Qualitative assessment of attitudes and knowledge on preterm birth in Malawi and within country framework of care

Abstract

BackgroundThe overarching goal of this study was to qualitatively assess baseline knowledge and perceptions regarding preterm birth (PTB) and oral health in an at-risk, low resource setting surrounding Lilongwe, Malawi. The aims were to determine what is understood regarding normal length of gestation and how gestational age is estimated, to identify common language for preterm birth, and to assess what is understood as options for PTB management. As prior qualitative research had largely focused on patient or client-based focused groups, we primarily focused on groups comprised of community health workers (CHWs) and providers.MethodsA qualitative study using focus-group discussions, incidence narrative, and informant interviews amongst voluntary participants. Six focus groups were comprised of CHWs, patient couples, midwives, and clinical officers (n = 33) at two rural health centers referring to Kamuzu Central Hospital. Semi-structured questions facilitated discussion of PTB and oral health (inclusive of periodontal disease), including definitions, perception, causation, management, and accepted interventions.ResultsEvery participant knew of women who had experienced “a baby born too soon”, or preterm birth. All participants recognized both an etiology conceptualization and disease framework for preterm birth, distinguished PTB from miscarriage and macerated stillbirth, and articulated a willingness to engage in studies aimed at prevention or management. Identified gaps included: (1) discordance in the definition of PTB (i.e., 28–34 weeks or less than the 8th month, but with a corresponding fetal weight ranging 500 to 2300 grams); (2) utility and regional availability of antenatal steroids for prevention of preterm infant morbidity and mortality; (3) need for antenatal referral for at-risk women, or with symptoms of preterm birth. There was no evident preference for route of progesterone for the prevention of recurrent PTB.ConclusionsQualitative research was useful in (1) identifying gaps in knowledge in urban and rural Malawi, and (2) informing the development of educational materials and implementation of programs or trials ultimately aimed at reducing PTB. As a result of this qualitative work, implementation planning was focused on the gaps in knowledge, dissemination of knowledge (to both patients and providers), and practical solutions to barriers in known efficacious therapies.

Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi

“…However, there is limited evidence to show how preterm births are handled at the health facility level in Malawi. A literature review reveals few studies that have investigated care of preterm infants at health facilities in Malawi other than one recent study which looked at provider attitudes and knowledge of preterm birth [10]. Therefore, an in-depth understanding of health stakeholders' experiences about current preterm infants care is significant in improving care of preterm infants, and consequently infant health at health facility level.…”

<p>Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years</p>

“…2,14,15 However, in our prior publication, we recognized that the success of these interventions depends upon the community wherein they occur; specifically, if at-risk women (or providers) have knowledge gaps, referrals and appropriate care may not occur. 16 For instance, if patients are not aware that interventions are available, they may not seek care; if providers are unaware, they may not appropriately refer. 16 Ultimately, the adoption and utilization of such interventions depends upon the community's perception of the problem and incorporation of the intervention into their belief system and standard practice.…”

“…16 For instance, if patients are not aware that interventions are available, they may not seek care; if providers are unaware, they may not appropriately refer. 16 Ultimately, the adoption and utilization of such interventions depends upon the community's perception of the problem and incorporation of the intervention into their belief system and standard practice. 16 Therefore, in 2012, we performed needs assessment and gap analysis in four rural and urban communities surrounding Lilongwe, Malawi via focus groups as described in detail elsewhere.…”

Post‐Ebola situational assessment of opportunities for capacity building at the national obstetrics and gynecology referral hospital in Sierra Leone

“…Lack of human resources presents a major challenge to the United Nations’ 2030 agenda for sustainable development . Academic partnerships to improve medical education can help to improve in‐country retention of physicians and transform maternal care capacity . University‐based postgraduate training programs in obstetrics and gynecology have a significant impact on public health .…”

“…General physicians currently leave the country to obtain specialty training in obstetrics and gynecology, and many do not return. Sierra Leone needs in‐country postgraduate and continuing medical education opportunities to train and maintain the obstetricians and gynecologists who are needed to provide leadership and create a high level of clinical obstetric expertise to provide tertiary‐level care, train the next generation of providers, and influence local and national policy in reproductive, maternal, newborn, child and adolescent health (RMNCAH) services …”