Analysis of maternal and child health policies in Malawi: The methodological perspective

The question of why most health policies do not achieve their intended results continues to receive a considerable attention in the literature. This is in the light of the recognized gap between policy as intent and policy as practice, which calls for substantial research work to understand the factors that improve policy implementation. Although there is substantial work that explains the reasons why policies achieve or fail to achieve their intended outcomes, there are limited case studies that illustrate how to analyze policies from the methodological perspective. In this article, we report and discuss how a mixed qualitative research method was applied for analyzing maternal and child health policies in Malawi. For the purposes of this article, we do not report research findings; instead we focus our dicussion on the methodology of the study and draw lessons for policy analysis research work. We base our disusssion on our experiences from a study in which we analyzed maternal and child health policies in Malawi over the period from 1964 to 2008. Noting the multifaceted nature of maternal and child health policies, we adopted a mixed qualitative research method, whereby a number of data collection methods were employed. This approach allowed for the capturing of different perspectives of maternal and child health policies in Malawi and for strengthening of the weaknesses of each method, especially in terms of data validity. This research suggested that the multidimensional nature of maternal and child health policies, like other health policies, calls for a combination of research designs as well as a variety of methods of data collection and analysis. In addition, we suggest that, as an emerging research field, health policy analysis will benefit more from case study designs because they provide rich experiences in the actual policy context.

Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana.

Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. Objectives: To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana. Methods: Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants). Results: The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries. Conclusion: There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana. Keywords:

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

The effects of vitamin D supplementation on maternal and neonatal outcome: A randomized clinical trial

Background: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes. Objective: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes (GDM), gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily. Materials and Methods: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D (25 (OH) D ) less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups. Results: The incidence of GDM in group B was significantly lower than group A (6.7% versus 13.4%) and odds ratio (95% Confidence interval) was 0.46 (0.24-0.87) (P=0.01). The mean ± SD level of 25 (OH) D at the time of delivery in mothers in group B was significantly higher than A (37.9 ± 19.8 versus 27.2 ± 18.8 ng/ml, respectively) (P=0.001). There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 (OH) D in cord blood of group B was significantly higher than group A (37.9 ± 18 versus 29.7 ± 19ng/ml, respectively). Anthropometric measures between neonates were not significantly different. Conclusion: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM.

Perception of HIV among pregnant women in the public health system in two municipalities of the state of São Paulo

Aim: To verify the knowledge of pregnant women on mother-to-child transmission (MTCT) of HIV, the availability of HIV tests in the public health system and counseling on the disease in two cities, Birigui and Piacatu, São Paulo State, Brazil. Methods: This is a descriptive and exploratory research using as samples, the files of 141 pregnant women attending the Basic Health Unit. Data were collected by survey, followed by a semi-structured questionnaire with open and closedend questions. Data were analyzed on Epi Info™ 7.1.4, by the Chi-square and Exact Fisher tests. Results: From all the 141 pregnant women, 119 were interviewed and 92.4% reported to have been informed about the need of taking the HIV test during prenatal exams. However, only 5.9% were counseled and 20.2% reported to be aware of how to prevent MTCT of HIV, usually mentioning lactation suppression and prescribed medication. The association between the knowledge about how to prevent MTCT of HIV and some social, demographic and economic variables like ethnics, educational level, home location, occupation, age and parenting was not verified. Conclusions: It is necessary to advise pregnant women on the importance of taking the HIV test regardless of the examination outcome, which was not observed in the cities where the research was conducted.