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Kachimanga C, Mulwafu M, Ndambo MK, Harare J, Murkherjee J, Kulinkina AV, Mbae S, Ndarama E, van den Akker T, Abejirinde IOO. Experiences of community health workers on adopting mHealth in rural Malawi: A qualitative study. Digit Health 2024; 10:20552076241253994. [PMID: 38757088 PMCID: PMC11097726 DOI: 10.1177/20552076241253994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background The use of mobile health technology (mHealth) by community health workers (CHWs) can strengthen community-based service delivery and improve access to and quality of healthcare. Objective This qualitative study sought to explore experiences and identify factors influencing the use of an integrated smartphone-based mHealth called YendaNafe by CHWs in rural Malawi. Methods Using pre-tested interview guides, between August and October 2022, we conducted eight focus group discussions with CHWs (n = 69), four in-depth interviews with CHW supervisors, and eight key informant interviews in Neno District, Malawi. We audio-recorded and transcribed the interviews verbatim and organized them for analysis in Dedoose V9.0.62. We used an inductive analysis technique to analyze the data. We further applied the six domains of the socio-technical system (STS) framework to map factors influencing the use of YendaNafe. Results User experiences and facilitators and barriers were the two main themes that emerged. mHealth was reported to improve the task efficiency, competence, trust, and perceived professionalism of CHWs. CHWs less frequently referred to cultural factors influencing app uptake. However, for other social systems, they identified relationships and trust with stakeholders, availability of training and programmatic support, and performance monitoring and feedback as influencing the use of YendaNafe. From the STS technical domain, the availability and adequacy of hardware such as phones, mobile connectivity, and usability influenced the use of YendaNafe. Conclusions Despite the initial discomfort, CHWs found mHealth helpful in supporting their service delivery tasks. Identifying and addressing social and technical factors during mHealth implementation may help improve end users' attitudes and uptake.
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Affiliation(s)
- Chiyembekezo Kachimanga
- Partners In Health, Neno, Malawi
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | - Alexandra V Kulinkina
- Partners In Health, Neno, Malawi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Ibukun- Oluwa Omolade Abejirinde
- Women College Hospital Institute for Health System Solutions and Virtual Care, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontorio, Canada
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Acup W, Opollo MS, Akullo BN, Musinguzi M, Kigongo E, Opio B, Kabunga A. Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross-sectional study. BMJ Open 2023; 13:e071165. [PMID: 37524555 PMCID: PMC10391812 DOI: 10.1136/bmjopen-2022-071165] [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: 08/02/2023] Open
Abstract
OBJECTIVE This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City. DESIGN A cross-sectional study. SETTINGS The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda. PARTICIPANTS The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City. PRIMARY AND SECONDARY OUTCOME MEASURES Level of first ANC attendance within 12 weeks of pregnancy and associated factors. RESULTS Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early. CONCLUSIONS Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda.
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Affiliation(s)
- Walter Acup
- Department of Community Health, Lira University, Lira, Uganda
| | - Marc Sam Opollo
- Department of Community Health, Lira University, Lira, Uganda
| | | | | | - Eustes Kigongo
- Department of Environmental Health and Disease Control, Lira University, Lira, Uganda
| | - Bosco Opio
- Department of Epidemiology and Biostatistics, Lira University, Lira, Uganda
| | - Amir Kabunga
- Department of Psychiatry, Lira University, Lira, Uganda
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Aron MB, Ndambo MK, Munyaneza F, Mulwafu M, Makungwa H, Nhlema B, Connolly E. A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi. HUMAN RESOURCES FOR HEALTH 2023; 21:51. [PMID: 37365561 DOI: 10.1186/s12960-023-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi. METHODS We conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood's median test to compare the median time spent at a household during monthly visits with the program design standard time. We used pairwise median test to test differences in median time duration for health conditions and assigned tasks. RESULTS We observed 660 CHW visits from 64 CHWs, with 95.2% (n = 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 min, statistically less than the program design time of 60 min (p < 0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p < 0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p < 0.05). CONCLUSION This study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.
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Affiliation(s)
- Moses Banda Aron
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | | | | | - Manuel Mulwafu
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Henry Makungwa
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, United States of America
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, United States of America
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Asmamaw DB, Belachew TB, Endawkie A, Debebe Negash W. Early Postnatal Home Visit Coverage by Health Extension Workers and Associated Factors Among Postpartum Women in Gidan District, Northeast Ethiopia. Int J Public Health 2023; 68:1605203. [PMID: 37077510 PMCID: PMC10106612 DOI: 10.3389/ijph.2023.1605203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
Objectives: To determine the coverage and associated factors of early postnatal home visits (PNHVs) by health extension workers (HEWs) among postpartum women in Gidan district, Northeast Ethiopia.Methods: A community-based, cross-sectional study was conducted between 30 March and 29 April 2021 in the Gidan district, Northeast Ethiopia. A multistage sampling technique was employed to select 767 postpartum women participants. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted to identify factors associated with early PNHVs by HEWs.Results: The coverage of early postnatal home visits was 15.13% [95% confidence interval (CI): 12.75, 17.87]. Women’s education, institutional delivery, time to reach health posts, and participation in pregnant women forums were significantly associated with early PNHVs by HEWs.Conclusion: In the current study, the coverage of early postnatal home visits by HEWs remains low in the study area. The concerned bodies should consider interventions that promote women’s education and institutional delivery, and more efforts should be made to improve community-based participation and links with HEWs.
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Affiliation(s)
- Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Desale Bihonegn Asmamaw,
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Olds P, Kachimanga C, Talama G, Mailosi B, Ndarama E, Totten J, Musinguzi N, Hangiwa D, Bukhman G, Wroe EB. Non-communicable disease burden among inpatients at a rural district hospital in Malawi. Glob Health Res Policy 2023; 8:4. [PMID: 36810123 PMCID: PMC9945353 DOI: 10.1186/s41256-023-00289-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. METHODS We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality. RESULTS Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001). CONCLUSIONS There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.
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Affiliation(s)
- Peter Olds
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | | | | | - Enoch Ndarama
- grid.415722.70000 0004 0598 3405Ministry of Health and Population, Lilongwe, Malawi
| | - Jodie Totten
- grid.34477.330000000122986657Department of Emergency Medicine, University of Washington, Seattle, WA USA
| | - Nicholas Musinguzi
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gene Bukhman
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Emily B. Wroe
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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Nigusie A, Azale T, Yitayal M, Derseh L. The impact of perception on institutional delivery service utilization in Northwest Ethiopia: the health belief model. BMC Pregnancy Childbirth 2022; 22:822. [PMID: 36336694 PMCID: PMC9639283 DOI: 10.1186/s12884-022-05140-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/20/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ethiopia has been striving to promote institutional delivery through community wide programs. However, home is still the preferred place of delivery for most women encouraged by the community`s perception that delivery is a normal process and home is the ideal environment. The proportion of women using institutional delivery service is below the expected level. Therefore, we examined the impact of perception on institutional delivery service use by using the health belief model. METHODS A community-based cross-sectional study was conducted among 1,394 women who gave birth during the past 1 year from September to December 2019. A multistage sampling technique was used to select the study participants. Data were collected by using health belief model constructs, and structured and pretested questionnaire. Binary logistic regression was performed to identify factors associated with the outcome variable at 95% confidence level. RESULTS Institutional delivery service was used by 58.17% (95% CI: 55.57- 60.77%) of women. The study showed that high perceived susceptibility (AOR = 1.87; 95% CI 1.19-2.92), high cues to action (AOR = 1.57; 95% CI: 1.04-2.36), husbands with primary school education (AOR = 1.43; 95% CI 1.06-1.94), multiparty(5 or more) (AOR = 2.96; 95% CI 1.85-4.72), discussion on institutional delivery at home (AOR = 4.25; 95% CI 2.85-6.35), no close follow-up by health workers (AOR = 0.59;95% CI 0.39-0.88), regular antenatal care follow-up (AOR = 1.77;95% CI 1.23,2.58), health professionals lack of respect to clients (AOR = 2.32; 95% CI 1.45-3.79), and lack of health workers (AOR = 0.43;95% CI 0.29-0.61) were significantly associated with the utilization health behavior of institutional delivery service. CONCLUSION The prevalence of institutional delivery in the study area was low. The current study revealed that among the health belief model construct perceived susceptibility and cues to action were significantly associated with the utilization behavior of institutional delivery service. On top of that strong follow-up of the community and home based discussion was a significant factor for the utilization behavior of institutional delivery service.
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Affiliation(s)
- Adane Nigusie
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Departemenr of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh
- Departement of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Working lives of maternity healthcare workers in Malawi: an ethnography to identify ways to improve care. AJOG GLOBAL REPORTS 2022; 2:100032. [PMID: 36274966 PMCID: PMC9563393 DOI: 10.1016/j.xagr.2021.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Maternal mortality in East Africa is high with a maternal mortality rate of 428 per 100,000 live births. Malawi, whilst comparing favourably to East Africa as a whole, continues to have a high maternal mortality rate (349 per 100,000 live births) despite it being reduced by 53% since 2000. To make further improvements in maternal healthcare, initiatives must be carefully targeted and evaluated to achieve maximum influence. The Malawian Government is committed to improving maternal health; however, to achieve this goal, the quality of care must be high. Furthermore, such a goal requires enough staff with appropriate training. There are not enough midwives in Malawi; therefore, focusing on staff working lives has the potential to improve care and retain staff within the system. OBJECTIVE This study aimed to identify ways in which working lives of maternity healthcare workers could be enhanced to improve clinical care. STUDY DESIGN We conducted a 1-year ethnographic study of 3 district-level hospitals in Malawi. Data were collected through observations and discussions with staff and analyzed iteratively. The ethnography focused on the interrelationships among staff as these relationships seemed most important to working lives. The field jottings were transcribed into electronic documents and analyzed using NVivo. The findings were discussed and developed with the research team, participants, and other researchers and healthcare workers in Malawi. To understand the data, we developed a conceptual model, “the social order of the hospital,” using Bourdieu's work on political sociology. The social order was composed of the social structure of the hospital (hierarchy), rules of the hospital (how staff in different staff groups behaved), and precedent (following the example of those before them). RESULTS We used the social order to consider the different core areas that emerged from the data: processes, clinical care, relationships, and context. The Malawian system is underresourced with staff unable to provide high-quality care because of the lack of infrastructure and equipment. However, some processes hinder them on national and local level, for example staff rotations and poorly managed processes for labeling drugs. The staff are aware of the clinical care they should provide; however, they sometimes do not provide such care because they are working with the predefined system and they do not want to disrupt it. Within all of this, there are hierarchical relationships and a desire to move to the next level of the system to ensure a better life with more benefits and less direct clinical work. These elements interact to keep care at its most basic as disruption to the “usual” way of doing things is challenging and creates more work. CONCLUSION To improve the working lives of the Malawian maternity staff, it is necessary to focus on improving the working culture, relationships, and environment. This may help the next generation of Malawian maternity staff to be happier at work and to better provide respectful, comprehensive, high-quality care to women.
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Wroe EB, Nhlema B, Dunbar EL, Kulinkina AV, Kachimanga C, Aron M, Dullie L, Makungwa H, Chabwera B, Phiri B, Nazimera L, Ndarama EPL, Michaelis A, McBain R, Brown C, Palazuelos D, Lilford R, Watson SI. A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. BMJ Glob Health 2021; 6:bmjgh-2021-006535. [PMID: 34526321 PMCID: PMC8444244 DOI: 10.1136/bmjgh-2021-006535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/27/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC). METHODS We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20-40 households for monthly (or more frequent) visits. FINDINGS The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (-0.8 percentage points (pp) (95% credible interval: -2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: -0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (-0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (-0.6 per 1000 (95% CI -2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges. INTERPRETATION CHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.
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Affiliation(s)
- Emily B Wroe
- Partners In Health, Neno, Malawi .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Elizabeth L Dunbar
- Partners In Health, Neno, Malawi.,Human Centered Design & Engineering, University of Washington, Seattle, Washington, USA
| | - Alexandra V Kulinkina
- Partners In Health, Neno, Malawi.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | - Ryan McBain
- Partners In Health, Boston, Massachusetts, USA.,RAND, Boston, Massachusetts, USA
| | | | - Daniel Palazuelos
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Partners In Health, Boston, Massachusetts, USA
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Aranda Z, Fulcher IR, Hedt-Gauthier B, Mugunga JC, Binde T. COVID-19 and maternal and perinatal outcomes. LANCET GLOBAL HEALTH 2021; 9:e1065. [PMID: 34297959 PMCID: PMC8294003 DOI: 10.1016/s2214-109x(21)00297-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico/Compañeros En Salud, Ángel Albino Corzo, Chiapas 30370, México.
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard Data Science Initiative, Boston, MA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jean Claude Mugunga
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Thierry Binde
- Partners In Health Sierra Leone, Koidu, Kono, Sierra Leone
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Magombo PW, Ntenda PAM, Nkoka O. Association between intimate partner violence and the use of maternal health care services among married Malawian women. BMC WOMENS HEALTH 2021; 21:173. [PMID: 33892706 PMCID: PMC8066443 DOI: 10.1186/s12905-021-01312-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
Background Maternal and child health care (MCH) services aim at improving the overall health outcomes of both the mother and newborn. Intimate partner violence (IPV) has been linked with poor health outcomes and under usage of MCH services. In Malawi, IPV is a persistent problem, while MCH services’ uptake remains a constant challenge. However, there is limited information on the association between IPV and MCH services in Malawi. The study examined the association between IPV and the use of MCH services among married Malawian women.
Methods The 2015–16 Malawi demographic and health survey was used to analyze the association of IPV and the use of MCH services among 2712 married Malawian women. Multivariable logistic regression models were used to estimate the strength of association. Results Approximately 41.4% of the women reported experiencing IPV. Specifically, 27.8%, 19.3%, and 23.6% reported experiencing physical, sexual, and emotional violence, respectively. Women who reported experiencing any form of IPV had a 34% reduced likelihood of delivering at a health facility [adjusted odds ratio (aOR): 0.66; 95% confidence interval (CI) 0.46–0.96] or were 36% less likely [aOR: 0.64; 95% CI 0.46–0.90] to have had skilled assistance during delivery compared to those who never experienced IPV. Conclusion IPV was associated with MCH services use, specifically delivery at a health facility and skilled birth attendants. The high prevalence of IPV underscores the need to design effective programs to raise awareness regarding IPV and reduce IPV. Reducing IPV may be a promising means to support a more integrated and sustainable approach to improve the use of MCH services.
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Affiliation(s)
| | - Peter A M Ntenda
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Owen Nkoka
- Institude of Health and Wellbeing, University of Glasgow, Glasgow, UK.
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Palazuelos D, Jabateh LM, Choi M, Jimenez A, Hing M, Iberico MM, Nhlema B, Wroe E. Early Lessons From Launching an Innovative Community Health Household Model Across 3 Country Contexts. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:S168-S178. [PMID: 33727328 PMCID: PMC7971378 DOI: 10.9745/ghsp-d-20-00405] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
Community health worker programs can contribute substantively to health systems working to implement universal health coverage, but there is no one-size-fits-all model. Program leaders should anticipate needing to adapt their plans as local realities demand, but lessons learned in other contexts can provide guidance on how to best proceed. Community health workers (CHWs) are integrated into health systems through a variety of designs. Partners In Health (PIH), a nongovernmental organization with more than 30 years of experience in over 10 countries, initially followed a vertical approach by assigning CHWs to individual patients with specific conditions, such as HIV, multidrug resistant-TB, diabetes, and other noncommunicable diseases, to provide one-on-one psychosocial and treatment support. Starting in 2015, PIH-Malawi redesigned their CHW assignments to focus on entire households, thereby offering the opportunity to address a wider variety of conditions in any age group, all with a focus on working toward effective universal health coverage. Inspired by this example, PIH-Liberia and then PIH-Mexico engaged in a robust cross-site dialogue on how to adapt these plans for their unique nongovernmental organization-led CHW programs. We describe the structure of this “household model,” how these structures were changed to adapt to different country contexts, and early impressions on the effects of these adaptations. Overall, the household model is proving to be a feasible and functional method for organizing CHW programs so that they can contribute toward achieving universal health coverage, but there is no “one-size-fits-all” approach. Other countries planning on adopting this model should plan to analyze and adapt as needed.
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Affiliation(s)
- Daniel Palazuelos
- Partners In Health, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Miry Choi
- Partners In Health - Liberia, Monrovia, Liberia
| | | | - Matthew Hing
- Partners In Health, Boston, MA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mariano Matias Iberico
- Compañeros En Salud - México, Chiapas, Mexico.,Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Emily Wroe
- Partners In Health, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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