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1.
S Afr Fam Pract (2004) ; 63(1): e1-e7, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34636592

RESUMO

BACKGROUND: Intimate partner violence (IPV) during the perinatal period and when one is HIV-positive is a great concern because of the physical and mental impacts it has on health and on adherence to prevention of mother to child transmission (PMTCT) services. However, factors associated with IPV amongst perinatal women on PMTCT services are not adequately explored in Malawi. The aim of this study was to estimate the various types of IPV and the associated factors amongst HIV-positive pregnant and postnatal women in selected health centres in Blantyre district. METHODS: In this cross-sectional study, we recruited 200 HIV-positive women from antenatal, postnatal and antiretroviral therapy (ART) clinics from four selected primary care facilities of Blantyre district. Data were collected between March and May 2018. RESULTS: A total of 50% of the participants reported to have experienced either physical, psychological or sexual violence from their partner in the last 12 months. The multivariate logistic regression model showed that feelings about safety of the relationship and depression were the only factors that were consistently associated with IPV in the last 12 months (p = 0.001, Pseudo R2 = 0.20). CONCLUSION: The presence of depression and safety concerns amongst our study participants calls for serious prioritisation of psychological interventions and risk assessment in the management of HIV-positive perinatal mothers who report IPV cases.

2.
Afr J Prim Health Care Fam Med ; 13(1): e1-e7, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34342479

RESUMO

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.


Assuntos
Mortalidade Materna , Período Periparto , Período Pós-Parto , Gestantes/psicologia , Apoio Social , Feminino , Grupos Focais , Humanos , Recém-Nascido , Malaui , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa
3.
Afr J Prim Health Care Fam Med ; 13(1): e1-e6, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34212743

RESUMO

BACKGROUND: Psychological well-being of nurses is crucial for them to effectively discharge their duties. However, coronavirus disease 2019 (COVID-19)-related anxiety can interfere with nurses' performance and reduce their self-efficacy. AIM: The primary aim of this study was to assess COVID-19-related anxiety and functional impairment amongst nurses in Malawi. The secondary aim of the study was to determine reliability and validity of the Coronavirus Anxiety Scale. SETTING: The study was conducted in Malawi. METHODS: This was a cross-sectional study that collected quantitative data from 102 nurses in Malawi online. Data were analysed using descriptive statistics and receiver operating curve analysis. RESULTS: This study found that 25.5% (26) of respondents had COVID-19-related anxiety and 48% (49) functional impairment. There were significant differences in the numbers of respondents who had functional impairment in relation to workplace (Χ2 = 8.7, p = 0.03), with many of those working in hospitals (58.6%, n = 34) having highest levels (mean = 20.6 ± 10.4). The Coronavirus Anxiety Scale proved to be an effective instrument (Sensitivity = 73.1%; Specificity = 60.5%; area under the curve = 0.73) for assessing COVID-19-related anxiety amongst nurses. CONCLUSION: It is necessary to screen nurses for COVID-19-related anxiety and functional impairment and provide them effective psychosocial interventions. Policymakers should place more emphasis on allocation of financial resources to mental health services and staff support programmes targeting nurses during pandemics. There is a need to conduct future research on mental health interventions that might be used to assist nurses with COVID-19-related anxiety and functional impairment.


Assuntos
Ansiedade/psicologia , COVID-19/psicologia , Depressão/psicologia , Enfermeiras e Enfermeiros/psicologia , Pandemias , Adulto , Ansiedade/etiologia , COVID-19/epidemiologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional , Reprodutibilidade dos Testes , SARS-CoV-2 , Inquéritos e Questionários , Local de Trabalho
4.
Ethics Hum Res ; 43(4): 11-19, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34196502

RESUMO

Interest in maternal mental health research is growing around the world. Maternal mental health research studies in Malawi have, for instance, sought to determine and establish the incidence and prevalence of depression and anxiety in pregnant people and the factors that contribute to experiences of these states. This article reports stakeholder perspectives on potential community concerns with biopsychosocial mental health research (which might include collecting blood samples) in Malawi. These perspectives were generated through a town hall event that featured five focus group discussions with various participants. In this article, we reflect on key themes from these discussions, demonstrating the endurance of long-standing concerns and practices around autonomy, consent, and the drawing of blood. We conclude by arguing that, while maternal mental health research conducted in Malawi could benefit Malawian women and children, consultation with community stakeholders is necessary to inform whether and how such research should be conducted.

5.
Lancet Psychiatry ; 8(6): 465-466, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023018
6.
S Afr Fam Pract (2004) ; 62(1): e1-e6, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32787385

RESUMO

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.

7.
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
8.
S Afr J Psychiatr ; 24: 1181, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30568841

RESUMO

Background: Pregnancy is a period associated with major psychological and social changes in the life of a woman and can be associated with anxiety and depression. Aim: To describe demographic, clinical and risk profile of antenatal depression among pregnant women attending antenatal clinics in Blantyre district, Malawi. Setting: The study was conducted in eight antenatal clinics in Blantyre district, Malawi. Methods: A cross-sectional study of 480 randomly selected pregnant women attending antenatal clinics was conducted. Prevalence was determined using the Edinburgh Postnatal Depression Scale (EPDS) which was validated against a sub-sample using the Mini International Neuropsychiatric Interview. The risk factors of depression were assessed using the Pregnancy Risk Questionnaire. Data were analysed using descriptive statistics, Pearson chi-square test and binary logistic regression. Results: Prevalence of antenatal depression using the EPDS was 19% (95% CI 15.5% - 22.5%, n = 91) and was comparable to the Mini International Neuropsychiatric Interview (25.8% [95% CI = 17.5-34], n = 25). The key risk factors that predicted antenatal depression were: 'being distressed by anxiety or depression for more than 2 weeks during this pregnancy' (OR = 4.1 [2.1-7.9], p ≤ 0.001); 'feeling that a relationship with partner is not an emotionally supportive one' (OR = 3.5 [1.4-8.4], p = 0.01); 'having major stresses, changes or losses in the course of this pregnancy' (OR = 3.2 [1.7-6.2], p = 0.01); 'feeling that father was critical of her when growing up' (OR = 3.2 [1.4-7.6], p = 0.01); and 'having history of feeling miserable or depressed for ≥2 weeks before this pregnancy' (OR = 2.4 [1.3-4.4], p = 0.01). Conclusion: This study confirmed the high-prevalence rate of depression in this group and illustrated that antenatal depression was associated with being distressed by anxiety or depression; support from partner; major stresses during pregnancy; and history of feeling miserable or depressed before pregnancy. This study also found a history of poor relationship between pregnant women and their fathers during childhood.

9.
Malawi Med J ; 30(3): 184-190, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30627354

RESUMO

Background: Screening instruments for antenatal depression vary in performance. This study aimed at assessing the performance of a range of screening instruments in detecting depressive symptoms in antenatal clinics in Blantyre district, Malawi. Methods: A cross-sectional study was conducted to screen for depression among women attending 8 selected antenatal clinics in Blantyre district using 3-item screener, Edinburgh Postnatal Depression Scale (EPDS), Hopkins Symptoms Checklist-15 (HSCL-15), Self-Reporting Questionnaire (SRQ) and Pregnancy Risk Questionnaire (PRQ). The instruments were administered to a random sample of 480 pregnant women. Data were analysed using SPSS 22.0 testing for performance differences in proportions of screen positives and how screen positive results might differ by particular variables. Results: The prevalence estimates yielded by screening instruments ranged from 12.9% (SRQ) to 42.1% (3-item screener). There were no significant differences in prevalence estimates for EPDS, HSCL-15, PRQ and SRQ. There were performance differences in the proportions of screen positives with significant systematic differences between proportions of screen positives of PRQ and SRQ (p<.001), EPDS and HSCL-15 (p=.001), HSCL and PRQ (p<.001), and EPDS and SRQ (p<.001). Screen positive results on HSCL-15, PRQ, 3-item screener and EPDS were found to differ by variables such as "not being supported by partner" which resulted in respondents having ≥3 times chances to screen positive on these four instruments. The screen positive results on SRQ were found not to differ by age, education, employment status, marital status, setting, gestation and number of pregnancies. Conclusions: There were minimal variations in the performance of the EPDS, SRQ and HSCL-15 as standard public health screening instruments. However, systematic differences between proportions of screen positives exist and screen positive results from these instruments differed by demographics. It is important to validate screening instruments against a gold standard to ensure relevant clinical outcomes for pregnant women with depression.


Assuntos
Depressão/diagnóstico , Programas de Rastreamento/métodos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Diagnóstico Pré-Natal/métodos , Inquéritos e Questionários , Adolescente , Adulto , Lista de Checagem , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Malaui/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Psicometria , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
10.
BMC Psychiatry ; 17(1): 112, 2017 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-28340609

RESUMO

BACKGROUND: In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings. METHODS: Searching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots. RESULTS: Eleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity. CONCLUSION: This review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity. PROSPERO REGISTRATION: CRD42015020316 .


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Psicometria/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/prevenção & controle , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Fatores de Risco
11.
Glob Health Action ; 7: 24816, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25226420

RESUMO

BACKGROUND AND OBJECTIVES: This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these. DESIGN: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes. RESULTS: The significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for 'counselling'. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity. CONCLUSION: Despite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience.


Assuntos
Atenção à Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Saúde Mental , Percepção , Maus-Tratos Conjugais/psicologia , Maus-Tratos Conjugais/terapia , Feminino , Humanos , Entrevistas como Assunto , Malaui , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Características de Residência
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