BackgroundExploring barriers contributing to low utilization of Antenatal Care (ANC) during the first trimester of pregnancy is of national programmatic importance. We conducted an exploratory study in 2013 at Bilira Health Centre in Ntcheu district-Malawi with an aim of understanding barriers that prevent pregnant women from attending antenatal clinics in the first trimester of pregnancy.MethodThis was cross sectional exploratory study using qualitative approach. Data were collected from ANC clients, key informants, health services professionals and women of child bearing age (15–49 years) using an in-depth interviews and Focus Group Discussions (FGDs). Data were analysed manually by reading the transcriptions and memos several times inorder to be familiar with the themes emerged. The emerged themes were coded.ResultsMost of the women reported that they have a feeling of starting ANC in the early days of their pregnancies, however, they also reported several barriers ranging from cultural beliefs, social economic to service delivery barriers. On cultural barriers many women wait for marriage counselors from husband’s side to give them advice before starting ANC in the process called “Kuthimba”. Some women hide the pregnancy in early months to avoid being bewitched. On social-economic barriers, some of the women mentioned that they don’t start ANC early waiting for new clothes. Poor attitude of health workers also has an effect on ANC attendants. Most women pointed out that they started ANC late because some health workers were rude and do not observe confidentiality. Men’s refusal to accompany their spouses to antenatal clinic in fear of HIV test and some by-laws which restrict women who had pregnancy outside marriage to seek an authorisation letter first from Traditional Leaders for them to start ANC at the health facility were also mentioned as contributing barriers.ConclusionWomen should be oriented on the national guidelines on Focused ANC (FANC) which advocates for at least 4 visits. There should also be Information, Education and Communication (IEC) on ANC and interventions to deal with social-cultural issues while at the same time improving service delivery at the health facility so that ANC services can be accessible and responsive enough.

Background We conducted this study to understand roles of community leaders on adolescent’s HIV and Sexual and Reproductive Health (SRH) rights in Mulanje-Malawi. We discussed how each role can influence health seeking behaviour and improve SRH rights among adolescents from the local perspective. Methods A qualitative study approach was used. We conducted 17 Key Informant Interviews (KIIs) and 12 Focus Group Discussions (FGDs) with community leaders. Purposive sampling technique was used to select study participants for KIIs. We also used purposive sampling technique to identify two villages from each of the six Traditional Authorities (TAs) where FGDs were conducted. All participants in FGDs were purposively selected. Inductive thematic content analysis was done guided by the study objectives to generate emerging themes. Results Community leaders have many roles on adolescents HIV and SRH. These roles include advisory, encouragement, regulating and restricting cultural practices, formulating bye-laws and handling sexual abuse complaints. However, community leaders with religious affiliation have shown to have different views with those representing other institutions not affiliated to religion. In addition, the majority of community leaders indicated low level of knowledge on adolescent’s SRH rights. Conclusion We suggest that the roles of community leaders differ depending on the position held and institution represented. Those not affiliated with religious institutions can encourage certain behaviour in adolescents while those from religious background are discouraging it. Stakeholders involved in the fight against HIV, promotion of SRH and rights should invest more on capacity building among the community leaders.

Introduction the spread of HIV among adolescents requires effective interventions as new infections are high in this cohort globally. We explored perception of community leaders on the prevalence of adolescent´s HIV in Mulanje, Malawi. Methods focus group discussion (n=11) and in-depth interviews (n=15) were conducted with community leaders in all Traditional Authorities in Mulanje district, Malawi. The interviews were audio recorded and transcribed. Data were analysed using thematic content approach. Results the perceptions of community leaders on the HIV prevalence among adolescents fall into three groups: lack of access to health services in rural areas, cultural beliefs and social practices. Unavailability of condoms and youth centres were perceived to contribute to lack of access to health services. On harmful cultural beliefs, study participants observed that initiation ceremonies and prolonged wedding dances at night were contributing to HIV spread. Several issues were reported on social issues including poverty, illicit drug and substance abuse, long distances to school, modern technologies and peer pressure. Conclusion there are many factors perceived to contribute towards high HIV prevalence among adolescents. Our study suggests urgent need for the country to sustainably address key harmful cultural and social practices that potentially increase adolescents´ vulnerability to HIV.

Background Low uptake of family planning services by adolescent girls remains a public health concern. An estimated 120 out of every 1,000 girls aged 15 to 19 years are having unplanned pregnancies in the sub-Saharan region. Between January and June 2020, the Phalombe District of Malawi reported 3,030 adolescent pregnancies. At this stage, most Malawian schools were closed due to the COVID-19 pandemic. The high rate of adolescent pregnancies prompted the Ministry of Health to provide emergency contraceptives to reduce the number of unplanned pregnancies among adolescents. The provision of emergency contraceptives would be effective if girls were willing and able to access these family planning services. We thus explored the views of school-going adolescent girls regarding their preferences for modern family planning methods including emergency contraceptives in Phalombe, Malawi. Methods This was a cross-sectional, descriptive study, where quantitative data were collected using a structured questionnaire. Participants included randomly sampled school-going adolescent girls from eight purposively selected secondary schools and eight randomly selected primary schools. All the schools were sampled from three purposively selected Traditional Authorities namely Nkhulambe, Jenala and Nkhumba which had reported high numbers of adolescent pregnancies. We analyzed the GeoPoints for schools and health facilities using ArcGIS, while adolescent girls’ views were analyzed using STATA. Results Participants included 388 adolescent girls, ranging in age from 10 to 19 years (median age = 15.5 years, SD = 1.9 years). Participants were hesitant to use contraceptives because they were afraid of being stigmatized and embarrassed, had to travel long distances to reach the service center, knew little about modern family planning and were afraid of medical complications. Conclusion The uptake of family planning services by adolescent girls can be improved by bringing healthcare services closer to schools and homes. Family planning services should employ health workers who are non-judgmental and who are able to remove the stigma associated with family planning. Health workers should at any given opportunity, address the misconceptions and beliefs that adolescents have towards contraceptives. Community sensitization and health talks should be done to improve adolescent girls’ understanding of family planning services.

Background: We conducted this study to understand roles of community leaders on adolescents HIV and Sexual and Reproductive Health (SRH) rights in Mulanje-Malawi. We assessed how each role influence health seeking behaviour and improve SRH rights among adolescents from the local perspective. Methods: A qualitative study approach was used. We conducted 12 Focus Group Discussions (FGDs) and 17 Key Informant Interviews (KIIs) with community leaders. Purposive sampling technique was used to select study participants for both KIIs and FGDs. Random sampling technique was used to identify one Traditional Authority (TA) and 12 villages where FGDs were conducted. Inductive thematic content analysis was done guided by the study objectives to generate emerging themes. Results: Community leaders have many roles on adolescents HIV and SRH. These roles include advisory, encouragement, regulating and restricting cultural practices, formulating bye-laws and handling sexual abuse complaints. However, community leaders with religious affiliation have shown to have different views with those representing other institutions not affiliated to religion. In addition, the majority of community leaders indicated low level of knowledge on adolescent’s SRH rights. Conclusion: We suggest that the roles of community leaders differ depending on the position held and institution represented. Those community leaders not affiliated to religious can encourage certain behaviour in adolescents while those from religious background are discouraging it. Stakeholders involved in the fight against HIV and SRH rights should invest more on capacity building among the community leaders.