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Garvs J, Genzel-Boroviczény O, Phiri A, Schultz A. Improvement of temperature surveillance of neonates in low-resource settings by a simple low-cost device: a descriptive study. BMJ Paediatr Open 2024; 8:e002432. [PMID: 39153824 PMCID: PMC11331896 DOI: 10.1136/bmjpo-2023-002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/26/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Neonatal hypothermia in low-resource settings is prevalent and closely associated with high morbidity and mortality. We examined if an easy-to-read temperature detector device improves health outcomes. METHODS In a descriptive study, 1009 admissions to a neonatal ward in a tertiary care hospital in Lilongwe, Malawi, were analysed and divided into a baseline and a trial group. The data of 531 newborns with standard care (SC) before the trial were compared with 478 newborns during the implementation of the device (device care=DC). Staff and caregivers were trained on using the device and how to react in case of hypothermia. Data were collected from patient files, device documentation sheets, interviews and focus group discussions. Hypothermia was defined as a body temperature <36.5°C. RESULTS During the trial, body temperatures throughout the hospital stay were significantly more often obtained (p<0.0001). The median temperature measurements per newborn per day were 1.3 times with SC and 1.6 times with DC, and mild hypothermia was more frequently detected. Moderate hypothermia was avoided in the lightest weight group possibly contributing to significantly shorter hospital stays of surviving newborns (p=0.007). Many caregivers had difficulties using and interpreting the device correctly, and 47% of the reported colours did not match the registered temperatures. Contrary to the above, a questionnaire and focus group discussions with caregivers and health workers showed a high acceptance and the overall opinion that the device was beneficial. CONCLUSION With more frequent temperature checks, infants with lower birth weight possibly benefited from implementing an easy-to-read continuous temperature indicator, but hypothermia rates remained high. Our data and experiences reveal structural, communicational and consistency/interpretation deficits. Although specifically designed for low-resource settings, the implementation of the device needs a well-working and structured environment, especially regarding staff and caregiver communication.
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Affiliation(s)
- Janneke Garvs
- Department of Pediatrics at Dr von Hauner Children's Hospital, LMU Hospital, Munchen, Germany
| | | | - Ajib Phiri
- Department of Paediatrics, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Andreas Schultz
- Department of Paediatrics, Kamuzu University of Health Sciences, Lilongwe, Malawi
- Section Global Health, University Hospital Bonn, Bonn, Germany
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Mhango P, Nyondo-Mipando AL. Factors influencing fathers' involvement in the care of hospitalized preterm newborns in Balaka, Malawi. BMC Pediatr 2023; 23:432. [PMID: 37644490 PMCID: PMC10463498 DOI: 10.1186/s12887-023-04253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Malawi has one of the highest incidences of premature birth, with twice the mortality compared to full-term. Excluding fathers from preterm newborn care has negative consequences, including father feeling powerless, missed bonding opportunities with the newborn, additional strain on the mother, and negative family dynamics such as breakdown in communication, reduced trust, and strained relationships. In Malawi, there is no deliberate policy to have fathers involved in preterm care despite having high incidence of preterm birth and neonatal mortality. There is also limited literature on the factors that influence fathers' involvement in the care. The aim of the study was to explore factors influencing fathers' involvement in the care of hospitalized preterm newborns. METHODS A descriptive qualitative study design was used, guided by Theory of planned behaviour and the model proposed by Lamb on male involvement. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively and conveniently sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were organized and analyzed using Nvivo software and thematic analysis approach was used because the approach allows deeper understanding of the data, identification of patterns and themes, and provides rich insights into participants' experiences and perspectives. RESULTS The barriers and facilitators that influence a father's involvement in the care of preterm newborn babies include: perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby's physical appearance/nature and health status, feedback from the baby, multiple births, and hospital's physical environment and provision of basic needs. CONCLUSION The study found that fathers value their involvement in caring for hospitalized preterm newborns but face barriers. Evidence-based interventions like education programs, training sessions, and support groups can help fathers overcome barriers and promote better outcomes for infants and families.
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Affiliation(s)
- Patani Mhango
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Blantyre, Malawi.
- Centre for Reproductive Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Blantyre, Malawi.
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Blantyre, Malawi
- Maternal and Fetal Health Group, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
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3
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Schoenmakers S, Aagaard K, Borenstein-Levin L, Kawaza K, van der Meeren LE, Mol BW, Rhoda NR, Shawe J, Allegaert K. Editorial: Preterm birth and placental pathology. Front Endocrinol (Lausanne) 2023; 14:1168185. [PMID: 37077362 PMCID: PMC10106768 DOI: 10.3389/fendo.2023.1168185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus Medical Center (MC), University Medical Center, Rotterdam, Netherlands
- *Correspondence: Sam Schoenmakers,
| | - Kjersti Aagaard
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston TX, United States
| | | | - Kondwani Kawaza
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lotte Elisabeth van der Meeren
- Department of Pathology, Erasmus Medical Center (MC), University Medical Center, Rotterdam, Netherlands
- Department of Pathology, Leiden Medical University Center (LUMC), Leiden, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Nathasha Raygaan Rhoda
- Groote Schuur Hospital, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Jill Shawe
- Faculty of Health, University of Plymouth, Devon, United Kingdom
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- South West Clinical School, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus Medical Center, Rotterdam, Netherlands
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4
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Prang KH, Mamani-Mategula E, Verbunt E, Chipeta E, Ataide R, Mwangi M, Phiri K, Pasricha SR, Kelaher M, Manda-Taylor L. An implementation research programme to support an intravenous iron intervention for pregnant women with moderate and severe anaemia in Malawi: study protocol. Implement Sci Commun 2022; 3:68. [PMID: 35729604 PMCID: PMC9210048 DOI: 10.1186/s43058-022-00299-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Antenatal iron supplementation is critical to maternal and child health; however, access and adherence to oral iron are inconsistent in many low- and middle-income countries (LMICs). Modern intravenous (IV) iron products have become available in high-income clinical settings and provide an opportunity to deliver high doses of iron in a single-short infusion during pregnancy. However, there is limited knowledge of the drivers and barriers for such an intervention to be effectively delivered and upscaled in LMICs. In this study protocol, we describe the implementation research programme to support an IV iron intervention in Malawi for pregnant women with moderate and severe anaemia. Methods The implementation research programme has three phases, each guided by implementation science conceptual frameworks. In Phase 1, we will conduct formative research (context assessment of the health system with key informant interviews) to determine how IV iron can be effectively introduced into routine antenatal care. We will use the findings to co-develop potential strategies with end-users and healthcare providers to improve intervention implementation. In Phase 2, we will disseminate the implementation strategies to support the uptake and delivery of the intervention in the study settings. In Phase 3, the intervention will be implemented, and we will conduct formative evaluation (interviews with end-users, healthcare providers, and analysis of health services data) to investigate the feasibility and acceptability of the intervention and strategies. We will also identify processes and contextual factors that facilitate or impede the delivery and uptake of IV iron. Discussion In LMICs, modern IV iron products present a novel opportunity to rapidly cure moderate and severe anaemia in pregnancy, thereby improving maternal and child health outcomes. This implementation research programme will provide guidance and recommendations on how best an IV iron intervention for pregnant women with anaemia can be implemented in an LMIC setting like Malawi. We will develop locally relevant and culturally appropriate implementation strategies by engaging with key stakeholders (pregnant women, healthcare providers, and policymakers) and identifying factors likely to facilitate successful implementation. The findings of this research can guide the implementation of an IV iron intervention in Malawi and other LMICs.
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Lydon MM, Lwesha V, Likomwa D, Chimtembo L, Guenther T, Longwe M. Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00727. [PMID: 36041831 PMCID: PMC9426989 DOI: 10.9745/ghsp-d-21-00727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/14/2022] [Indexed: 12/02/2022]
Abstract
Successful kangaroo mother care (KMC) efforts must understand and address social norms that influence this practice. The current study offers a model for how to connect social norms analysis to specific actions to improve KMC implementation. Introduction: Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program. Methods: In this qualitative study, we conducted 11 focus group discussions and 20 in-depth interviews. Participants were identified through purposive and snowball sampling and included pregnant women, parents engaged in KMC, health workers, community members, and religious leaders. Audio recordings were transcribed and translated into English. An inductive thematic analysis was applied. Results: Our analysis revealed 3 key injunctive norms influencing KMC engagement in this setting: (1) a perception that although preterm infants are abnormal, they should still be cared for, (2) an understanding that men should provide for their families while women should care for their families, and (3) families and communities should support one another. These norms operated at the community, family, household, and individual levels. Community members enforced social norms but also offered social support. Family members supported KMC parents as well. Both KMC parents actively engaged in the practice; however, their interest in and ability to manage its demands were influenced by the prevailing social norms, their economic situation, family obligations, and the mother’s health status. Conclusion: KMC efforts can be strengthened by incorporating context-specific actions to bolster social norms that align with KMC and shift those that discourage it. Activities must include a focus on the community and family levels to engender meaningful change at the household level.
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Chamanga R, Katumbi C, Gadama L, Kawalazira R, Dula D, Makanani B, Dadabhai S, Taha TE. Comparison of adverse birth outcomes among HIV-infected and HIV-uninfected women delivering in high and low risk settings in the era of universal ART in Malawi: a registry study. Paediatr Int Child Health 2021; 41:112-122. [PMID: 33881967 DOI: 10.1080/20469047.2021.1874200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.Aim: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infected women receiving lifelong ART and HIV-uninfected women giving birth in low- and high-risk settings in Malawi.Methods: This observational, registry study was conducted from January 2016 to August 2017 in one large, tertiary referral hospital and four primary healthcare (PHC) facilities in Blantyre, Malawi. Women who delivered singleton live births or stillbirths of ≥20 weeks gestation were included in the analysis. Descriptive and stratified analyses were conducted using χ2 tests and multivariable logistic models to control for maternal age, gravidity and health facility.Results: A total of 14,233 births were included in the analysis (7715 from the tertiary hospital and 6518 from PHC facilities). In the univariable analysis, there were no differences in rates of LBW (6.7% vs 6.4%) and PTB (42.5% vs 42.0%) between HIV-infected and -uninfected women delivering in PHC facilities. However, differences in LBW were significantly higher in HIV-infected women in multivariable analysis (LBW aOR 1.40, 95% CI 1.01-1.95). Rates of LBW and PTB were significantly higher in HIV-infected women than in uninfected women delivering at the tertiary hospital (LBW 17.6% vs 13.2%, aOR 1.53, 95% CI 1.27-1.85; PTB 28.2% vs 24.9%, aOR 1.37, 95% CI 1.17-1.60)Conclusion: Rates of adverse birth outcomes are significantly higher in HIV-infected women than in HIV-uninfected women, and this is more apparent in high-risk hospital settings than in low-risk PHC settings.
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Affiliation(s)
- Rachel Chamanga
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Chaplain Katumbi
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Luis Gadama
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rachel Kawalazira
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Dingase Dula
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Bonus Makanani
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nyondo-Mipando AL, Kinshella MLW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Njirammadzi J, Hiwa T, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K. "It brought hope and peace in my heart:" Caregivers perceptions on kangaroo mother care services in Malawi. BMC Pediatr 2020; 20:541. [PMID: 33261568 PMCID: PMC7709227 DOI: 10.1186/s12887-020-02443-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Kangaroo mother care (KMC) is an effective intervention for preterm and low birth weight infants. Effective implementation of KMC relies on a multidisciplinary team centering on the newborn’s caregiver, who delivers care with support from health care workers. This study explored the experiences of caregivers on the implementation of KMC. Methods We conducted a descriptive qualitative study in the phenomenological tradition, an interpretative approach to describe the caregivers’ lived experience with KMC at four health facilities in Malawi from April and June 2019 through 10 non-participatory observations and 24 face-to-face interviews. We drew a purposive sample of 14 mothers, six fathers, three grandmothers, and one grandfather of infants receiving KMC in three secondary and one tertiary level hospitals. Data were analyzed following a thematic approach. Results Caregivers had limited information on KMC before admission with most of the information learned from peers rather than medical professionals. Stories of positive outcomes following KMC contributed to a shift in perceptions of premature babies and acceptability of KMC as an effective intervention. Unintended consequences resulting from admission due to KMC disrupts responsibilities around the home and disrupts economic activities. Gender division of roles exists with the implementation of KMC and a mother’s support networks are crucial. Conclusion Kangaroo mother care is feasible and acceptable among caregivers. KMC babies are described more positively with the potential to grow into strong and healthy children. KMC remains focused on the mother, which undervalues the important roles of her support network. A change in the nomenclature from kangaroo mother care to kangaroo care would include fathers and others delivering care.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi. .,College of Medicine, IMCHA Project, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | - Felix Chikoti
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | | | | | - Mwai Banda
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | - Laura Newberry
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jenala Njirammadzi
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | - Queen Dube
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth Molyneux
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
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Valentine GC, Chiume M, Hagan J, Kazembe P, Aagaard KM, Patil M. Neonatal mortality rates and association with antenatal corticosteroids at Kamuzu Central Hospital. Early Hum Dev 2020; 151:105158. [PMID: 32871453 DOI: 10.1016/j.earlhumdev.2020.105158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/15/2020] [Accepted: 08/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Malawi has one of the highest child mortality rates in the world, and neonates account for nearly half of all under-five mortality. No previous study has reported neonatal outcomes in Malawi over 12 months. We aimed to evaluate outcomes in the neonatal intensive care unit (NICU) at Kamuzu Central Hospital (KCH) and to determine if there was an association between increased survival and antenatal corticosteroid (ACS) exposure. STUDY DESIGN We introduced a prospective, observational electronic database to collect 122 de-identified variables related to neonatal outcomes for all neonates admitted to the KCH NICU over 12 months. Patients with congenital anomalies were excluded. We compared neonatal mortality rates in neonates who were exposed to ACS compared to those who were not. Statistical methodology included the Wilcoxon rank sum test, Fisher's exact test, and logistic regression. RESULTS Of 2051 neonates admitted to the KCH NICU, the overall neonatal mortality rate was 23.1% and remained similar across 12 months. Mortality was inversely related to birth weight, and outborn neonates referred to KCH had the highest mortality rate (29%). After controlling for confounding covariates, inborn infants exposed to ACS had significantly lower odds of death compared to those without exposure to ACS (adjusted odds ratio = 0.46, 95% confidence interval: 0.24-0.88, p = 0.020). CONCLUSION Lower birth weight, outborn, and no ACS exposure were associated with increased mortality. ACS was associated with a 54% reduction in odds of mortality in inborn neonates highlighting the need for further evaluations of ACS use in resource-limited settings.
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Affiliation(s)
- Gregory C Valentine
- Department of Pediatrics, Division of Neonatology at University of Washington, United States of America; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, United States of America; Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America.
| | | | - Joseph Hagan
- Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America
| | - Peter Kazembe
- Kamuzu Central Hospital, Lilongwe, Malawi; Baylor College of Medicine Children's Foundation, Malawi
| | - Kjersti M Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, United States of America; Translational Biology & Molecular Medicine, Baylor College of Medicine, United States of America; Center for Microbiome and Metagenomics Research, Baylor College of Medicine, United States of America; Molecular & Human Genetics, Baylor College of Medicine, United States of America; Molecular & Cell Biology at Baylor College of Medicine, United States of America
| | - Monika Patil
- Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America
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