ABSTRACT
Objective: This study aimed to develop and evaluate a mobile health (mHealth)-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with human immunodeficiency virus (HIV). Methods: This study involved two phases: Phase 1: development of a theory-guided and culturally adapted STN intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three arms: Arm 1: tablet-based video (mHealth) with STN (n = 60); Arm 2: mHealth with a video of nonnarrative educational materials (n = 59); and Arm 3: control group with only reading nonnarrative educational materials in person (n = 60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Results: Both arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50.0%, respectively, vs. 35.0%, P = 0.01) at 2 months follow-up, but there were no differences among groups from 2- to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention, and VIA uptakes. Conclusions: The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-min session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.
ABSTRACT
Aim: This report of five cases of peripartum cardiomyopathy (PPCM) treated at Daeyang Luke Hospital in Lilongwe, Malawi, illustrates presentation and treatment of this increasingly commonly recognized medical condition. Methods: Information including history, physical examination, and imaging studies were collected from five cases of peripartum women who presented to the hospital over an 18-month period. Results: A summary of recommended treatment is included in table form, and a flow chart proposing a care pathway for managing PPCM in Malawi, beginning at the district hospital level, is presented. Conclusion: Clinical recognition, appropriate diagnostic modalities, and informed treatment of PPCM in Malawi will improve care of peripartum woman and reduce maternal morbidity and mortality.
Subject(s)
Cardiomyopathies , Puerperal Disorders , Female , Humans , Peripartum Period , Malawi , Cardiomyopathies/diagnostic imaging , Puerperal Disorders/diagnostic imaging , Puerperal Disorders/therapyABSTRACT
OBJECTIVE: Cervical cancer is preventable, and early diagnosis is possible using low-cost technologies, but a scant number of women receive cancer screening in Malawi. This study aims to identify facilitators and barriers that influence the uptakes of cervical cancer screening behavior in Malawi. METHODS: A rapid ethnographic approach with the goal of optimizing planning for a future intervention study was utilized. Data were collected from three focus groups and seven individual interviews with adults in their communities, stakeholders, and health-care providers. RESULTS: Three categories (sociocultural influences, access to the health-care system, and individual factors) have emerged as facilitators or barriers to cervical cancer screening among Malawian women. The findings also showed that cervical cancer screening behavior is situated socially through cultural and health-care services of a given community. CONCLUSIONS: Cancer screenings are only sought when illness symptoms persist or worsen. Awareness and knowledge of cervical cancer and cervical cancer screening is low among both health-care providers and the general population. Health-care systems are donor driven and focus on a single disease, health-care access is the greatest challenge to cervical cancer screening, and health-care providers are not adequately prepared to work for rapid increase in the prevalence of cervical cancer. Integrating cervical cancer screening into the existing health-care system is sustainable way forward, and nurses prepared to handle cervical cancer management can play an essential role to promote cervical cancer screening in a health resource-constrained setting.
ABSTRACT
BACKGROUND: In Malawi, cervical cancer is the most prevalent form of cancer among women, with an 80% mortality rate. The Mulanje Mission Hospital has offered free cervical cancer screening for eight years; however, patients primarily seek medical help for gynecologic complaints after the disease is inoperable. METHODS: We investigated how women in rural Malawi make health-seeking decisions regarding cervical cancer screening using qualitative research methods. The study was conducted between May and August of 2009 in Mulanje, Malawi. RESULTS: This study found that the primary cue to action for cervical cancer screening was symptoms of cervical cancer. Major barriers to seeking preventative screening included low knowledge levels, low perceived susceptibility and low perceived benefits from the service. Study participants did not view cervical cancer screening as critical health care. Interviews suggested that use of the service could increase if women are recruited while visiting the hospital for a different service. CONCLUSION: This study recommends that health care providers and health educators target aspects of perceived susceptibility among their patients, including knowledge levels and personal risk assessment. We believe that continued support and advertisement of cervical cancer screening programs along with innovative recruitment strategies will increase usage density and decrease unnecessary deaths from cervical cancer in Malawi.
