , Gravidez , Pesquisa Qualitativa , Adulto Jovem
19.
J Interprof Care ; 31(5): 667-669, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28726532

RESUMO

Since 2012, the University of Wisconsin-Milwaukee (UWM) faculty from nursing and physical therapy (PT) have been working together towards a common goal: to meet the healthcare needs of vulnerable populations in Malawi and Milwaukee. Sharing valuable knowledge and understanding one another's professions have allowed us to develop interprofessional education (IPE) learning experiences for students to help identify how quality of life could be improved or enhanced for children and their families across two different geographic spaces, one in rural Malawi and the other in urban Milwaukee. IPE learning modules were implemented in UWM's community health-focused short-term study abroad programmes to Malawi. IPE learning modules were also piloted at one of UWM's nurse-managed community health centres, located in a low-income, African American community in the inner city of Milwaukee, Wisconsin. Based on survey data collected from 10 participating IPE students in Milwaukee, from nursing, occupational therapy, PT, and speech and language pathology, a pilot study yielded a statistically significant change in a positive direction for increased understanding of three interprofessional collaborative practice core competencies: values and ethics, roles and responsibilities, and teams and teamwork. In this article, we discuss the processes used to develop, implement, and evaluate IPE experiences for UWM students, which may enable other professionals to envision the various projects they can embark upon from an interprofessional perspective.


Assuntos
Centros Comunitários de Saúde/organização & administração , Comportamento Cooperativo , Ocupações em Saúde/educação , Intercâmbio Educacional Internacional , Relações Interprofissionais , Educação em Enfermagem/organização & administração , Ocupações em Saúde/ética , Humanos , Malaui , Projetos Piloto , Papel Profissional , Qualidade de Vida , Características de Residência , Wisconsin
20.
BMJ Glob Health ; 1(1): e000022, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28588917

RESUMO

BACKGROUND: The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative-the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). OBJECTIVE: This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. METHODS: Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. POTENTIAL IMPACT: The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research.

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