Malawian Midwives’ Perceptions of Occupational Risk for HIV Infection

Abstract

In this study, Malawian midwives' perceptions of occupational risk of human immunodefiency virus (HIV) infection are described. Knowledge of perceptions of HIV risk in developing countries and consequences on patient care is limited. A qualitative approach using purposive sampling was undertaken with 7 midwives. Participants considered their occupational risk to be high, encompassing these four themes: exposure to body fluids, availability of resources, hand washing practices, and support from management. Additional themes related to the impact of high risk on clinical practice: working in a climate of fear, refraining from touch, loss of interest in midwifery, and improvising care practices.

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

“…In DeMaria 2012, nurses had a four-year university-level training that included one year of midwifery training. In other studies, nurses had two to three years of nursing training, while a few had diploma-level or certificate-level training in midwifery (Mathole 2006; Mondiwa 2007). …”

“…Sixteen of the studies were conducted in low-income countries: Bangladesh (Afsana 2001; Anwar 2009; Blum 2006; Pitchforth 2006), Benin (Fujita 2012), Ethiopia (Pitchforth 2010), Malawi (Bradley 2009; Mondiwa 2007; Thorsen 2012), Mozambique (Pettersson 2006), Tanzania (Lugina 2001; Penfold 2013; Spangler 2012), Uganda (Fränngård 2006; VSO 2012), and Zimbabwe (Mathole 2006). …”

“…Staff shortages and work overload jeopardised health workers’ ability to provide timely care, and manage routine care as well as emergency cases. In addition, shortage of staff sometimes led health workers to exceed their scope of practice, and influenced a health facility's ability to provide 24-hour care.Afsana 2001; Anwar 2009; Barua 2011; Bradley 2009; Conde-Agudelo 2008; Fränngård 2006; Fujita 2012; Graner 2010; Hassan-Bitar 2011; Ith 2012; Khalaf 2009; Lugina 2001; Maputle 2010; Mathole 2006; Mondiwa 2007; Spangler 2012; Thorsen 2012; VSO 2012Moderate confidenceDue to minor concerns about coherence; and minor concerns about methodological limitationsA lack of specialists or experienced staff, including absence of health workers with key skills such as anaesthetists, influenced the provision of care and supervision of junior staff. When no specialists were available, some tasks such as emergency obstetric care were not delivered at all, or tasks were transferred to health workers who were not properly qualified or trained to deliver them.…”

“…In addition, interference in treatment decisions by local politicians and mismanagement of posting and transfer from the national level were demotivating to health workers working in rural facilities.Anwar 2009; Bradley 2009; De Brouwere 2009; Fränngård 2006; Hassan-Bitar 2011; Ith 2012; VSO 2012Moderate confidenceDue to minor concerns for methodological limitations and relevanceHealth workers perceived managers as lacking in management capacity and skills and sometimes felt unsupported. Health workers also complained that concerns about the workplace were sometimes left unheard, and no solutions or feedback given.Anwar 2009; Bradley 2009; Ith 2012; Lester 2003; Mondiwa 2007; VSO 2012Moderate confidenceDue to moderate concerns about relevance; and minor concerns about methodological limitations and adequacyHelping women access financial assistance for out-of-pocket payments was sometimes time-consuming for health workers.Pitchforth 2006Very low confidenceDue to serious concerns about relevance and adequacy HEALTH WORKER EDUCATION AND TRAINING Inadequate pre-service and in-service training sometimes limited health workers' skills and ability to provide care. For instance, some health workers lacked training to attend home births or manage complicated pregnancies or deliveries, e.g.…”

Surviving Life as a Woman: A Critical Ethnography of Violence in the Lives of Female Domestic Workers in Malawi

“…The women's main concern, especially voiced in the focus groups, was the fear of contracting HIV, since HIV is endemic in Malawi (Mondiwa & Hauck, 2007). Other forms of domestic abuse mentioned by the women included physical abuse, particularly when their husbands were drunk; abandonment; and withholding of support, such as food and other provisions, particularly following an argument.…”