Abstract
BackgroundThe 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.MethodsA 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.ResultsEvery 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 8th 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.ConclusionsQualitative 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.
Highlights
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
Success of these efforts may be hampered by accompanying gaps in our knowledge of the perceptions and framework with which preterm birth is understood among at-risk women and families, as well as regional health care providers and community health workers in such low-resource settings
As prior qualitative research had largely focused on patient or client-based focused groups, we included groups largely comprised of community health workers (CHWs) and providers
Summary
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. Recognition of the prevalence of preterm birth in sub-Saharan Africa as well as the survival gap has led to recent good intentioned efforts aimed at both primary prevention and secondary interventions [4]. Success of these efforts may be hampered by accompanying gaps in our knowledge of the perceptions and framework with which preterm birth is understood among at-risk women and families, as well as regional health care providers and community health workers in such low-resource settings. The successful acceptance and utilization of any given preterm birth prevention or intervention is dependent upon a communities perception of the underlying prevalence, etiology, attributable risk-factors, and in-country framework for care
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