829: Utility of qualitative research for assessment of attitudes and knowledge on preterm birth in a low resource setting

Abstract

attitudes and knowledge on preterm birth in a low resource setting Judy Levison, Debora Nanthuru, Grace Chiudzu, Peter Kazembe, Henri Phiri, Kjersti Aagaard Baylor College of Medicine, Obstetrics&Gynecology, Houston, TX, Kamuzu Central Hospital, Obstetrics&Gynecology, Lilongwe, Malawi, Kamuzu Central Hospital, Children’s Clinical Center of Excellence, Lilongwe, Malawi OBJECTIVE: Malawi has one of the highest preterm birth (PTB) rates in the world at 20.3%. At the start of a funded initiative in the largest populated district (Lilongwe), we sought to complete a needs assessment and gap analyses employing validated qualtitative field research methodologies in order to focus potential high-impact interventions. STUDY DESIGN: In mentored partnership with regional providers 14 and 50 km from the central referral hospital, investigative teams comprised of clinician investigators, data recorder, and interpreters held focus groups for voluntary participants (n 28) of community health workers (CHWs), patient couples, midwives and clinical officers. Directed, non-directed, structured and unstructured questions facilitated PTB discussion, including definitions, perception, causation, management, and accepted interventions. RESULTS: Robust discussion occurred in all groups. Among patient couples, a total of 162 questions were asked with 298 answers given (1:1.84), the majority answered by women (55.6%-87.6%). No knowledge gap was observed for accepted dating and length of gestation, biologic causation of PTB, and presumptive benefit of antenatal care, nutrition, and optimized maternal health. Generalized concensus among all groups defined the threshold of viability by gestational age at 26-28 weeks, which was discordant with similarly defined birthweight threshold at 1.4-1.9 kg. Knowledge and prevention-intervention gaps were uniformly observed among all participants regarding any prevention or intervention strategies, including antenatal corticosteroids, prevention of recurrent PTB, PTB risk-managment and interventions, and referral service-line utilization. CONCLUSION: Qualitative research into community baseline gaps and needs is essential. Applied and informed dynamic education and knowledge dissemination, accepted prevention-intervention strategies, and inpatient and outpatient referral networks are under development as a result of this study.