Malawi Medical Journal最新文献

{"title":"Experiences of health care workers' on interprofessional collaborative practice at Mzuzu Central and Ntcheu District hospitals","authors":"I. Chamangwana, D. Jere, A. Kazembe","doi":"10.4314/mmj.v33iS.3","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.3","url":null,"abstract":"Background Interprofessional collaborative practice (ICP) is a new approach to delivery of health care. It is the practice which happens when healthcare providers work together with different professionals such as nurse/midwives, medical officers towards a common goal to improve patient outcomes.There is no evidence on healthcare workers' experiences on ICP in Malawi and a study on healthcare workers experiences would provide insight towards ICP. The objective of this study was to describe healthcare workers' experiences on ICP in model wards. Methods We conducted a qualitative exploratory descriptive study at Mzuzu Central and Ntcheu District Hospitals. We purposely selected nurses, clinical officers and medical doctors out of 25 sampled healthcare workers working in model wards. Data were collected through in-depth interviews using a semi-structured interview guide. Hospital authorities provided permission to conduct the study in their sites. Informed consent was obtained from participants before interviews. The study was approved by College of Medicine Research Committee (COMREC). Content analysis was utilized to analyse data. Results Four key themes emerged describing healthcare workers experiences on ICP:Increased management/leadership support in terms of resources and structures, good communication among staff, learning together as group of qualified healthcare workers and students and increased teamwork. Conclusion This study highlights healthcare workers' experiences on ICP: management support, communication, learning together of healthcare workers and teamwork. Findings can be used to inform management and practice for the development and implementation of ICP in service delivery.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"10 - 15"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45296442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The roles and experiences of preceptors in clinical teaching of undergraduate nursing and midwifery students in Malawi","authors":"Lucky Mhango, D. Jere, G. Msiska, G. Chorwe-Sungani, E. Chirwa","doi":"10.4314/mmj.v33iS.7","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.7","url":null,"abstract":"Introduction Clinical teaching is essential for undergraduate nursing and midwifery students. Registered nurses/midwives trained as preceptors (an experienced nursing/midwifery professional who teaches, supervises and serves as a role model for a student), guide the students during clinical practices. Literature is scanty on the roles and experiences of the preceptors in Malawi. This study explored the roles and experiences of preceptors during clinical teaching of the students. Methods A cross-sectional study utilising quantitative research design was conducted at four tertiary level hospitals; a mental hospital; one mission hospital and five district hospitals. A total of 87 preceptors completed a Clinical Preceptor Experience Evaluation Tool. Data were analysed using SPSS version 20 and descriptive statistics were computed. Analysis of variance (ANOVA) and post hoc analysis were used to determine and test significant differences. Results The study revealed that respondents were confident in performing their preceptor role; with good level of experience and education qualification of BSc in Nursing. ANOVA and post hoc comparisons using the Tukey HSD test indicated that the role domain mean scores for the respondents with 4–5 years of post-registration experience (M = 6.61, SD = 0.36) was significantly different (p=0.02) with those with >9 years (M = 6.13, SD = 0.60). The results showed that respondents with 4 -5 years experience were more confident in their preceptorship role than those with >9 years. Conclusion This study indicates the roles of preceptors in Malawi to involve facilitating students' clinical teaching and learning. It suggests that registered nurses/midwives with a BSc in Nursing are suitable preceptors to facilitate students' clinical teaching and learning. There is revelation that preceptors with more years of post-registration experience are less confident in their preceptorship role performance.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"35 - 39"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48448111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that influence ethical competence among nurses in health facilities in Malawi","authors":"V. Maluwa, G. Mwalabu, G. Msiska","doi":"10.4314/mmj.v33iS.8","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.8","url":null,"abstract":"Background Clinical nurses' (CNs) ethical competence (EC) is essential for nursing practice because it facilitates high-quality care to patients. To develop ethically competent nurses, factors that positively affect EC must be explored and promoted. Few studies have explored ethical issues in Malawi and the aim of this study was to explore the factors that affect EC. Methods This study used a qualitative exploratory design to collect data through in-depth interviews from 10 key informants (KI) and 9 focus group discussions (FGD) in the selected government, CHAM and private hospitals in Malawi. It was conducted between April and May 2019. Data were analysed manually using thematic content analysis. The data were coded, and words with similar meaning were organized into categories from which themes and sub themes were developed. The themes and sub themes are reported as the results of the study. Results One major theme emerged from the thematic content analysis namely: systems influencing EC among nurses in Malawi. The study has identified continuing professional development in ethics, supportive supervision, availability of resources and leadership to be among the major factors that facilitate EC. Factors that hinder EC among the nurses included; inadequate supervision, inadequate resources, lack of teamwork, increased workload coupled with inadequate nursing staff. Conclusion This study has exposed the factors that influence EC in health facilities and shown that nurse leaders are key to enhancing EC through continuing ethics education, supportive supervision, staffing and provision of resources. Therefore, all the stakeholders in nursing should support the efforts to remove the factors that hinder EC in the health facilities.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"40 - 45"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46445754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Duration of Untreated Psychosis: Exploring Psychosocial and Clinical Predictors of Duration of Untreated Psychosis in First-Episode Psychotic Patients in Mzuzu, Malawi.","authors":"Japhet Myaba, Charles M Mwale, Vincent C Jumbe","doi":"10.4314/mmj.v33iS.5","DOIUrl":"10.4314/mmj.v33iS.5","url":null,"abstract":"<p><strong>Introduction: </strong>The duration of untreated Psychosis (DUP) is a modifiable factor in the management and outcome of patients with psychosis. However, its predictive factors have not been studied much in Malawi. Our study was aimed at determining the psychosocial and clinical predictors of DUP in first episode psychosis in Malawi.</p><p><strong>Method: </strong>A quantitative cross-sectional study, using secondary data from an early intervention study project was done in Mzuzu, Malawi. We analysed 140 adult participants enrolled in early intervention project in 2010. Data was collected using abstraction sheet to target predictive factors. We conducted univariate and multivariate logistic regression at confidence interval of 95%. We described the mean DUP, and looked at relationship of clinical and psychosocial factors with DUP.</p><p><strong>Results: </strong>Most participants were male (60%, n=84) and single (51.4%, n=72). The median age of male participants was 31 years (Range=18 to 60), lower than females 35 years (Range=18 to 65). (what were the numbers of females). The majority of the participants' highest education level was secondary school (63.6%, n=89), and most had DUP of ≥ 6 months (74%, n=103). We found mean DUP of 42 months (SD= ±71). Employment status, diagnosis of schizophrenia (OR=10.93, 95% C.I 3.08-38.89), and negative symptoms of psychosis were associated with DUP of ≥ 6 months. Public self-consciousness and social quality of life were associated with long DUP.</p><p><strong>Conclusion: </strong>Our study shows psychosocial and clinical factors that predict long DUP in Malawi. This highlights the need to target these factors when working on first episode psychosis for a better outcome.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"23-29"},"PeriodicalIF":1.2,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of maternal near-miss cases at two selected central hospitals in Malawi","authors":"F. Kachale, A. Malata, G. Chorwe-Sungani, A. Maluwa, E. Chirwa","doi":"10.4314/mmj.v33iS.2","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.2","url":null,"abstract":"Background Maternal near-miss cases occur in larger numbers than maternal deaths hence they require comprehensive analysis when studied. However, there is scarcity of information on determinants of maternal near-miss cases in Malawi. Therefore, this study aimed at establishing the determinants of maternal near-miss cases at two selected central hospitals in Malawi. Methods This was a case control study that utilized a quantitative approach. A random sample of 458 case files comprising maternal near-miss cases (161) and non-cases (297) was drawn using a ratio of 1:1.8. Data were analyzed using Stata 14 to generate descriptive statistics, Chi Square values to describe the data and determine associations among variables and logistic regression was conducted to determine the determinants of maternal near-miss. Results We found significant differences between demographic characteristics (marital status, occupation, admission mode, means of transport and age) of maternal near-miss cases and the non-cases (P<0.05). Age and mode of birth were found to be significantly associated (P<0. 05) with maternal near-miss. Women aged 31–35 years were 3.14 times more likely to experience maternal near-miss [OR=3.14, 95% CI: 1.09, 9.02, p=0.03] compared to those aged less than 20 years. Furthermore, emergency caesarean [OR=4.08, 95% CI: 2.34, 7.09, p=0.001] and laparotomy for uterine rupture [OR=83.49, 95% CI: 10.49, 664.55, P=0.001] were significantly associated with maternal near-miss. Conclusion Among pregnant women, health workers need to pay close attention to factors such as age and mode of birth for them to implement targeted maternal health services in order to reduce incidence of maternal near-miss cases.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"3 - 9"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44647492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘This disease would suit better those who have money’: Insulin-Treated Diabetes Illness Experience in rural Malawi","authors":"Ellen Nkambule, Annie Msosa, Kondwani Wella, G. Msiska","doi":"10.4314/mmj.v33iS.4","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.4","url":null,"abstract":"Background Understanding the illness experience among rural-based insulin-treated diabetic patients has implications for practice and policy. However, there is a lack of in-depth knowledge about insulin-treated diabetic patients' illness experiences in rural Malawi. We explored the experiences of people living with insulin-treated diabetes in rural Malawi. Research Designs and Methods The study used a qualitative narrative inquiry. Participants were identified at Kamuzu Central Hospital Diabetes Clinic. The hospital is a tertiary level health care facility. We purposively selected 10 participants from rural areas attending the clinic. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using Riessman approach of thematic narrative analysis. Results The following five themes emerged: (1) diabetes perceived as the illness for the rich; (2) ‘everything is on a standstill’; (3) dietary challenges of the diabetes illness experience; (4) drug-related challenges associated with the diabetes illness experience and (5) experiencing physical effects of the diabetes illness. Conclusion Rural-based insulin-treated diabetic patients struggled to live with the illness in the context of low resources. There is a need for multi-factorial approaches at both the community and system levels so as to support people living with diabetes in the rural areas in order to improve their experiences.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"16 - 22"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47678505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimenting with mentoring “junior” authors to encourage scientific publications in Malawi","authors":"A. Muula","doi":"10.4314/mmj.v33iS.1","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.1","url":null,"abstract":"Fannie Kachale, Address Mauakowa Malata, Genesis Chorwe-Sungani, Alfred Maluwa, Ellen Chirwa Experiences of health care workers’ on interprofessional collaborative practice at Mzuzu Central and Ntcheu District hospitals..................................................................................................................................................................................10 Immaculate C. Chamangwana, Diana Jere, Abigail Kazembe","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"1 - 2"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49117584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faculty knowledge and skills needs in interprofessional education among faculty at the College of Medicine and Kamuzu College of Nursing, University of Malawi","authors":"Caroline Chitsulo, E. Chirwa, L. Wilson","doi":"10.4314/mmj.v33iS.6","DOIUrl":"https://doi.org/10.4314/mmj.v33iS.6","url":null,"abstract":"Background Undergraduate health professionals' education in Malawi is mostly provided through a uniprofessional approach, even though the World Health Organization (WHO) recommends interprofessional education (IPE) in order to prepare health workers for collaborative practice. Because IPE is not widely practiced in Malawi, faculty may not have the knowledge and skills required for successful IPE implementation. Aim To explore perceived needs for knowledge and skills related to IPE among faculty in undergraduate health professional programs at the University of Malawi - Kamuzu College of Nursing (KCN) and College of Medicine (COM). Design A qualitative exploratory descriptive study capturing the perspectives of purposively selected participants was conducted at the University of Malawi KCN and COM. Data were collected through in-depth interviews (n = 16) and focus group interviews (n=20). Data analysis was done using qualitative content analysis. Findings Faculty perceived the need for being knowledgeable in IPE and understanding its benefits. The need for training in IPE was perceived as key to increasing faculty members' confidence for IPE. Faculty also perceived the need for enhanced skills in interpersonal relationships, communication, and facilitation of learning, conflict resolution, and clinical teaching in order to successfully implement IPE. Conclusion Faculty perceived the need to be knowledgeable about IPE, its benefits and the need for enhanced skills related to IPE. The need for formal training in IPE was perceived key for successful implementation of IPE. These findings provide information which can help to identify faculty training needs for IPE and to design faculty training activities.","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"30 - 34"},"PeriodicalIF":0.8,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70575010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Tuberculous Mycobacterial Pulmonary Disease identified during community-based screening for <i>Mycobacterium Tuberculosis</i>: a case report.","authors":"Hussein H Twabi,&nbsp;Madalo Mukoka-Thindwa,&nbsp;Doris Shani,&nbsp;Marriott Nliwasa,&nbsp;Elizabeth L Corbett","doi":"10.4314/mmj.v33i1.10","DOIUrl":"https://doi.org/10.4314/mmj.v33i1.10","url":null,"abstract":"<p><p>There is a rising prevalence of Non-Tuberculous Mycobacterial (NTM) disease in sub-Saharan Africa identified on culture specimens. However, distinguishing mycobacterial colonisations from infection from identified NTMs on culture in the sub-Saharan Africa setting remains to be established. A 49-year-old man presented with the cardinal symptoms of tuberculosis (TB) in a community TB prevalence survey in Blantyre, Malawi. Mycobacteriology was atypical, prompting a line probe assay which revealed Mycobacterium avium complex (MAC) species. The epidemiology of <i>Mycobacterium tuberculosis</i> complex (MTBC) is better known than that of NTM. Up-scaling culture and speciation may be a solution to this gap in knowledge of the burden of disease of NTM. Like most resource-poor settings, TB culture is not routinely done in the diagnosis and management of TB in Malawi. Furthermore, the treatment of NTM is not analogous to that of MTBC. The multi-drug regimens used for NTM disease treatment includes a newer macrolide (azithromycin, clarithromycin), ethambutol, and rifamycin, and require prolonged durations of therapy aimed at facilitating clearance of the mycobacteria and minimizing the emergence of drug resistance. Clinicians must thus be aware of this rising burden of NTM disease and consider other diagnostic options to better investigate this disease in patients.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"33 1","pages":"65-67"},"PeriodicalIF":0.8,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/9a/MMJ3301-0065.PMC8360289.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9106128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence of pulmonary tuberculosis among miners from the Karonga, Rumphi, Kasungu and Lilongwe Districts of Malawi in 2019.","authors":"Ethel Rambiki,&nbsp;Andrew Dimba,&nbsp;Pilirani Banda,&nbsp;Wingston Ng'ambi,&nbsp;Knox Banda,&nbsp;Belaineh Girma,&nbsp;Birru Shight,&nbsp;Levi Lwanda,&nbsp;Isaias Dambe,&nbsp;Jaya Prasad Tripathy,&nbsp;Mumbi Chola,&nbsp;Pascalina Chanda-Kapata,&nbsp;James Mpunga,&nbsp;Damson Kathyola","doi":"10.4314/mmj.v32i4.2","DOIUrl":"https://doi.org/10.4314/mmj.v32i4.2","url":null,"abstract":"<p><strong>Introduction: </strong>Miners in sub-Saharan Africa have a greater risk of tuberculosis (TB) than any other working population in the world. In spite of the presence of large and vulnerable population of miners in Malawi, no previous study has aimed to assess the burden of TB among these miners. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and health-seeking behaviour (HSB) in a population of miners in Malawi, and a range of associated factors. Our goal was to develop a method to identify missing cases of TB.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in the Karonga, Rumphi, Kasungu and Lilongwe districts of Malawi in 2019. We calculated frequencies, proportions, odds ratios (ORs) and their 95% confidence intervals (95% CIs), and used the chi-square test in STATA version15.1 to investigate the burden and magnitude of PTB in the mining sector. Bivariate and multivariate logistic regression models were also fitted for PTB and HSB.</p><p><strong>Results: </strong>Of the 2400 miners approached, we were able to interview 2013 (84%). Of these, 1435 (71%) were males, 1438 (71%) had known HIV status and 272 (14%) had PTB. Multivariate analysis showed that the miners performing informal mining were 50% more likely to develop PTB compared with those in formal mining (adjusted odds ratio [AOR]=1.50, 95% CI: 1.10-2.05, <i>P</i>=0.01). A total of 459 (23% of 2013) miners had presumptive TB. Of these, 120 (26%) sought health care; 80% sought health care at health facilities. Multivariate analysis also showed that miners who experienced night sweats were less likely to seek health care compared with those without night sweats (AOR=0.52, 95% CI: 0.30-0.90, <i>P</i>=0.02).</p><p><strong>Conclusion: </strong>The prevalence of PTB was higher among miners than in the general population. Consequently, targeted TB screening programmes for miners may represent a suitable strategy to adopt if we are to end TB by 2030. Poor health-seeking behaviours among miners is worrisome and further qualitative research is necessary to understand the barriers to accessing health care in these settings.</p>","PeriodicalId":18185,"journal":{"name":"Malawi Medical Journal","volume":"32 4","pages":"184-191"},"PeriodicalIF":0.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/57/MMJ3204-0184.PMC8364790.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39364550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}