Background: Preconception care is one of the preventive strategies in maternal and new-born health as recommended by WHO. However, in sub-Saharan Africa there is poor preconception care practices. This study examined knowledge and perceptions of preconception care among health workers and women of reproductive age group in Mzuzu city, Malawi. Methods: A descriptive cross-sectional mixed methods approach utilizing quantitative and qualitative methods was employed. Selection of respondents was done through a multistage and purposive sampling techniques. A total of 253 women of reproductive age from 9 townships of Mzuzu City responded to the questionnaire and 20 health workers were interviewed.Results: Of the 253 women, 57.7% (n =146) demonstrated a good level of knowledge of preconception care while 42.3 % (n =107) had poor knowledge level. About 72% (n =105) of those with good level of knowledge lacked awareness on possibilities of talking to a health care provider on intentions of getting pregnant. About 74.7 % (n =189) of women had a positive perception towards preconception care. Knowledge level of women was a good predictor of positive perception (AOR = 2.5; 95% CI = 1.215 – 5.023), however its prediction capacity varied with the academic level attained. Those with secondary (AOR =10.2; 95% CI = 3.285 - 26.276) and tertiary (AOR=2.3; 95% CI = 1.146 – 4.952) were more likely to have good knowledge than those with primary school level education. About 95% (n =19) of health workers lacked details about preconception care but they admitted their role in preconception care.Conclusion: Preconception care practice among health workers and women of reproductive age in Mzuzu City is low but there is positive perception towards preconception care among both parties. There is an opportunity in existing platforms for implementation of interventions targeting identified predictors for increased knowledge and uptake of preconception care.
Since, the last polio case was in 1992, health authorities in Malawi declared an outbreak of wild poliovirus type 1 (WPV1) on 17 February 2022. A 3‐year‐old girl was diagnosed with WPV1 in the country's capital, Lilongwe, after getting paralyzed by the virus in November 2021. The re‐emergence of polio presents a new public health challenge that Malawi must respond to avoid the further spread of the virus within and outside the country. With an ongoing Coronavirus disease (Covid‐19) pandemic, responding to polio could be a challenge as the healthcare system is already challenged with responding to the pandemic. Frequent cross‐border movement in the region also poses another challenge, particularly in the background of poor vaccination coverage and poor‐quality vaccines. We recommend the development of a risk assessment plan that will guide in implementing vaccination campaigns. Additionally, polio surveillance programmes must be put in place with strong political, stakeholder and community engagement.
Objective The objective of this study was to assess the feasibility and acceptability of institutionalizing Health Technology Assessment (HTA) in Malawi. Methods This study employed a document review and qualitative research methods, to understand the status of HTA in Malawi. This was complemented by a review of the status and nature of HTA institutionalization in selected countries.Qualitative research employed a Focus Group Discussion (FGD ) with 7 participants, and Key Informant Interviews (KIIs) with12 informants selected based on their knowledge and expertise in policy processes related to HTA in Malawi.Data extracted from the literature was organized in Microsoft Excel, categorized according to thematic areas and analyzed using a literature review framework. Qualitative data from KIIs and the FGD was analyzed using a thematic content analysis approach. Results Some HTA processes exist and are executed through three structures namely: Ministry of Health Senior Management Team, Technical Working Groups, and Pharmacy and Medicines Regulatory Authority (PMRA) with varyingdegrees of effectiveness.The main limitations of current HTA mechanisms include limited evidence use, lack of a standardized framework for technology adoption, donor pressure, lack of resources for the HTA process and technology acquisition, laws and practices that undermine cost-effectiveness considerations. KII and FGD results showed overwhelming demand for strengthening HTA in Malawi, with a stronger preference for strengthening coordination and capacity of existing entities and structures. Conclusion The study has shown that HTA institutionalization is acceptable and feasible in Malawi. However, the current committee based processes are suboptimal to improve efficiency due to lack of a structured framework. A structured HTA framework has the potential to improve processes in pharmaceuticals and medical technologies decision-making.In the short to medium term, HTA capacity building should focus on generating demand and increasing capacity in cost-effectiveness assessments. Country-specific assessments should precede HTA institutionalization as well as recommendations for new technology adoptions.
Background Informal payments in public health facilities act as a barrier to accessing quality health services, especially for poor people. This research aimed to investigate informal payments for health care services at Kamuzu Central Hospital (KCH), a public referral hospital in Malawi. Results of this study provide evidence on the prevalence and influencing factors of informal payments for health care so that relevant policies and strategies may be developed to address this problem. Methods This study employed a mixed methods research design. The quantitative study had a sample size of 295 patients and guardians. The qualitative study had 7 key informant interviews (with health workers, health managers and policy makers) and 3 focus group discussions (FGDs) with guardians. Each FGD included 10 participants. Thus, in total, the qualitative sample comprised 52 participants. Quantitative data was analyzed using Excel and STATA. Qualitative data was analyzed using a thematic content analysis approach. Results 80% of patients and guardians had knowledge of informal payments. Approximately 47% of respondents admitted making informal payments to access health services, and 87% of informal payments were made at the request of a health worker. Lack of knowledge, fear and desperation among patients and guardians, low salaries of health workers, and lack of effective disciplinary measures, were reported as key factors influencing informal payments. Regression analysis results showed that occupation and gender were the main determinants of informal payments. Conclusions Informal payments exacerbate inequality in access to free public health services. Particularly, poor people have limited access to health services when informal payments are demanded. This practice is unethical and infringes on people’s rights to universal access to health care. There is a need to strengthen the public health care system by formulating deliberate policies that will deter informal payments in Malawi.
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