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Journal articles on the topic 'Child care services – Malawi'

Author: Grafiati

Published: 4 June 2021

Last updated: 15 February 2022

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1

Liu, Lingrui, Hannah H. Leslie, Martias Joshua, and Margaret E. Kruk. "Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a cross-sectional study." BMJ Open 9, no. 7 (July 2019): e029631. http://dx.doi.org/10.1136/bmjopen-2019-029631.

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ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare.DesignWe measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013–2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population—facility matching criteria.Setting and population568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility.ResultsOverall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding.ConclusionAlthough Malawi’s health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.

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Downing, Julia, Richard A. Powell, Joan Marston, Cornelius Huwa, Lynna Chandra, Anna Garchakova, and Richard Harding. "Children's palliative care in low- and middle-income countries." Archives of Disease in Childhood 101, no. 1 (September 14, 2015): 85–90. http://dx.doi.org/10.1136/archdischild-2015-308307.

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One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs—highlighting examples of best practice among service models in Malawi, Indonesia and Belarus—before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.

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Kays, Megan, Godfrey Woelk, Tegan Callahan, Leila Katirayi, Michele Montandon, Felluna Chauwa, Anne Laterra, et al. "Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi." PLOS ONE 16, no. 8 (August 11, 2021): e0255788. http://dx.doi.org/10.1371/journal.pone.0255788.

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Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE’s) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.

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Makuta, C., and H. Du Toit. "FACTORS INFLUENCING THE UTILISATION OF MATERNAL AND CHILD HEALTH CARE SERVICES IN BALAKA DISTRICT OF MALAWI." Africa Journal of Nursing and Midwifery 18, no. 1 (June 1, 2016): 61–77. http://dx.doi.org/10.25159/2520-5293/862.

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Shapira, Gil, Tashrik Ahmed, Salomé Henriette Paulette Drouard, Pablo Amor Fernandez, Eeshani Kandpal, Charles Nzelu, Chea Sanford Wesseh, et al. "Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries." Health Policy and Planning 36, no. 7 (June 19, 2021): 1140–51. http://dx.doi.org/10.1093/heapol/czab064.

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Abstract The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March–July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.

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Andriano, Liliana, and Christiaan W. S. Monden. "The Causal Effect of Maternal Education on Child Mortality: Evidence From a Quasi-Experiment in Malawi and Uganda." Demography 56, no. 5 (October 2019): 1765–90. http://dx.doi.org/10.1007/s13524-019-00812-3.

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Abstract Since the 1980s, the demographic literature has suggested that maternal schooling plays a key role in determining children’s chances of survival in low- and middle-income countries; however, few studies have successfully identified a causal relationship between maternal education and under-5 mortality. To identify such a causal effect, we exploited exogenous variation in maternal education induced by schooling reforms introducing universal primary education in the second half of the 1990s in Malawi and Uganda. Using a two-stage residual inclusion approach and combining individual-level data from Demographic and Health Surveys with district-level data on the intensity of the reform, we tested whether increased maternal schooling reduced children’s probability of dying before age 5. In Malawi, for each additional year of maternal education, children have a 10 % lower probability of dying; in Uganda, the odds of dying for children of women with one additional year of education are 16.6 % lower. We also explored which pathways might explain this effect of maternal education. The estimates suggest that financial barriers to medical care, attitudes toward modern health services, and rejection of domestic violence may play a role. Moreover, being more educated seems to confer enhanced proximity to a health facility and knowledge about the transmission of AIDS in Malawi, and wealth and improved personal illness control in Uganda.

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Kongnyuy, Eugene J., Jan Hofman, Grace Mlava, Chisale Mhango, and Nynke van den Broek. "Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi." Maternal and Child Health Journal 13, no. 5 (June 26, 2008): 687–94. http://dx.doi.org/10.1007/s10995-008-0380-y.

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Nkhoma, Nicola, Linda Alinane Nyondo-Mipando, Chandra Makanjee, Nellie Dominica Myburgh, and Peter Suwirakwenda Nyasulu. "“What Will I Be Doing There Among So Many Women?”: Perceptions on Male Support in Prevention of Mother to Child Services in Lilongwe, Malawi." Global Pediatric Health 6 (January 2019): 2333794X1986544. http://dx.doi.org/10.1177/2333794x19865442.

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Participation of males in the prevention of mother-to-child transmission (PMTCT) programs remains a challenge despite the implementation of guidelines. The study aimed at exploring male involvement in the PMTCT program at a primary health facility in Lilongwe, Malawi. Focus group discussions and in-depth individual interviews were used to collect data from health care workers, men, and women who were attending PMTCT services. Snowball sampling was used to recruit participants who were purposively identified. Alcohol consumption, pressure from work places, stigma, role conflict, denial or nondisclosure of HIV status among women, and lack of awareness were among factors found to hinder male participation in PMTCT services. Therefore, to have an effective PMTCT program, male involvement is needed as this could positively influence the delivery of interventions including antiretroviral treatment among HIV-infected pregnant women. As such, health education awareness campaigns emphasizing the value of men in PMTCT services should be reinforced.

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Nkhonjera, Joe, Leticia C. Suwedi-Kapesa, Benjamin Kumwenda, and Alinane Linda Nyondo-Mipando. "Factors Influencing Loss to Follow-up among Human Immunodeficiency Virus Exposed Infants in the Early Infant Diagnosis Program in Phalombe, Malawi." Global Pediatric Health 8 (January 2021): 2333794X2110041. http://dx.doi.org/10.1177/2333794x211004166.

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The efforts to prevent mother to child transmission of HIV in Malawi are impeded by the loss to follow-up of HIV-exposed infants (HEI) in care. Early infant diagnosis (EID) of HEI and linkage to care reduces morbidity and mortality. There has been limited attention to infants who are lost to follow up despite their mothers being compliant to the PMTCT program. This study explored factors that influence loss-to-follow up among HEI in the EID program whose mothers were retained in care for up to 24 months in Phalombe district, Malawi. We conducted a descriptive phenomenological qualitative study from May 2017 to July 2018. We purposively conducted 18 in-depth interviews among HIV positive mothers whose HEI were enrolled in the follow-up program and 7 key informant interviews among healthcare workers (HCW). All interviews were digitally recorded, transcribed, and translated verbatim. Data were analyzed manually using a thematic step-by-step approach. Results showed that retention in care is facilitated by aspirations to have a healthy infant and linkage to a nearer facility to a mother’s place of residency. The barriers to retention were non-disclosure of HIV status, inadequate resources, and support, suboptimal guidelines for, a lack of privacy, and unsynchronized hospital visits between a mother and her baby. The study has shown that successful implementation of EID services requires concerted efforts from various contextualized stakeholders whilst focusing on family-centered care. To maximize retention in EID and innovative ways of reaching mothers and babies through flexible guidelines are urgently needed.

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Besada, Donela, Ameena Goga, Emmanuelle Daviaud, Sarah Rohde, Jacqueline Rose Chinkonde, Susie Villeneuve, Guy Clarysse, et al. "Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal." BMJ Open 8, no. 3 (March 2018): e020754. http://dx.doi.org/10.1136/bmjopen-2017-020754.

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ObjectivesTo explore the roles of community cadres in improving access to and retention in care for PMTCT (prevent mother-to-child transmission of HIV) services in the context of PMTCT Option B+ treatment scale-up in high burden low-income and lower-middle income countries.Design/MethodsQualitative rapid appraisal study design using semistructured in-depth interviews and focus group discussions (FGDs) between 8 June and 31 July 2015.Setting and participantsInterviews were conducted in the offices of Ministry of Health Staff, Implementing partners, district offices and health facility sites across four low-income and lower-middle income countries: Cote D’Ivoire, Democratic Republic of Congo (DRC), Malawi and Uganda. A range of individual interviews and FGDs with key stakeholders including Ministry of Health employees, Implementation partners, district management teams, facility-based health workers and community cadres. A total number of 18, 28, 31 and 83 individual interviews were conducted in Malawi, Cote d’Ivoire, DRC and Uganda, respectively. A total number of 15, 9, 10 and 16 mixed gender FGDs were undertaken in Malawi, Cote d’Ivoire, DRC and Uganda, respectively.ResultsCommunity cadres either operated solely in the community, worked from health centres or in combination and their mandates were PMTCT-specific or included general HIV support and other health issues. Community cadres included volunteers, those supported by implementing partners or employed directly by the Ministry of Health. Their complimentary roles along the continuum of HIV care and treatment include demand creation, household mapping of pregnant and lactating women, linkage to care, infant follow-up and adherence and retention support.ConclusionsCommunity cadres provide an integral link between communities and health facilities, supporting overstretched health workers in HIV client support and follow-up. However, their role in health systems is neither standardised nor systematic and there is an urgent need to invest in the standardisation of and support to community cadres to maximise potential health impacts.

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Mulewa, Patience, Egrina Satumba, Christopher Mubisi, Joseph Kandiado, Tumaini Malenga, and Alinane Linda Nyondo-Mipando. "“I Was Not Told That I Still Have The Virus”: Perceptions of Utilization of Option B+ Services at a Health Center in Malawi." Journal of the International Association of Providers of AIDS Care (JIAPAC) 18 (January 1, 2019): 232595821987087. http://dx.doi.org/10.1177/2325958219870873.

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Utilization of the prevention of mother-to-child transmission of HIV (PMTCT) services remains a challenge as losses to follow-up are substantial. This study explored factors that influence adherence to maternal antiretroviral (ARV) medications among PMTCT mothers in Malawi. We conducted a descriptive qualitative study from September 2016 to May 2017 using purposive sampling among 16 PMTCT mothers and 4 key informant interviews with health-care workers. Data were audio-recorded and analyzed thematically. The factors that influence adherence to maternal ARV medications include the quality of PMTCT services and social support. Factors that impede adherence include suboptimal counseling women receive on ARV medications, cost of travel, and conflicting advice from religious institutions. Adherence to maternal ARV medications will require the use of existing social support systems in a woman’s life as a platform for delivery of the drugs while also maintaining continued and comprehensive counseling on the benefits of maternal ARV medications.

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Molyneux, E. M., V. Lavy, M. Bunn, Z. Palmer, and F. Chiputula. "Developing a palliative care service for children in the Queen Elizabeth Central Hospital, Blantyre, Malawi." Archives of Disease in Childhood 98, no. 9 (July 29, 2013): 698–701. http://dx.doi.org/10.1136/archdischild-2013-303722.

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Lungu, Edgar Arnold, Amarech Guda Obse, Catherine Darker, and Regien Biesma. "What influences where they seek care? Caregivers’ preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment." PLOS ONE 13, no. 1 (January 19, 2018): e0189940. http://dx.doi.org/10.1371/journal.pone.0189940.

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Kinshella, Mai-Lei Woo, Sangwani Salimu, Brandina Chiwaya, Felix Chikoti, Lusungu Chirambo, Ephrida Mwaungulu, Mwai Banda, et al. "“So sometimes, it looks like it’s a neglected ward”: Health worker perspectives on implementing kangaroo mother care in southern Malawi." PLOS ONE 15, no. 12 (December 17, 2020): e0243770. http://dx.doi.org/10.1371/journal.pone.0243770.

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Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. Methods This study is part of the “Integrating a neonatal healthcare package for Malawi” project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). Findings A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. Conclusion Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.

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Brough, Helen, and Tiwaope Kachaje. "Follow-Up Care for Pediatric Hearing Aid Users at an Audiology Clinic in Malawi." Perspectives of the ASHA Special Interest Groups 5, no. 6 (December 17, 2020): 1809–12. http://dx.doi.org/10.1044/2020_persp-20-00129.

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Purpose Hearing loss can have a negative impact on a child's development. Hearing aids, if fitted appropriately, maintained well, and used regularly, can offer benefit to children with hearing loss. Regular reviews of hearing aid users can help to monitor a child's progress and provide timely intervention when problems arise or needs change. This study investigates the follow-up care received by children fitted with hearing aids at a clinic in Malawi. Method A clinical audit was done of the frequency of face-to-face follow-up appointments, following which all pediatric hearing aid users who had not recently received follow-up care were called to invite them for a review, and then a re-audit was conducted. Results Of the 47 children in the audit, 46 had not had a recent face-to-face follow-up appointment. Strenuous efforts were made to call those 46 children to the clinic for review: 20 caregivers agreed to bring their child for review, 10 of whom attended. It was not possible to contact 24 caregivers. Conclusions Reasons for low attendance for review at this service are not known, but may be related to the financial circumstances of the patients' families as well as difficulty in maintaining contact with families. It has not yet been possible to establish a system for routine follow-up care for pediatric hearing aid users at this well-established clinic in a low-income country.

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Chan, Adrienne K., Emmanuel Kanike, Richard Bedell, Isabel Mayuni, Ruth Manyera, William Mlotha, Anthony D. Harries, Joep J. van Oosterhout, and Monique van Lettow. "Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother-to-child transmission services at antenatal care in Zomba District, Malawi." Journal of the International AIDS Society 19, no. 1 (January 2016): 20672. http://dx.doi.org/10.7448/ias.19.1.20672.

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Uwemedimo, Omolara T., Todd P. Lewis, Elsie A. Essien, Grace J. Chan, Humphreys Nsona, Margaret E. Kruk, and Hannah H. Leslie. "Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi." BMJ Global Health 3, no. 2 (March 2018): e000506. http://dx.doi.org/10.1136/bmjgh-2017-000506.

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BackgroundPneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi.MethodsData were obtained from the 2013–2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity.Results3136 clinical visits for children 2–59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity.ConclusionsCare quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.

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Muhayimana, Alice, Donatilla Mukamana, Jean Pierre Ndayisenga, Olive Tengera, Josephine Murekezi, Josette Uwacu, Eugenie Mbabazi, and Joyce Musabe. "Implications of COVID-19 Lockdown on Child Preparedness among Rwandan Families." Research Journal of Health Sciences 8, no. 3 (October 9, 2020): 214–20. http://dx.doi.org/10.4314/rejhs.v8i3.8.

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The world is currently facing the fatal viral pandemic called coronavirus disease 2019 (COVID-19), earlier named 2019-novel coronavirus (2019- nCoV). Every country of the world keeps responding to the challenges posed by covid-19 in all aspects of human endeavour with high demand and burden on health care. The report of the first case in Rwanda on 14th March 2020 was accompanied by actions to drive control measures by the government of Rwanda importantly to prevent the spread of COVID-19. Those measures included education on personal preventive behaviours, social distancing and restricting the movement of people locally, nationally and internationally resulting to lockdown that allowed only essential services. Lockdown has particularly affected Rwandan families with pregnant mothers in the context of childbirth preparation in different aspects. This review paper articulates the possible various dimensions of influence of the COVID-19 lockdown on birth preparedness by families and the possible maternal and neonatal health adverse outcomes that may be associated. This is with the intention of helping health care providers and other stakeholders anticipate, track and prepare for appropriate mitigation to reduce maternal-neonatal morbidity and mortality. French title: Implications du verrouillage de COVID-19 sur la préparation des enfants dans les familles RwandaisesLe monde est actuellement confronté à la pandémie virale mortelle appelée maladie à coronavirus 2019 (COVID-19), précédemment appelée 2019-nouveau coronavirus (2019-nCoV). Chaque pays du monde continue de répondre aux défis posés par le Covid-19 dans tous les aspects de l'activité humaine avec une forte demande et un fardeau sur les soins de santé. Le rapport du premier cas au Rwanda le 14e mars 2020 a été accompagné d'actions à conduire des mesures de contrôle par le gouvernement du Rwanda important pour prévenir la propagation de Covid-19. Ces mesures comprenaient une éducation sur les comportements personnels de prévention, la distanciation sociale et la restriction de la circulation des personnes aux niveaux local, national et international, entraînant un verrouillage qui n'autorisait que les services essentiels. Le verrouillage a particulièrement affecté les familles Rwandaises de mères enceintes dans le cadre de la préparation à l'accouchement sous différents aspects. Cet article de synthèse articule les différentes dimensions possibles de l'influence du verrouillage du COVID-19 sur la préparation à la naissance des familles et les éventuels effets indésirables sur la santé maternelle et néonatale qui peuvent être associés. Ceci dans le but d'aider les prestataires de soins de santé et les autres parties prenantes à anticiper, suivre et préparer des mesures d'atténuation appropriées pour réduire la morbidité et la mortalité materné-néonatales.

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Kainga, Hamilton Wales, Steven Ssendagire, Jacquellyn Nambi Ssanyu, Sarah Nabukeera, Noel Namuhani, and Fred Wabwire Mangen. "Proportion of children aged 9–59 months reached by the 2017 measles supplementary immunization activity among the children with or without history of measles vaccination in Lilongwe district, Malawi." PLOS ONE 16, no. 1 (January 11, 2021): e0243137. http://dx.doi.org/10.1371/journal.pone.0243137.

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Background The measles Supplementary Immunization Activity (SIA) was implemented in June, 2017 to close immunity gaps by providing an additional opportunity to vaccinate children aged between 9 months and up to 14 years in Lilongwe District, Malawi. This study was conducted to determine the proportion of eligible children that were reached by the 2017 measles SIA among those children with or without history of measles vaccination, and possible reasons for non-vaccination. Methods A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 19 households from each of the 25 clusters (villages) that were randomly selected in Lilongwe District. A child was taken to have been vaccinated if the caretaker was able to explain when and where the child was vaccinated. Eight Key Informant Interviews (KIIs) were conducted with planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between non-vaccination and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with non-vaccination of eligible children in this study. Results A total of 476 children and their caretakers were surveyed. The median age of the children was 52.0 months. Overall, 41.2% [95% CI 36.8–45.7] of the children included in the study were not vaccinated during the SIA. Only 59.6% of children with previous measles doses received SIA dose; while 77% of those without previous measles vaccination were reached by the SIA. Low birth order, vaccination history under routine services, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the SIA were significantly associated with non-vaccination among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers’ perspectives), poor delivery of health education, logistical and human resource challenges as possible reasons for non-vaccination. Conclusion Many children (41%) were left unvaccinated during the SIA and several factors were found to be associated with this finding. The Lilongwe District Health Team should endeavor to optimize routine immunization program; and community mobilization should be intensified as part of SIA activities.

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Topp, Stephanie M., Nicole B. Carbone, Jennifer Tseka, Linda Kamtsendero, Godfrey Banda, and Michael E. Herce. "“Most of what they do, we cannot do!” How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi." BMJ Global Health 5, no. 6 (June 2020): e002220. http://dx.doi.org/10.1136/bmjgh-2019-002220.

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BackgroundIn the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi’s three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT.MethodsWe conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2–4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches.ResultsAcross all three models, PMTCT LHWs carried out a number of ‘targeted’ activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women’s fears and uncertainties; (ii) enhancing women’s social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members’ recognition of and trust in services.ConclusionPMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the ‘treat-all’ era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.

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Xue, Jiayin, Zenabu Mhango, Irving F. Hoffman, Innocent Mofolo, Esmie Kamanga, James Campbell, Greg Allgood, et al. "Use of nutritional and water hygiene packages for diarrhoeal prevention among HIV-exposed infants in Lilongwe, Malawi: an evaluation of a pilot prevention of mother-to-child transmission post-natal care service." Tropical Medicine & International Health 15, no. 10 (August 4, 2010): 1156–62. http://dx.doi.org/10.1111/j.1365-3156.2010.02595.x.

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Grace, Debra, and Aron O’Cass. "Child care services." European Journal of Marketing 37, no. 1/2 (February 2003): 107–32. http://dx.doi.org/10.1108/03090560310453993.

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Lungu, Florence, Address Malata, Ellen Chirwa, and Ida Mbendera. "Quality assessment of focused antenatal care services in Malawi." African Journal of Midwifery and Women's Health 5, no. 4 (October 2011): 169–75. http://dx.doi.org/10.12968/ajmw.2011.5.4.169.

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Majamanda, Maureen Daisy, Tiwonge Ethel Mbeya Munkhondya, Miriam Simbota, and Maria Chikalipo. "Family Centered Care versus Child Centered Care: The Malawi Context." Health 07, no. 06 (2015): 741–46. http://dx.doi.org/10.4236/health.2015.76088.

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Adams, Yenupini Joyce, Manfred Stommel, Adejoke Ayoola, Mildred Horodynski, Address Malata, and Barbara Smith. "Use and Evaluation of Postpartum Care Services in Rural Malawi." Journal of Nursing Scholarship 49, no. 1 (October 25, 2016): 87–95. http://dx.doi.org/10.1111/jnu.12257.

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Muheriwa, Sadandaula, Angela Chimwaza, Alfred Maluwa, and Martha Kamanga. "Prevention of mother to child transmission of HIV services in Malawi." African Journal of Midwifery and Women's Health 6, no. 3 (July 2012): 139–44. http://dx.doi.org/10.12968/ajmw.2012.6.3.139.

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Lilford, Philippa. "Mental health in Malawi." BJPsych International 17, no. 2 (November 20, 2019): 32–33. http://dx.doi.org/10.1192/bji.2019.28.

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This is a reflective essay about the time I spent volunteering in mental healthcare in Malawi, prior to commencing my psychiatry training. The burden of illness I saw was enormous and the resources very limited; however, I describe some particular experiences where we were able to deliver excellent care, and which made me reflect about mental health services in low-income countries in general. Details of the patients discussed in this essay have been fully anonymised.

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Kayambankadzanja, Raphael. "Emergency and critical care services in Malawi: Findings from a nationwide survey of health facilities." Malawi Medical Journal 32, no. 1 (March 31, 2020): 19–23. http://dx.doi.org/10.4314/mmj.v32i1.5.

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BackgroundGlobally, critical illness causes up to 45 million deaths every year. The burden is highest in low-income countries such as Malawi. Critically ill patients require good quality, essential care in emergency departments and in hospital wards to avoid negative outcomes such as death. Little is known about the quality of care or the availability of necessary resources for emergency and critical care in Malawi. The aim of this study was to assess the availability of resources for emergency and critical care in Malawi using data from the Service Provision Assessment (SPA).MethodsWe conducted a secondary data analysis of the SPA – a nationwide survey of all health facilities. We assessed the availability of resources for emergency and critical care using previously developed standards for hospitals in low-income countries. Each health facility received an availability score, calculated as the proportion of resources that were present. Resource availability was sub-divided into the seven a-priori defined categories of drugs, equipment, support services, emergency guidelines, infrastructure, training and routines.ResultsOf the 254 indicators in the standards necessary for assessing the quality of emergency and critical care, SPA collected data for 102 (40.6%). Hospitals had a median resource availability score of 51.6% IQR (42.2-67.2) and smaller health facilities had a median of 37.5% (IQR 28.1-45.3). For the category of drugs, the hospitals’ median score was 62.0% IQR (52.4-81.0), for equipment 51.9% IQR (40.7-66.7), support services 33.3% IQR (22.2-77.8) and emergency guidelines 33.3% IQR (0-66.7). SPA did not collect any data for resources in the categories of infrastructure, training or routines. ConclusionHospitals in Malawi lack resources for providing emergency and critical care. Increasing data about the availability of resources for emergency and critical care and improving the hospital systems for the care of critically ill patients in Malawi should be prioritized.

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Talama, George C., Mairead Shaw, Jordan Maloya, Tafwirapo Chihana, Lawrence Nazimera, Emily B. Wroe, and Chiyembekezo Kachimanga. "Improving uptake of cervical cancer screening services for women living with HIV and attending chronic care services in rural Malawi." BMJ Open Quality 9, no. 3 (September 2020): e000892. http://dx.doi.org/10.1136/bmjoq-2019-000892.

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Malawi has the second highest age-standardised incidence rate and the highest mortality rate of cervical cancer in the world. Though the prevalence of HIV is currently 11.7% for Malawian women of reproductive age, cervical cancer screening rates remain low. To address this issue, we integrated cervical cancer screening into a dual HIV and non-communicable disease clinic at a rural district hospital in Neno, Malawi. The project was implemented between January 2017 and March 2018 using the Plan-Do-Study-Act model of quality improvement (QI). At baseline (January to December 2016), only 13 women living with HIV were screened for cervical cancer. One year after implementation of the QI project, 73% (n=547) of women aged 25 to 49 years living with HIV enrolled in HIV care were screened for cervical cancer, with 85.3% of these receiving the screening test for the first time. The number of women living with HIV accessing cervical cancer services increased almost 10 times (from four per month to 39 per month, p<0.001). Key enablers in our QI process included: strong mentorship, regular provision of cervical cancer health talks throughout the hospital, nationally accredited cervical cancer prevention training for all providers, consistent community engagement, continuous monitoring and evaluation, and direct provision of resources to strengthen gaps in the public system. This practical experience integrating cervical cancer screening into routine HIV care may provide valuable lessons for scale-up in rural Malawi.

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Machira, Kennedy, and Martin Palamulen. "Rural–urban differences in the use of postnatal care services in Malawi." Journal of Egyptian Public Health Association 92, no. 1 (March 1, 2017): 1–10. http://dx.doi.org/10.21608/epx.2017.7003.

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Machira, Kennedy, and Martin Palamulen. "Rural–urban differences in the use of postnatal care services in Malawi." Journal of Egyptian Public Health Association 92, no. 1 (March 1, 2017): 1–10. http://dx.doi.org/10.21608/epx.2018.6645.

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Waterlow, JC. "Intensive nursing care of kwashiorkor in Malawi." Acta Paediatrica 89, no. 2 (January 2, 2007): 138–40. http://dx.doi.org/10.1111/j.1651-2227.2000.tb01204.x.

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Manary, MJ, and DR Brewster. "Intensive nursing care of kwashiorkor in Malawi." Acta Paediatrica 89, no. 2 (January 2, 2007): 203–7. http://dx.doi.org/10.1111/j.1651-2227.2000.tb01217.x.

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Gunda, Andrews, Aurelie Jousset, Timothy Tchereni, Jessica Joseph, and Victor Mwapasa. "Integrating HIV and Maternal, Neonatal and Child Health Services in Rural Malawi." JAIDS Journal of Acquired Immune Deficiency Syndromes 75 (June 2017): S132—S139. http://dx.doi.org/10.1097/qai.0000000000001367.

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Richardson, Jim, and Judy Edwards. "Integrating services in community child care." Nursing Standard 8, no. 7 (November 3, 1993): 32–35. http://dx.doi.org/10.7748/ns.8.7.32.s41.

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Kerbl, Reinhold, Georg Ziniel, Petra Winkler, Claudia Habl, Rudolf Püspök, and Franz Waldhauser. "Child Health Care Services in Austria." Journal of Pediatrics 177 (October 2016): S35—S47. http://dx.doi.org/10.1016/j.jpeds.2016.04.039.

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Lindsay, Amy E., and Stephen Byers. "Evaluation of undergraduate psychiatry teaching in Malawi." BJPsych. International 12, S1 (May 2015): S—9—S—11. http://dx.doi.org/10.1192/s2056474000000775.

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In Malawi, mental health services account for only 2% of the health budget; there are just 4.5 full-time psychiatrists and 433 psychiatric beds. The Scotland Malawi Mental Health Education Project (SMMHEP) aims to provide sustainable support for psychiatric training for healthcare professionals and has increased the number of psychiatrists in the country. There has been a recent change in the educational programme in order to maximise clinical exposure and experience, particularly with the care of in-patients. The new programme has had a positive effect on students' attitudes towards psychiatry and their consideration of psychiatry as a career. This paper supports the ongoing work SMMHEP does in developing psychiatric services through education.

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Adams, Yenupini Joyce. "Strategies to Increase Use of Postpartum Care Services for Women in Rural Malawi." Journal of Obstetric, Gynecologic & Neonatal Nursing 48, no. 3 (June 2019): S139. http://dx.doi.org/10.1016/j.jogn.2019.04.232.

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Yasuoka, Masaya, and Atsushi Miyake. "Effectiveness of Child Care Policies in an Economy with Child Care Services." Modern Economy 03, no. 05 (2012): 658–70. http://dx.doi.org/10.4236/me.2012.35085.

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Johns, Benjamin, Spy Munthali, Damian G. Walker, Winford Masanjala, and David Bishai. "A cost function analysis of child health services in four districts in Malawi." Cost Effectiveness and Resource Allocation 11, no. 1 (2013): 10. http://dx.doi.org/10.1186/1478-7547-11-10.

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Chokotho, Linda, Wakisa Mulwafu, Isaac Singini, Yasin Njalale, Limbika Maliwichi-Senganimalunje, and Kathryn H. Jacobsen. "First Responders and Prehospital Care for Road Traffic Injuries in Malawi." Prehospital and Disaster Medicine 32, no. 1 (December 7, 2016): 14–19. http://dx.doi.org/10.1017/s1049023x16001175.

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AbstractIntroductionRoad traffic collisions are a common cause of injuries and injury-related deaths in sub-Saharan Africa (SSA). Basic prehospital care can be the difference between life and death for injured drivers, passengers, and pedestrians.ProblemThis study examined the challenges associated with current first response practices in Malawi.MethodsIn April 2014, focus groups were conducted in two areas of Malawi: Karonga (in the Northern Region) and Blantyre (in the Southern Region; both are along the M1 highway), and a qualitative synthesis approach was used to identify themes. All governmental and nongovernmental first response organizations identified by key informants were contacted, and a checklist was used to identify the services they offer.ResultsAccess to professional prehospital care in Malawi is almost nonexistent, aside from a few city fire departments and private ambulance services. Rapid transportation to a hospital is usually the primary goal of roadside care because of limited first aid knowledge and a lack of access to basic safety equipment. The key informants recommended: expanding community-based first aid training; emphasizing umunthu (shared humanity) to inspire bystander involvement in roadside care; empowering local leaders to coordinate on-site responses; improving emergency communication systems; equipping traffic police with road safety gear; and expanding access to ambulance services.ConclusionPrehospital care in Malawi would be improved by the creation of a formal network of community leaders, police, commercial drivers, and other lay volunteers who are trained in basic first aid and are equipped to respond to crash sites to provide roadside care to trauma patients and prepare them for safe transport to hospitals.ChokothoL, MulwafuW, SinginiI, NjalaleY, Maliwichi-SenganimalunjeL, JacobsenKH. First responders and prehospital care for road traffic injuries in Malawi. Prehosp Disaster Med. 2017;32(1):14–19.

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Yusof, K., YL Wong, GL Ooi, and F. Hamid-Don. "Child Care Services in Malaysia: An Overview." Asia Pacific Journal of Public Health 1, no. 3 (July 1987): 11–16. http://dx.doi.org/10.1177/101053958700100303.

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Sipila, Jorma, and Johanna Korpinen. "Cash versus Child Care Services in Finland." Social Policy and Administration 32, no. 3 (September 1998): 263–77. http://dx.doi.org/10.1111/1467-9515.00102.

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Hagen, Jan L. "Child care services in the JOBS program." Children and Youth Services Review 26, no. 8 (August 2004): 697–710. http://dx.doi.org/10.1016/j.childyouth.2004.02.014.

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van den Akker, T., M. Bemelmans, N. Ford, M. Jemu, E. Diggle, S. Scheffer, I. Zulu, A. Akesson, and J. Shea. "HIV care need not hamper maternity care: a descriptive analysis of integration of services in rural Malawi." BJOG: An International Journal of Obstetrics & Gynaecology 119, no. 4 (January 18, 2012): 431–38. http://dx.doi.org/10.1111/j.1471-0528.2011.03229.x.

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Park, Sun-Wook. "Factors that Influence the Type of Child Care Services and Child Care Expenses." Korean Journal of Human Ecology 20, no. 4 (August 31, 2011): 831–47. http://dx.doi.org/10.5934/kjhe.2011.20.4.831.

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Chimtembo, Lydia Kanise, Alfred Maluwa, Angela Chimwaza, Ellen Chirwa, and Mercy Pindani. "Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi." Open Journal of Nursing 03, no. 04 (2013): 343–50. http://dx.doi.org/10.4236/ojn.2013.34046.

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Machira, Kennedy, and Martin Palamuleni. "Women’s perspectives on quality of maternal health care services in Malawi." International Journal of Women's Health Volume 10 (January 2018): 25–34. http://dx.doi.org/10.2147/ijwh.s144426.

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Rosenberg, Nora E., Nivedita L. Bhushan, Dhrutika Vansia, Twambilile Phanga, Bertha Maseko, Tiyamike Nthani, Colleta Libale, et al. "Comparing Youth-Friendly Health Services to the Standard of Care Through “Girl Power-Malawi”." JAIDS Journal of Acquired Immune Deficiency Syndromes 79, no. 4 (December 2018): 458–66. http://dx.doi.org/10.1097/qai.0000000000001830.

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Tomoka, T., N. D. Montgomery, C. Kampani, B. M. Dhungel, N. G. Liomba, S. Gopal, and Y. Fedoriw. "Developing and expanding pathology services to support clinical care and research efforts in Malawi." Blood Advances 1, Suppl (December 8, 2017): 5–7. http://dx.doi.org/10.1182/bloodadvances.2017gs102161.

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