Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi.

Introduction Malawi is experiencing slow progress in postnatal care of mothers within the first 48 hours after childbirth. Malawi Demographic and Health Survey (MDHS) 2015–16 reported a slow progress in postnatal care of mothers in the first 48 hours at 42% from 41% in 2010 despite a high number of institutional births. This is a critical period as a large proportion of maternal deaths occur during this period, currently at 439 per 100,000 live births. During postnatal care the mother is given important information to assist in caring for herself and her baby. The lack of well documented guidelines and funding to employ more midwives to manage mothers in postnatal ward contributes to poor quality of postnatal care. Methods This is an evidence-based policy brief that was prepared to inform policy makers, health workers, clients, community and other stakeholders to consider the available evidence about the impact of the suggested options in order to improve postnatal care. Results Several factors that contribute to low utilization of postnatal care among mothers after childbirth were identified. Factors included lack of clear guidelines on postnatal care, shortage of skilled health workers and inadequate resources. Conclusion Implementation of the identified policy options may improve postnatal care.

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Background: Two thirds of all women who deliver in an urban hospital in Malawi do not return for postnatal care at 1 and 6 weeks after labour. Factors that influence their postnatal visit are not well established. Aim: This study investigates factors influencing the attendance at postnatal visits at 1 and 6 weeks among mothers at Zomba Central Hospital in Malawi. Specifically, the study assessed mothers' knowledge about postnatal care at 1 week and 6 weeks, and determined the characteristics of mothers who did or did not attend postnatal appointments on these dates. Method: A descriptive quantitative, cross-sectional study was conducted to assess mothers' knowledge. Data were collected using a structured interview. A convenient sample of 154 mothers participated in the study. Ethical approval was obtained from the Malawi College of Medicine Ethical Review Board. Data were analysed using SPSS. Findings: A sample of 154 mothers participated in the study who were all attendees at an under-fives clinic and had infants who were between 8 weeks and 12 months old. More than 75% of participants were aged between 20 and 30 years old. The main factor that hindered attendance was lack of advice given by midwives to return for postnatal care. Awareness of postnatal services, mothers' educational level and growth monitoring all promoted utilisation of postnatal care at 1 and 6 weeks. These findings have implications for training and practice: training institutions should emphasise the importance of postnatal care at 1 and 6 weeks; and, with reference to practice, supervisors of midwives should ensure that mothers are booked for postnatal care at 1 week and 6 weeks.

Clinical decision-making is an important element in midwifery practice. Midwives are required to have a sound knowledge to manage complications during childbirth. Any misjudgement by a midwife may lead to adverse birth outcomes. The aim of this paper is to review factors that contribute to clinical decision-making of midwives. This was achieved by reviewing published research articles. Studies have shown that shortage of human and material resources, poor skill mix, absence of mentors and lack of autonomy are some of the contributing factors that may affect midwives’ decision-making.