Abstract
Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility’s preterm unit.
Similar content being viewed by others
References
Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., et al. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet, 379, 2162–2172.
Lawn, J. E., Kinney, M. V., Black, R. E., Pitt, C., Cousens, S., Kerber, K., et al. (2012). Newborn survived: a multi-country analysis of a decade of change. Health Policy and Planning, 27(Suppl. 3), iii6–iii28.
Lawn, J. E., Davidge, R., Paul, V., Xylander, S., Johnson, G. J., Costelo, A., et al. (2013). Born too soon: Care for the preterm baby. Reproductive Health J, 10(Suppl1), S5.
March of Dimes, PMNCH, Save the Children, WHO. (2012). Born too soon: The global action report on preterm birth. C. P. Howson, M. V. Kinney, & J. E. Lawn (Eds.). World Health Organization, Geneva http://www.who.int/pmnch/media/news/2012/201204_borntoosoon-report.pdf. Accessed 14 Apr 2014.
PMNCH. (2011). A global review of the key interventions related to reproductive, maternal, newborn and child health (RMNCH). Geneva: The Partnership for Maternal, Newborn and Child Health.
Lawn, J. E., Rudan, I., & Rubens, C. (2008). Four million newborn deaths. Is the global research agenda evidence-based? Early Human Development, 84, 809–814.
Blencowe, H., Cousens, S., Chou, D., Oestergaard, M., Say, L., Moller, H., et al. (2013). Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health Journal, 10(Suppl 1), S2.
Lobis, S., Mbaruku, G., Kamwendo, F., McAuliffe, E., Austin, J., & de Pinho, H. (2011). Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania. International Journal of Gynaecology and Obstetrics, 115, 322–327.
Pignotti, M. S., & Donzelli, G. (2008). Perinatal care at the threshold of viability: An international comparison of practical guidelines for the treatment of extremely preterm births. American Academy of Pediatrics, 121(1), e193–e198.
Levison, J., Nanthuru, D., Chiudzu, G., Kazembe, P. N., Phiri, H., Ramin, S. M., & Aagaard, K. M. (2014). Qualitative assessment of attitudes and knowledge on preterm birth in Malawi and within country framework of care. BMC Pregnancy and Childbirth, 14, 123.
Government of Malawi. (2011). Health sector strategic plan 2011–2016. Moving towards equity and quality. Ministry of Health: Lilongwe.
Cavanagh, S. (1997). Content analysis: Concepts, methods and applications. Nurse Researcher, 4, 5–16.
Requejo, J. H, Bryce, J., Deixel, A., & Victora, C. (2012). Accountability for maternal, newborn and child survival: An update on progress in priority countries. World Health Organization.
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abdoud, P. C., & Rubin, H. R. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement a review. JAMA, 282, 1458–1465.
Opondo, C., Ntoburi, S., & Wagai, J. (2009). Are hospitals prepared to support new-born survival? An evaluation of eight first-referral level hospitals in Kenya. Tropical Medicine and International Health, 14, 1165–1172.
Waiswa, P., Nyanzi, S., Namusoko-Kalungi, S., Peterson, S., Tomson, G., & Pariyo, G. W. (2010). ‘I never thought that this baby would survive; I thought that it would die any time’: perceptions and care for preterm babies in eastern Uganda. Tropical Medicine and International Health, 15, 1140–1147.
Lawn, J. E., McCarthy, B. J., & Ross, S. R. (2001). The healthy new-born: A reference guide for program managers. Atlanta: CDC and CARE.
Liu, L., Johnson, H. L., Cousens, S., et al. (2012). Global, regional, and national causes of child mortality in 2000–10: An updated systematic analysis. Lancet, 2(12), 60560–60561.
Koblinsky, M., Matthews, Z., Hussein, J., Mavalankar, D., Mridha, M. K., Anwar, I., et al. (2006). Going to scale with professional skilled care. Lancet, 368(9544), 1377–1386.
Dominick, A., & Kurowski, C. (2004). Human Resources for health—An appraisal of the status quo in Tanzania mainland. Washington, DC: World Bank.
Charpak, N., & Ruiz-Peláez, J. G. (2006). Resistance to implementing kangaroo mother care in developing countries, and proposed solutions. Acta Paediatrica, 95(5), 529–534.
Black, R. S., & Brocklehurst, P. (2003). A systematic review of training in acute obstetric emergencies. BJOG, 110, 837–841.
Opiyo, N., & English, M. (2010). In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries. Cochrane Database of Systematic Reviews, 4(4), CD007071.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gondwe, A., Munthali, A., Ashorn, P. et al. Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi. Matern Child Health J 20, 1441–1447 (2016). https://doi.org/10.1007/s10995-016-1942-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-016-1942-z