544 research outputs found
Assessing some of the associations with perinatal mortality at Kamuzu central hospital in Lilongwe, Malawi
No full textIncludes bibliographical references.The study objectives were to: determine the prevalence of perinatal mortality (PNM) and causes of early neonatal deaths (ENNDs), describe socio-demographic factors of mothers with PNM and assess some of the associations with PNM at Kamuzu Central Hospital
Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study.
No full textBACKGROUND: In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation. METHODS: Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach. RESULTS: Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector. CONCLUSIONS: Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors
Experience of and factors associated with violence against sexual and gender minorities in nine African countries: a cross-sectional study
No full textObjective
The objective of this research was to assess physical and sexual violence experienced by sexual and gender minorities in nine African countries, and to examine factors associated with violence.
Methods
We conducted an exploratory multi-country cross-sectional study among self-identifying sexual and gender minorities, using a survey tool available in paper and online. Participants were sampled through venue-based and web-based convenience sampling. We analysed data using descriptive statistics and logistic regression, with Stata15.
Findings
Of 3798 participants, 23% were gender minorities, 20% were living with HIV, and 18% had been coerced into marriage. Fifty-six per cent of all participants had experienced physical or sexual violence in their lifetime, and 29% in the past year. Gender minorities had experienced significantly higher levels of violence compared to cisgender (sexual minority) participants. The variable most strongly associated with having experienced violence was being coerced into marriage (AOR, 3.02), followed by people living nearby knowing about one’s sexual orientation and/or gender identity (AOR, 1.90) and living with HIV (AOR, 1.47).
Conclusion
Sexual and gender minorities in Eastern and Southern Africa experience high levels of violence. Sexual orientation and gender identity need to be recognised as risk factors for violence in national and regional law and policy frameworks. States should follow the African Commission Resolution 275 and provide protection against violence based on real or perceived sexual orientation or gender identity
Evaluating complex health financing interventions: using mixed methods to inform further implementation of a novel PBI intervention in rural Malawi
No full textBackground: Gaps remain in understanding how performance-based incentive (PBI) programs affect quality of care and service quantity, whether programs are cost effective and how programs could be tailored to meet client and provider needs while remaining operationally viable. In 2014, Malawi’s Ministry of Health launched the Service Delivery Integration-PBI (SSDI-PBI) program. The program is unique in that no portion of performance bonuses are paid to individual health workers, and it shifts responsibility for infrastructure and equipment procurement from facility staff to implementing partners. This protocol outlines an approach that analyzes processes and outcomes, considers expected and unexpected consequences of the program and frames the program’s outputs relative to its costs. Findings from this evaluation will inform the intended future scale-up of PBI in Malawi. Methods/design: This study employs a prospective controlled before-and-after triangulation design to assess effects of the PBI program by analyzing quantitative and qualitative data from intervention and control facilities. Guided by a theoretical framework, the evaluation consists of four main components: service provision, health worker motivation, implementation processes and costing. Quality and access outcomes are assessed along four dimensions: (1) structural elements (related to equipment, drugs, staff); (2) process elements (providers’ compliance with standards); (3) outputs (service utilization); (4) experiential elements (experiences of service delivery). The costing component includes costs related to start-up, ongoing management, and the cost of incentives themselves. The cost analysis considers costs incurred within the Ministry of Health, funders, and the implementing agency. The evaluation relies on primary data (including interviews and surveys) and secondary data (including costing and health management information system data). Discussion: Through the lens of a PBI program, we illustrate how complex interventions can be evaluated via not only primary, mixed-methods data collection, but also through a wealth of secondary data from program implementers (including monitoring, evaluation and financial data), and the health system (including service utilization and service readiness data). We also highlight the importance of crafting a theory and using theory to inform the nature of data collected. Finally, we highlight the need to be responsive to stakeholders in order to enhance a study’s relevance
Does the “world” still need to keep live samples of the smallpox virus?
No full textEarlier this year (2022), the world witnessed sporadic outbreaks of monkeypox disease in countries other than those in which the disease is endemic. For instance, as of June 10, the United Kingdom had witnessed as least 7 cases of the disease; the first case having been reported on the 7th May 2022 and thought to have been brought into the country by a traveller returning from Nigeria
An inquiry into the uneven distribution of women's HIV infection in rural Malawi
No full textEcological comparisons in sub-Saharan Africa show that HIV prevalence is lower where men are generally circumcised than where they are not. Randomized controlled trials have found a 50-60Š reduction in HIV acquisition for newly circumcised men. Yet in Malawi, HIV prevalence is highest in several districts in the Southern Region, where men are commonly circumcised. We draw upon a population-based sample of ever-married women to explore this unexpected finding. Our data show that in the southern district of Balaka, women with circumcised spouses have a lower probability of HIV infection compared to those with uncircumcised spouses. However, the strength of this effect is conditioned by specific marital histories: among women with circumcised spouses, those with multiple marriages and an absence of spousal co-residence have a higher probability of HIV infection than do those married once and those who have never lived apart from their spouses. The history of marital turnover and female-headed households among the ethnic groups of Balaka offer insight into the district's elevated HIV levels
Condom and sexual abstinence talk in the Malawi National Assembly
No full textBackground: Correct and consistent use of condoms has been reported as
effective in the prevention of transmission of HIV.There have been many
studies reporting on attitudes (perceptions) of communities on condoms
and other aspects of HIV and AIDS and yet there is paucity of data on
the perception towards condoms and abstinence by law makers.
Objective:To determine perceptions of Members of Parliament in Malawi
towards condoms. Methods: A qualitative study utilising parliamentary
Hansards to describe the discussions about condoms and abstinence in
the National Assembly 1999-2004. Content and discourse analyses were
used. Results: In general, Members of Parliament had negative attitudes
towards extra- and/or pre-marital sexual intercourse, condom promotion
and use. Sexual abstinence amongst non-married persons was preferred as
opposed to condom use. Condom use was not perceived as an effective way
of controlling the spread of HIV. Some MPs though called for a change
in mind-set so as to allow use of condoms in prisons, in order to
prevent transmission of infection from prisoners to the general
community once the prisoners were released. Conclusion:This study
confirms that health interventions such as condoms are not perceived
neutrally and may be construed as the enemy of society
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