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Vinsamlegast notið þetta auðkenni þegar þið vitnið til verksins eða tengið í það: http://hdl.handle.net/1946/35637

Titill: 
  • Titill er á ensku Preventive child health services in Mangochi District Hospital, Malawi
Námsstig: 
  • Bakkalár
Útdráttur: 
  • Útdráttur er á ensku

    Introduction: Malawi was one of few sub-Saharan countries to reach the Millennium Developmental Goal 4 to reduce child mortality by two thirds. However, children in sub-Saharan Africa are 15 times more likely to die before turning five years of age compared to those in high-income countries. Preventive services such as growth monitoring, immunisation and vitamin A supplementation play an important role in reducing child mortality. The aim of the study was to identify and describe potential problems in preventive child health services in a low-income sub-Saharan setting, in Mangochi District Malawi, assess the trends in vaccination coverage and explore how the services could be improved.
    Methods: Both qualitative and quantitative data was collected over the period 26 February to 17 March 2020. Qualitative data was collected with participatory observation and by conducting interviews with Health Surveillance Assistants. Quantitative data was collected for all vaccinations from 2015-2019 both in Mangochi District and Mangochi District Hospital (MDH) from the District Vaccine Data Management Tool. Data on the flow of children through the static under 5 (U5) clinic at MDH, was collected from a registration book for seven days during the period; 97 children came for vaccination services.
    Results: In the period 2015-2019, more than 3 million immunisation injections were provided in Mangochi District for children. Fewest were given in 2016 and most in 2019, a difference of 33%. Through the whole period, more static sessions at the health facilities were conducted than outreach in the rural villages. The proportion of cancelled sessions, both static and outreach, rose from 2015-2017; the average proportion of cancelled outreach sessions was 72% higher compared to static sessions over the period. The coverage rate for oral polio vaccine given at birth (OPV0) was significantly lower than the coverage rate for Bacillus Calmette-Guérin vaccine (BCG) (p=3.5*10-5). On average, the coverage for the third dose of pentavalent vaccine (penta3) was nine percentage points lower than for penta1, with the largest difference seen in 2017 and smallest in 2019. The coverage rate was significantly lower for measles-rubella 2 (MR2) than MR1 (p=0.01). At MDH, on average, 589 vaccinations were given at the static clinic weekly, 14% higher compared to vaccinations provided at the outreach clinics. BCG was administered 5.9 times more often at the static than the outreach clinics, with an average coverage of 155%. On average, there were 14 visits and 40 vaccines administered daily. Most of the children (70%) were given four vaccines, and 24% of them were not vaccinated at the visit. Half of the children who had their birth registered in the registration book, were immunised timely.
    Conclusion: Utilisation of health services is good both in Mangochi District and at MDH. The vaccination coverage was higher for immunisations provided earlier after birth compared to those provided later; still, not all children are reached. The facility at the static clinic has improved since the inauguration of a new maternal wing while the working conditions could still be improved with more space and staff. Further, data registration needs to be improved for all preventive child health services offered in the district.

Samþykkt: 
  • 25.5.2020
URI: 
  • http://hdl.handle.net/1946/35637


Skrár
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yfirlysing.snaedis.pdf414.3 kBLokaðurYfirlýsingPDF
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