OpenUCT :: Browsing by Author "Shea, Jawaya"

Browsing by Author "Shea, Jawaya"

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Open Access
An assessment of kangaroo mother care among staff in a specialized neonatal intensive care unit, Asmara, Eritrea
(2018) Araya, Elsa Semere; Shea, Jawaya; Bergman, Nils
Introduction: Preterm delivery remains the major cause of newborn infants’ morbidity and mortality globally and more so in low-income countries like Eritrea. Research has shown that the provision of Kangaroo mother care (KMC) can contribute to a reduction in morbidity and mortality among newborn infants. However, there is limited research on the practice of KMC in Eritrea. Methods: A mixed methods approach was adopted in a phenomenographic study to collect the data. Eleven participants with work experience of at least two years were recruited from the Specialised Neonatal Intensive Care Unit (SNICU) at Orotta Paediatric Hospital (OPH), Asmara, Eritrea. Data were collected via individual interviews and observations. Results: The results showed that participants had no prior KMC training and education. In addition, staff had limited knowledge and mixed attitudes about KMC practice. There were also no KMC guidelines and protocols. Furthermore, space was not adequate for full KMC practice except for implementation of the kangaroo position. The researcher’s observation confirmed similar evidence of a lack of availability of a KMC ward and lack of protocols and guidelines. Limited interaction and communication about KMC between participants and parents was also observed. Some of the most common hindrances to KMC practice were the perception that KMC increased staff work load and that it was time consuming. In addition, lack of regular KMC training for staff, lack of a convenient setup and too few staff members were among the hindrances. One staff members also perceived that KMC practice was not culturally accepted. 15 Conclusion: The results of this study showed that there were no proper KMC guidelines and protocols in the ward. In addition, only the kangaroo position was practiced, not the full KMC protocol. Furthermore, staff had limited knowledge and mixed attitudes. The observation component of the research highlighted the lack of space and KMC protocols and guidelines as key limitations for delivering KMC. Therefore, it is recommended that a programme to improve staff knowledge be implemented, that evidence-based KMC guidelines and polices be made available, that the KMC ward be expanded, and that health education about KMC practice be brought to the population through mass media
Open Access
An exploratory descriptive study of the sexual and reproductive health knowledge of postgraduate students at the University of Cape Town.
(2018) Mwamba, Bupe; Shea, Jawaya; Mayers, Pat
Globally and in South Africa, university students’ knowledge of sexual and reproductive health (SRH) is low. This study was conducted in response to the dearth of information about the sexual and reproductive health knowledge of postgraduate students. Research conducted to explore the SRH knowledge of undergraduate students suggests that the level of SRH knowledge among undergraduate students is low. The aim of this study was to determine the SRH knowledge of postgraduate students at University of Cape Town (UCT), in South Africa. A cross sectional survey design was utilized, using an adapted and pretested online questionnaire. All postgraduate students enrolled in the first semester of 2017 (9444) were invited to anonymously complete the online survey. Four hundred and six (406) students completed the online survey, of whom 293 were female and 107 males. The age range of respondents was between 18 years and 57 years, with the median age for both male and female respondents being 24 years. Six survey responses were excluded from the statistical analysis because of incomplete data. Post graduate students from the African continent comprised 90.75% of the respondents. Most respondents were white (51.50%) from both Africa and abroad. The results indicated that respondents knew about sexually transmitted infections, and human immunodeficiency virus (HIV) & acquired immune deficiency syndrome (AIDS). Female respondents were more aware of breast examination, and the role of Papanicolaou smear (Pap smear) in SRH. Almost half of the respondents in this study (49%) stated that they had no need for more information about contraceptives. Lecturers were identified as one of the top five sources of information across faculties, which could suggest that the university environment provides students with important SRH-related information. Most postgraduate students had knowledge of sexual and reproductive health with regards to contraception, Pap smear, clinical breast examination, STIs, HIV and AIDS. Further research should focus on the relationship between SRH knowledge and usage among this population. As university lecturers were identified as an important source of information across faculties, the University should consider the incorporation of SRH education in the broader curriculum and as an integral component of student health services.
Open Access
Assessment of antenatal and intrapartum referrals to Mowbray Maternity Hospital in Cape Town, South Africa
(2017) Mohamed, Ekram; Shea, Jawaya; Greenfield, David
Introduction: A continuous and concerning increase in the number of deliveries at Mowbray Maternity Hospital (MMH) has been noted over the years and now comprises a greater proportion of deliveries compared to deliveries conducted by midwives at midwife obstetric units (MOUs). To date there have been no studies assessing the changes in the pattern of deliveries at MMH. This study describes the antenatal and intrapartum referrals at MMH in 2005 and 2013, to identify any changes and whether or not referrals are appropriate. Method: This is a descriptive study with an analytic component involving review of a sample of hospital folders (138 for 2005 and 246 for 2013) of women who delivered at MMH from January to December 2005 and 2013. Results: The mean age of referred women was 27.259 (SD ± 6.277) years and 27.326 (SD ± 6.025) years in 2005 and 2013, respectively, with no significant statistical difference (p = 0.918). There was also no significant statistical difference (p=0.056) in the proportion of coloured, black or white women who delivered at MMH during 2005 and 2013. In 2005, a total of 27 (52.2 %) delivered women were single, 54 (39.1%) were married and two (1.4%) were divorced. In 2013, a total of 178 (72.4%) women were single, 65 (26.4%) were married and three (1.2%) were divorced, with a significant statistical difference (p < 0.001). In 2005, 75 (54.3%) women were unemployed and 46 (33.3%) were employed, whereas in 2013, 172 (69.9%) women were unemployed and 69 (28%) were employed, which shows a significant statistical difference (p < 0.001). In 2005, women mostly resided in Mitchell's Plain (32.6%), Gugulethu (28.3%) or in Khayelitsha (27.5%). In 2013, most women resided in Mitchell's plain (33.7%), Gugulethu (24.4%), Retreat 48 (19.5%) and Southern Peninsula 31 (12.6%), which represents a significant statistical difference (p= 0.001). 2 The median parity for 2005 sample was 1 (IQR: from 0 to 2), while in 2013 it was 1 (IQR: from 0 to 1). Although most women (94.2% versus 95.1%) booked at antenatal clinics in 2005 and 2013 respectively, with no significant statistical difference (p=0.697), the gestational age at first ANC differed significantly (p < 0.001) (median 24 versus 19 weeks). In 2005, the median number of ANC visits was five (IQR: from 4 to 7) visits, whereas the median was six (IQR: from 5 to 8) visits in 2013, with a significant statistical difference (p= 0.013). Over half of referred women (55.8% and 50.8%) in 2005 and 2013 respectively were delivered by normal vaginal delivery. The remainder had either a caesarean section or assisted delivery, with no significant statistical difference (p=0.139). Most women were referred from MOUs in both 2005 and 2013, at 90.6% and 85.45% respectively, with a significant statistical difference (p < 0.001). During both years virtually all pregnancies were considered high risk and the most common reason for referral was previous caesarean section (18.8% versus 19.9% respectively). For both years most pregnancy referrals experienced one, or more, antenatal risk factors, mainly previous caesarean section at 31 (12.5%), obesity at 27 (11%), prelabour rupture of membranes at 26 (10.6%) and HIV at 24 (9.8%) in 2005 and previous caesarean section accounted for 56 (11.1%), prolonged pregnancy for 51 (10.1), obesity for 50 (9.9%), HIV for 50 (9.9%) and tobacco use for 42 (8.3%) in 2013. The difference was statistically significant (p < 0.001). In 2005, the main intrapartum risk factors were fetal distress (23.6%), failure to progress and preterm labour (18% each). In 2013, fetal distress was most common (36.2%), followed by failure to progress (16.7%). The difference is statistically significant (p=0.034). Conclusion: The Cape Town Metro West health system features a functional maternity referral system. Midwives perform well in referring pregnant women who meet the criteria for high risk. There has been an increase in the number of women referred to the MMH over the study period but in this study group all referrals were found to be appropriate and were compliant with relevant obstetric management protocols. It appears there have not been large shifts in the demographics of referred women over the period reviewed. In addition, the change in the referral pathway has seen Southern Peninsula and Retreat referring to MMH but Khayelitsha no longer referring there. Furthermore, there are emerging risk factors that reflect the epidemiological changes currently being observed in the Cape Town Metro West region.
Open Access
An assessment of the Isoniazid preventative therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay, Eastern Cape Province
(2015) Tucker, Faye Bronwyn; Shea, Jawaya; Amien, Feroza
Introduction: Tuberculosis is the second leading cause of death from an infectious cause worldwide having claimed approximately 1.5 million lives in 2013. Estimates suggest that children account for about six percent of the total number of TB cases globally, however in South Africa this figure is much higher (15%). Young children are at particularly high risk of mortality and significant morbidity from TB. Despite clear evidence that Isoniazid preventative therapy (IPT) can reduce the risk of progression from TB infection to disease, IPT has been a poorly implemented component of national TB control programmes, especially in high TB-burden areas, including South Africa. This study aims to determine current practices regarding the identification and management of child contacts < 5 years in an area with an extremely high TB incidence rate where little background data exists on the topic. It will also assess the operational aspects of the TB control programme relating to the spread of TB to children. Methodology: A cross-sectional descriptive study was conducted using a retrospective review of clinic records from infectious index patients aged ≥15 years at West End clinic in the Nelson Mandela Bay health district in the Eastern Cape Province. A sample size of 246 child contacts (<5 years) was required to obtain a 95% confidence index with a 5% precision. This is based on 20% of eligible child contacts < 5years receiving IPT, as described by van Wyk, et al. (2010). 491 Index patient records were assessed in order to identify 261 child contacts < 5 years of age. Results: Contacts were generally well recorded with only 12.5% of index patient folders having no contacts documented although only 0.53 child contacts <5years were identified per index patient. A total of 261 child contacts < 5 years were identified and of these 184 (70.5%) were screened for TB. Two contacts were started on TB treatment and 108/184 (58.7%) were initiated on TB prevention therapy. For the remaining 74 (40.2%) children who were screened there was no documentation of further management. Adherence to IPT was extremely poor with only 4 (3.7%) children who started TB prevention completing the 24 week course. Female index patients were more likely to have contacts documented and to bring their contacts for screening. Contacts of index 16 patients who had previous TB were less likely to be screened and initiated on TB prevention therapy. The results of the assessment of programmatic factors relating to childhood TB control showed that patients were diagnosed and were rapidly initiated on treatment (median time of 5 days from sputum collection to commencement of treatment). It took a median of 4 days for children to be screened once the index patient had started treatment and a further 2 days (median) for child contacts < 5 years to be initiated on preventative therapy. Conclusion and recommendations: The results of this study are in keeping with those obtained in other settings with a high burden of TB. Although the documentation of contacts in this setting was relatively good, child contacts < 5 years were poorly identified and the fall-out of children at each step from identification to preventative treatment completion was still unacceptably high. Contacts of men and retreatment index patients are at particularly high risk of poor management. Recommendations are made for interventions at national and local level to improve contact management and the documentation thereof.
Open Access
Attitudes and perceptions of males towards contraceptives services in Engela District of Ohangwena Region, Namibia
(2019) Alagba, Alexander Adedotun; Shea, Jawaya; Akpabio, Ebong E
Introduction In sub-Saharan Africa the unmet need for contraception for married couples is estimated to be 24%, with rural, uneducated, poor women generally experiencing a greater risk for unplanned, unwanted pregnancies compared to their urban, educated, well informed counterparts. Recommendations for addressing unmet contraceptive need are inclined to emphasise family planning programmatic efforts. The role of men in contraceptive decisions tends to receive less attention, the perception being that men are often uninvolved and unsupportive of the contraceptive needs of their female partners. This study reviewed the attitudes and perceptions of men about contraceptive services in Engela District of the Ohangwena Region, Namibia. Methods A qualitative study was conducted using Focus Group Discussions (FGD) and Key Informant Interviews (KII) with men and women aged between 18-60 years residing in the Engela district of the Ohangwena Region. Men and women were purposively selected and participated in four and two focus group discussions respectively to explore the subject. Interviews with six influential and respected key informants, including government officials and community leaders were conducted. Data generated from the interviews were transcribed, coded, and content analysis conducted. Based on the research domain, themes and subthemes were generated. Purposive sampling was done. Many people were contacted to participate as participants in the research, some declined from participating due to lack of interest, and it was only those that were keen on participating that were enlisted by the research assistants. Influential leaders, respected in the community were also selected as KII. Results The findings revealed that specific reproductive health issues are common in the community, with a high level of awareness of family planning and contraceptives among men and women, many women having access to contraceptives Yet men held negative views about women’s decision to use contraceptives without their consideration and approval by them. The results indicated that community-level information was not ideal, and should be improved. Conclusion The study showed that most of the men who participated in the study are well informed about family planning and available contraceptive options for both men and women. It also revealed the attitudes and perceptions of men to FP and contraception use of women. However, there is little male involvement in contraceptive decisions.
Open Access
Autism Spectrum Disorder: Assessing the level of knowledge and perceived challenges to early diagnosis and intervention among general practitioners in the city of Tripoli, Libya
(2018) Jubr, Soad; Peterson, Reneva; Shea, Jawaya
Introduction Autism spectrum disorder (ASD) is an important global health problem. It has been shown that early diagnosis and intervention can improve the outcomes in affected children. Lack of knowledge about ASD among health care practitioners can delay the identification of children with ASD as well as early intervention. Currently, a dearth of epidemiological information exists regarding ASD in Africa. The aim of this study was to assess the knowledge of general practitioners (GPs) in Libya regarding ASD and to identify perceived challenges by GPs to early diagnosis and intervention of children with ASD in Libya. The study included the working GPs in the city of Tripoli. Methodology This cross-sectional descriptive study was conducted between 1st June 2017 to 31st August 2017 and utilized an electronic platform, the Research Electronic Data Capture (REDCap) from the University of Cape Town to collect study information. The Knowledge about Childhood Autism among Healthcare Workers (KCAHW) is validated questionnaire that explores health care worker knowledge about ASD across four domains. The KCAHW was used in combination with a more detailed questionnaire which explored challenges to early identification and interventions by GP’s in Libya. Descriptive statistics are reported in percentages and the Wilcoxon rank sum test was used to explore relationships between domain knowledge scores with age and gender as well as years of experience as a GP. Results The number of surveys returned to the REDCap application survey site was 215 which represent a response rate of 58.1%. However, the number of complete responses which could be included in data analysis was found to be only 62, indicating an overall response rate of 16.7%. The median age of the participants was 30 years old, IQR (29-33) years with a female predominance amongst participants (n= 55, 89%). The total median score from the knowledge questionnaire was 10, IQR (8- 12). No statistical differences could be found between domain knowledge scores and participants' age, gender and work practice. Participants showed good knowledge about stereotypical movements and repetitive behaviours in ASD, but 48% were not aware of comorbidities associated with ASD. The main challenges identified by GPs in the management of ASD were lack of awareness, insufficient experience, and health infrastructure in Libya as well as social stigma associated with developmental disorders. Conclusion and recommendations GPs in Libya have limited knowledge about certain aspects of ASD. A number of challenges were identified by GPs which hamper the early identification and management of ASD in Libya. There is a need to improve undergraduate medical training about ASD as well as to offer ongoing medical education to GP’s to improve recognition and management of ASD in Libya. Further research is indicated to explore the epidemiology, clinical spectrum and severity of ASD as well as intervention in Libya
Open Access
Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi
(2011) Van den Akker, Thomas; Shea, Jawaya
Background: In recent years there has been increasing debate about the impact of scaled-up ART and PMTCT programmes on the uptake and outcomes of reproductive health services, in particular the potential detrimental effects of HIV-care on the overall capacity of fragile health systems. The objective of this study was to evaluate changes in the uptake of reproductive health services as well as the main pregnancy outcomes during the scaling up of ART and PMTCT in Thyolo District, Malawi. Methods : Study design: retrospective descriptive district-wide cohort analysis for the period 2005 to 2009. Setting: Thyolo District, an area with around 600,000 inhabitants, an adult HIV-prevalence of 21% and a Total Fertility Rate of 5.7 in 2004. HIV-care including ART and PMTCT was scaled up since 2004 in Thyolo District to reach district-wide coverage in 2007. HIV-care is provided at district hospital, health centre and community health post levels. Outcomes: uptake of antenatal, intrapartum and postpartum care, family planning and treatment of sexually transmitted infections; infrastructural changes, and changes in maternal and perinatal pregnancy outcome. Data collection and analysis: data were collected from facility antenatal, intrapartum and postpartum records, as well as from MoH and MSF databases maintained for routine programme monitoring. Chisquare tests were performed comparing the baseline year (2005) with the year of study end (2009). Results: Uptake of peripartum care had improved markedly by the end of the five-year study period: the percentages of pregnant women who took up antenatal, intrapartum and postpartum care increased by 30%, 25% and 20% respectively. The number of family planning consultations increased by almost 50% and the number of women treated for sexually transmitted infections more than doubled. Interactions between HIV-care and general reproductive health care had positive effects on key health system components, including governance, health financing, human resources and drug supply. Reliable pregnancy outcome indicators for the entire observation period were difficult to obtain due to likely under-reporting of facility-based maternal and perinatal mortality. However, previously documented results from Thyolo show a reduction of facility-based severe maternal complications, including uterine rupture, between 2007 and 2009. Conclusions: Uptake of reproductive health services and facility-based maternal outcomes increased markedly during the period of HIV scale–up. This implies that the scale up of HIV-care did not inhibit, and likely increased, uptake of reproductive health services, while quality improvements in perinatal care could still be successfully implemented. The finding that ART and PMTCT care may be successfully integrated into broader reproductive health services with satisfying outcomes is a strong argument for continued scale up of ART and PMTCT in similar settings.
Open Access
Evaluation of Burnout, Coping Strategies and Resilience in Paediatric Oncology Health Care Workers in Cape Town
(2018) Jimoh, Azeezat M.; Shea, Jawaya; Albertyn, Rene
Background: Burnout is a work-related condition with a significant footprint in the medical profession. It is characterised by emotional exhaustion (EE), depersonalisation (DP), and a low sense of personal accomplishment (PA) at one’s job. Depending on situational and individual factors, the prevalence of burnout among healthcare workers (HCWs) has shown an upward trajectory with peaks in certain medical specialities. Paediatric oncology unit (POU) HCWs are at a high risk of developing burnout because of the immense physical and emotional involvement that can be associated with caring for children with cancer. The burnout process can, however, be influenced by adopted coping strategies and resilience. Research into the phenomenon of burnout and associated factors in POU HCWs is low in South Africa in spite of the global attention it has commanded. Because of the need to institute appropriate and acceptable intervention strategies and to avoid erroneous conclusions often associated with burnout, it is imperative to understand the local prevalence and the possible associated factors. This study, therefore, seeks to establish the prevalence of burnout in POU HCWs and to understand how the adopted coping strategies and level of resilience influence the burnout process in a defined setting. Acknowledging and understanding how these psychosocial factors affect HCWs is fundamental to designing interventions to reduce work-related stress conditions. Objectives: This study seeks to determine the following: prevalence of burnout among POU HCWs in Red Cross War Memorial Children’s Hospital, Cape Town; identify adopted coping strategies by the HCWs; evaluate the level of resilience in the HCWs; and make recommendations that may help reduce burnout in paediatric oncology care and, probably, other fields of health care in South Africa. Methodology: This research used a mixed method approach (quantitative and qualitative) to explore burnout, coping and resilience amongst POU HCWs. A questionnaire consisting of validated instruments (Maslach Burnout Inventory-Human Services Survey [MBI- HSS], Brief Resilience Scale [BRS], the Brief COPE and researcher-designed questions) was used to conduct a survey after obtaining ethical clearance (HREC REF: 051/2017). Depending on preference, electronic or paper-based questionnaires were distributed to POU staff. Data analysis was performed using Microsoft EXCEL (2010 version). Results: The response rate was 50% (n= 25). Five out of the total respondents were dropped due to gross omissions in responses to the survey questions. The majority of the respondents were females (95%), and by profession, nurses had the highest representation (80%). Eightyfive per cent (85%) of the respondents have worked in the POU for more than a year. The burnout prevalence was 15% – 45% across the three dimensions of burnout - high EE (20%), high DP (15%) and reduced PA (45%). The majority (70%) of the respondents were moderately resilient. The coping styles predominantly used by the respondents in this study were positive reframing, religion, acceptance, planning, self-distraction and active coping. The least used coping styles were substance use, denial and behavioural disengagement, which are all maladaptive coping strategies. There was no statistically significant association between burnout and demographic characteristics. However, with a high prevalence of 45%, reduced personal accomplishment (rPA) was also associated with most demographic characteristics. rPA was high in females; age groups 25-25 and 46-60; single and married; respondents with number of children >1; respondents with a graduate level of education; POU professionals that are nurses and administrators; respondents with work experience in medicine and work experience in oncology for less than 10 years. Respondents with low levels of resilience experienced average levels of burnout as evidenced by average EE and DP scores, while those with moderate levels of resilience experienced low burnout as evidenced by low EE and DP scores (P< 0.05) Furthermore, EE and DP correlated negatively with the BRS while PA correlated positively with the BRS. Concerning coping strategies, EE and DP correlated positively with denial, substance use, behavioural disengagement, venting and self-blame. PA correlated positively with emotional support, positive reframing and religion but negatively correlated with active coping. Generally, the respondents expressed the desire for better goal-focused teamwork in the POU as well as the implementation of effective intervention strategies. Conclusion: The prevalence of burnout in this study is between 15% - 45%. The particularly high prevalence of reduced personal accomplishment (45%) is of interest because it cuts across most demographic features. This is suggestive of a stronger influence of situation specific factors, common to all respondents, contributing to burnout. The predominant use of emotion and problem-focused coping methods, and the moderate level of resilience in the majority of the staff appear to be protective against burnout. There is, however, the need and desire for implementation of effective group and institutional intervention programmes for burnout in the POU staff in terms of availability, awareness and accessibility.
Open Access
An exploratory study of the key determinants of self-referral by women in labour to Chris Hani Baragwanath Hospital in the Johannesburg Metro District, South Africa
(2017) Kula, Nonkqubela Carvie; Shea, Jawaya; Michaels, Desireé; Buchmann, Eckhart
Introduction: At Chris Hani Baragwanath Hospital (CHBH) in Johannesburg overcrowding remains a concern as women who have low-risk pregnancies continue to bypass community-based obstetric facilities to deliver at the tertiary hospital. A significant number of self-referred pregnant women had no obstetric risk factors qualifying them for delivery at CHBH Maternity Unit. The primary concern at CHBH was that the management of low-risk maternity patients in high-risk a setting interfered with the care of patients requiring specialist care. Study Objectives: To determine the socio-demographic characteristics of the women who selfrefer to CHBH; to explore the reasons why low-risk patients present at CHB Maternity Hospital in labour, and to determine obstetric risk factors amongst self- referred pregnant women. Methods: A descriptive, cross-sectional study was conducted focusing on self-referred pregnant women who delivered at CHBH and were in the post-natal ward during the study period (26 October 2013 to 03 November 2013). A structured questionnaire was administered by the researcher to each study participant to establish variables of the key determinants of self-referral. The data were analyzed using SPSS version 18 and all tests for statistical significance between appropriate and inappropriate self-referral were carried out at a p=0.05 level of significance with a 95% confidence interval. Results: The total number of deliveries for the study period 26 October 2013 to 3 November 2013 was 514 of which 112 were self-referrals. Only 108 women consented to participate in the study and were subsequently interviewed. The results indicated that of the pregnant women who self-referred to CHBH for delivery (N=108), 58.33% travelled more than 5km, 14,81% were teenagers, 81.48% were single, only 1.85% had no formal education, while 72.22% were unemployed. The results further showed that 47.22% of the women had a history of obstetric risk factors and were appropriate for delivery at CHBH, while the majority (52.78%) were low-risk pregnancies and should have delivered at local MOUs. Analysis of the results showed that age (p=0.042), transport mode (p=0.030), transport cost (p=0.001), transport ownership (p=0.041), distance (p=0.032) and waiting times (p=0.025) had statistically significant influence on self-referral. 22.22% were of the high-risk age-groups (<20 years and >35 years), 2,78% had previous surgery, and 12.04% had medical conditions for which they were on treatment. Conclusion: This study showed that the referral system for maternity care within the Johannesburg Metro Health District is not fully functional. Most of selfreferrals were inappropriate for CHBH. The age of the pregnant woman, transport, distance and waiting times at the service point are key determinants of self-referral.
Open Access
Improving utilisation of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi
(2018) Kachimanga, Chiyembekezo; Shea, Jawaya; van den Akker, Thomas; Gates, Thomas
Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016. Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post-intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) 14 was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar pre-intervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs 15 visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%). Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
Open Access
Improving utilization of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi
(2018) Kachimanga, Chiyembekezo; Shea, Jawaya; van den Akker, Thomas; Gates, Thomas
Introduction: Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016. Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post- intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar preintervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%). Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
Open Access
Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi
(2020-01-06) Kachimanga, Chiyembekezo; Dunbar, Elizabeth L; Watson, Samuel; Cundale, Katie; Makungwa, Henry; Wroe, Emily B; Malindi, Charles; Nazimera, Lawrence; Palazuelos, Daniel; Drake, Jeanel; Gates, Thomas; van den Akker, Thomas; Shea, Jawaya
Abstract Background By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. Methods A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a “counterfactual site” was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. Results Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (− 37, 95% CrI: − 224, 170%). Conclusions In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.
Open Access
The influence of maternal socio-economic status on infant feeding practices and anthropometry of HIV-exposed infants
(2013) Aku, Amwe; Shea, Jawaya; Nikodem, Cheryl
The purpose of this quantitative, descriptive, cross sectional survey was to determine whether maternal socio-economic status has an influence on infant feeding practices, nutrition and growth status of HIV-exposed infants at Delft Community Health Centre. The aim of this study was to describe the influence of maternal socioeconomic status on infant feeding practices and infant anthropometric measurements. Information was collected from 125 mother-infant pairs who presented at the health clinic with infants aged between six weeks to six months. The WHO anthropometry calculator was used to determine the z scores of the anthropometric measurements. One hundred and twenty five Case Report Forms of mother-infant pairs were analyzed. Few infants were underweight if their mothers’ personal income or total household income were more than R800.00 per month, 12.7% and 1% respectively. Nearly twice as many infants (49.6%) of the single mothers were underweight as compared to infants (19.8%) whose parents were married. Similarly, twice as many infants (50%) were underweight if their mothers walked to the health facility compared to 23.8% of infants’ whose mothers’ used taxis. Education and employment status of mothers appear to prevent infants from becoming underweight as twice as many infants (55.8%) were underweight when their mothers did not complete secondary school compared to 23.3% of infants whose mothers did complete secondary school. Nearly four-fold more infants (59.5%) were underweight if their mothers were unemployed compared to those infants (14.9%) whose mother were employed. Housing, the presence of a flush toilet or running tap water in the house did not improve the body mass index of infants. A total of 57.4% of infants whose mothers resided in brick houses, 71.9% of infants whose mothers had access to flush toilets and 57.5% who had running tap water in the house were still underweight. Infants whose mothers lived in houses with less than two rooms or where 3-4 people occupy the house had higher risk of being underweight (54.6% and 40.5% respectively). Underweight children were still prevalent even if the room were occupied by only one person (50%) of 1-2 children (67.2%). All women chose to formula feed their infants after receiving infant feeding counselling. Despite the availability of free replacement feeds there were evidence that infants were not properly fed.
Open Access
Prevention of mother to child transmission of HIV services: viral load testing among pregnant women living with HIV in Mutare District of Manicaland Province, Zimbabwe
(2021) Musanhu, Christine Chiedza Chakanyuka; Eley, Brian; Shea, Jawaya; Chitsike, Inam
Background The human immunodeficiency virus (HIV) is a leading cause of death among women during pregnancy and the postpartum period, especially in areas of high prevalence. In 2018 there were approximately 1.3 million pregnant women living with HIV globally.Infants born to women living with HIV are at increased risk of contracting HIV as the virus can be transmitted to the foetus/ infant during pregnancy, labour, delivery and breastfeeding, posing a serious risk to their survival and well-being. Viral load (VL) testing of pregnant women living with HIV could contribute to improved care, thereby reducing the risk of vertical transmission of HIV from the mother to her infant. Aim The objective of this study was to describe HIV VL testing amongst pregnant women living with HIV at entry into the prevention-of-mother-to-child-transmission (PMTCT) services at selected health facilities in Mutare district of Manicaland Province, Zimbabwe from January to December 2018. Methods This descriptive cross-sectional mixed methods study evaluated the uptake of HIV VL testing amongst pregnant women living with HIV at entry into the prevention-of-mother-to-child transmission (PMTCT) services at 15 health facilities and explored factors that influence the provision of HIV VL testing services. Results Among 383 pregnant women living with HIV enrolled in antenatal care (ANC) and known to be on antiretroviral therapy (ART), only 121 (32%) had a VL sample collected and 106 (88%) received their results. Among these 106 women, 93 (88%) had a VL< 1, 000 copies/mL and 77 (73%) had a VL< 50 copies/mL. The overall median duration from ANC booking to VL sample collection was 87 (IQR, 7-215) days. The duration was significantly longer among pregnant women newly started on ART [207 (IQR, 99-299) days] compared to those already on ART [50 (IQR, 0-162) days], p< 0.001. The median time interval for the return of VL results from date of sample collection was 14 (IQR, 7-30) days. There was no significant difference when this variable was stratified by time of ART initiation. Viral load samples were significantly less likely to be collected at local authority facilities compared to government facilities [aOR=0.28; 95% CI: 0.16- 0.48]. Barriers for VL testing identified by health care providers included staff shortages, nonavailability of consumables and laboratory forms and weaknesses in sample transportation. Additionally, the turnaround time (TAT) was long as VL testing was centralised at the provincial hospital, and results feedback was not done electronically. High levels of knowledge among health care providers (75%) did not translate into high HIV VL testing coverage amongst pregnant women living with HIV. Conclusions and recommendations The low rate of HIV VL testing among pregnant women living with HIV in Mutare district is a cause of concern and needs to be addressed urgently in the interest of contributing to the eliminating mother to child transmission of HIV. The Ministry of Health should consider disseminating ARV and PMTCT guidelines and other policy documents using electronic platforms as these are more accessible and result in quicker dissemination, which may translate into faster implementation of new policies and policy updates. There is need to conduct regular mentorship and supervision processes and establish quality improvement initiatives for PMTCT services. Interventions like alert systems should be implemented for ease of identifying women who require HIV VL testing. Point of care technology and mHealth could reduce VL result turnaround time. All this should be aimed at ensuring that policies and guidelines are implemented, and targets are reached within agreed timeframes, to ensure that positive outcomes can be experienced by all pregnant women living with HIV.

Browsing by Author "Shea, Jawaya"

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