Introduction: Voluntary medical male circumcision (VMMC) reduces chances of contracting HIV during heterosexual intercourse in males, and risk of cervical cancer in their female sexual partners. However, its uptake among traditionally circumcising communities, where male circumcision carries a cultural significance, has not been studied. Previous research has focused on barriers to uptake of VMMC in non-circumcising communities. This study was conducted to determine socio-cultural barriers to VMMC uptake in order to identify culture-sensitive and evidence-based interventions to increase its uptake. Methodology: This exploratory mixed methods cross-sectional study generated quantitative data from 262 randomly sampled sexually active men; and qualitative data through four focus-group discussions with 58 purposely selected male participants and 10 key informants. Results: The study established that only 6.3% (n = 15) of those circumcised (90.8%, n = 238) were circumcised in clinical setting. Limited access to VMMC services, cost, pain, being attended to by female providers and cultural influences were the major hindrances to uptake of VMMC. Conclusion: Although there is a paradigm shift of preference from traditional male circumcision to VMMC in this community, its uptake is low. The study recommends that besides introducing mobile VMMC services, the Ministry of Health should collaborate with traditional circumcisers and local leaders to provide gender-and-culture-sensitive safer medical male circumcision services.

Introduction: Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults (4.9%) living with HIV and this is accounting for 69% of the people worldwide. Although the regional prevalence of HIV infection is nearly 25 times higher in sub-Saharan Africa than in Asia, almost 5 million people are living with HIV in South, South-East and East Asia combined. Purpose: The purpose of this study was to find out the factors that influence anti-retroviral therapy adherence among women in Lilongwe Urban, Malawi. Methods: A descriptive cross-sectional design was used to study multi sites using quantitative methods. The sites were ART clinics at Area 18 health centre, and Area 25 health centre. A questionnaire was used to a convenient sample of 118 HIV positive women. Quantitative data from close-ended questions were coded and analyzed using the Statistical Package for Social Science (SPSS), version 16. Logistic regression model was used to execute the potential covariates. Findings: ART adherence among women is influenced by knowledge levels on: perceived importance and consequences for not adhering to ART; Short waiting time; good relationships with the next of kin and service providers; trust and effective coping mechanisms to stressful events. Source of information was highly associated with adherence in the logistic regression OR ≤ 2.89; CI (1.66 ± 5.38); p (0.039). Moreover, Short waiting time of the women at the hospital during the ARV refill period is highly associated with ART adherence level OR ≤ 4.11; CI (2.05 ± 6.12); p (0.021). On the other hand, factors that contribute to non-adherence are reduced knowledge level p-0.002; Side effects of ART; bad relationships with service providers and relationship with the next of kin as well as occupation of the clients (women). Conclusion: Despite stressful events to HIV positive living women, this study revealed that the majority of these participants would continue taking ART if the factors are very minimal. Encouraging the women who stop taking ART particularly in urban health centres due to such factors like religious beliefs that God is superior and will heal them would influence the ART survival rate in Malawi.

Background: There are numerous teaching strategies that suit the pedagogical learning, but not all can yield the desired outcome and be properly applied by nurse tutors in both classroom and clinical area. Therefore, identifying the utilization of the teaching strategy for nurse tutors is very detrimental in nursing education. Methods: Descriptive exploratory design which utilized both qualitative and sequential quantitative methods was applied to Iterated Purposive Probability Sampling (IPPS) of 10 nursing colleges in Malawi. This was done to 129 student and 82 nurse tutors in two structured questionnaires, 40 in-depth interviews and 10 focus groups. There were 56 variables for the teaching strategy under five ranked Likert scale and the Cronbach's Alpha was found to be 0.964 without standardisation and it was 0.963 after standardisation. Results: Direct teaching strategies like the lecture method are very common although nurse tutors prefer to combine with other interactive instructions. There is statistical association of use of role play and group discussion methods and nurse tutor work experience with odds ratios of OR ≤ 1.624; CI(0.576 ± 4.579); p ≥ 0.359 and OR ≤ 1.397; CI(0.882 ± 2.306); p ≥ 0.147 respectively. The ability to use different teaching strategies competently is still very limited among nurse tutors in Malawi nursing colleges. This compromises quality of learning among nursing students in the colleges. Conclusion: Developing a new teaching strategy that could combine the different attributes in the variety of the teaching instructions can promote the quality of nursing education in Malawi.

The aim of this study was to describe the quality of practice offered by nurses to patients who underwent surgical incision into the abdomen (post-laparotomy) at tertiary hospitals (Kamuzu, Mzuzu, Queen Elizabeth and Zomba) in Malawi. The study design was descriptively cross sectional and utilized a quantitative data collection and analysis method. All available 48 registered nurses in the surgical ward of four central hospitals and 100 patients that were admitted in the ward during the time of study were recruited. A 3-point scale rating consisting of compliance (C = 1), partial compliance (C < 1.0-0.5) and non compliance (C < 0.5-0.0) was used to describe the nurse midwives compliance with the process standards of care. Results show that nurses in all the 4 central hospitals partially complied with assessment and planning standards. During assessment, the nurses assessed the physical aspects of care but did not assess the psychological, spiritual and cultural aspects of care. At planning the nurses assigned and delegated tasks based on the knowledge and skills of the provider selected but did not comply with factors related to safety, effectiveness and cost of care. All the facilities fully complied with implementation standard because they implemented care in a safe and appropriate manner and communicated with patients/ significant others and other health care providers. However, regarding systematic and ongoing evaluation of patients' condition only Mzuzu Central hospital partially complied while the rest of the facilities were not compliant. All the facilities did not comply with documentation standard of care because the patient records were not legible and did not precisely depict comprehensiveness of care nor bore signatures of the implementers of the care. Results are discussed by relating the level of compliance to standards and the quality of patient care.

Introduction: Nursing is the largest healthcare profession in Malawi with more than 11,000 registered nurses (RNs), nurse technicians and midwives (NTM) practicing in hospitals and other settings like nursing colleges nationwide. Student preparation is mostly done by nursing tutors in all the nursing colleges using numerous types of teaching aids. Methods: Descriptive exploratory design which utilized both qualitative and sequential quantitative methods was applied to Iterated Purposive Probability Sampling (IPPS) of 10 nursing colleges in Malawi. This was done to 129 students and 82 nurse tutors in two structured questionnaires, 40 nurse tutors in-depth interviews and 10 students focus groups. There were 32 variables for the teaching aids under five ranked Likert scale and the Cronbach's Alpha was found to be 0.932 without standardisation and it was 0.952 after standard-disation. Results: Although nurse tutors show that they use manikins to teach (0.011 < p = 0.05), students seem not to agree on the utilization of the manikins during teaching both in class and at the clinical area (0.05; p = 0.05). There is also increased discrepancy between students and nurse tutors on internet utilization as the teaching aid as the Beta Coefficient value was (B = 0.202) for the nurse tutors and (B = 1.061) for the students basing on their experience. Use of patient as a teaching aid is very common in Malawi and both the nurse tutors and students agree that it is the realistic and best way in teaching and has a strong binary logistic regression with a model outcome of (OR = 1.431; 95%CI (0.890 ± 2.304); p = 0.139). Conclusion: There is a need to develop the teaching strategies that would be conducive with the current scarcity of the teaching aids. Use of patients if ethically followed remains the most effective and efficient teaching aid in developing countries.