Background and objectivesThis study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these.DesignIn-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes.ResultsThe significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for ‘counselling’. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity.ConclusionDespite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience.

Public health scholars describe “culture of quality” in terms of desired values, attitudes, and practices, but this literature rarely includes explicitly stated theories of culture formation. In this article, we apply Fredrik Barth’s transactional model to demonstrate how taking a theory-centered approach can help to identify what would be necessary to foster “cultures of quality” outlined in the public health literature. We draw on data from a study of the Republic of Malawi’s Performance and Quality Improvement for Reproductive Health initiative. These data were generated in 2017–2018 through a 6-month organizational ethnography in three facilities selected to represent a range of districts with differing social and economic contexts. Our analysis revealed facility-level organizational cultures in which staff valued providing care, but responded to structural constraints by normalizing divergence from quality-of-care protocols. These findings indicate that sustaining a quality-oriented organizational culture requires addressing underlying conditions that generate routine experiences and practices.

Background Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. Methods We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people’s experience with and evaluation of the model. Results Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. Conclusion We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.

A peer group HIV intervention programme was developed using a qualitative community-based participatory action research approach. Twenty-eight community leaders and 11 selected couples in two districts of Malawi were interviewed using individual formal interviews and focus group discussions between september 2007 and april 2008. Data was analysed using a modified constant comparison method. The study has developed HIV prevention interventions through a participatory process focusing on couple acceptability, intervention delivery methods and outcomes of participatory research. The results show that the peer education sessions should involve both men and women so that they learn together. Strategies on the spread of HIV, fidelity, HIV prevention communication, alcohol abuse, educating children on HIV prevention, sexual satisfaction, and condom use should be included in the intervention. Partnerships between researchers and communities are crucial for conducting successful community-based participatory research.

Background. Responsive and resilient strategies to reduce the high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of highest maternal and infant mortality rates globally. Group-based healthcare is one such strategy to improve maternal and child health outcomes. Group-based care has been applied to the perinatal period, but less attention has been paid its potential benefits in postpartum care. The postpartum period is a period of opportunity for innovative approaches to engage mothers and children in care and contribute to the reduction of maternal and infant mortality and morbidity. We present the adaption of an evidence-based group-based perinatal care model to the postpartum period using human centered design with key stakeholders in Malawi. Methods. To adapt the perinatal group-based care model for the Malawian context, the team completed four steps of a five-step framework guiding the use of human centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Steps 2-4 relied on qualitative methods, in-depth interviews, and incubator sessions with key stakeholders to produce a prototype of the group-based postpartum care model. Results Once the stakeholders had defined the problem of limited postpartum care in the context and assembled local and global team members, we completed 20 interviews and 6 incubator sessions with stakeholders. All stakeholders reported a desire to participate in and offer group care in the postpartum period in their community. Health promotion priorities identified were hygiene (e.g., perineal care), breastfeeding, family planning, nutrition, and mental health. The recommended group-based care implementation schedule includes 6 sessions that corresponds with the child vaccination schedule over the 12-month postpartum period. A prototype for the curriculum and implementation structure for group postpartum and well-child care was created based on the findings. Conclusions A human centered design approach to adapt an evidence-based group-based care approach to an LMIC, Malawi is feasible and acceptable to key stakeholders and resulted in a prototype curriculum with practical strategies for implementation in the health care setting.