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

BMC Pregnancy and Childbirth

Kjersti M Aagaard¹  Susan M Ramin⁴  Henry Phiri²  Peter N Kazembe³  Grace Chiudzu²  Debora Nanthuru³  Judy Levison⁴ 

[1] Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA;Department of Obstetrics and Gynecology, Kamuzu Central Hospital, 265 Lilongwe, Malawi;Baylor Malawi Center of Excellence, Kamuzu Central Hospital, 265 Lilongwe, Malawi;Department of Obstetrics and Gynecology, Baylor College of Medicine, 1 Baylor Plaza, 77030 Houston, TX, USA

关键词: Periodontal disease;    Pregnancy;    Global women’s health;    Qualitative research;    Preterm birth;   

Others  :  1127455
DOI  :  10.1186/1471-2393-14-123

 received in 2013-12-14, accepted in 2014-03-27,  发布年份 2014

【 摘 要 】

Background

The 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.

Methods

A 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.

Results

Every 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 8^th 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.

Conclusions

Qualitative 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.

【 授权许可】

   
2014 Levison et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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