Malawi is currently facing a serious HIV/AIDS crisis. In 2002 Malawi received funding from the Gl... more Malawi is currently facing a serious HIV/AIDS crisis. In 2002 Malawi received funding from the Global Fund for HIV/AIDS Tuberculosis and Malaria (GFTAM) to start an ART program that will support 80 000 people on ART for five years. This is not enough; it is estimated that currently about 170 000 people need anti-retroviral therapy (ART) and there is still a critical shortage of resources. Furthermore ART services need to be delivered equitably and in a way that strengthens existing health systems. It remains difficult to make clear conclusions or recommendations about the current situation in Malawi because there is no detailed disaggregated HIV prevalence data and also because the ART programme is still in its infancy. Nonetheless this paper proposes ongoing monitoring and evaluation of equity and impacts on existing health systems. The results should be widely disseminated and complemented by qualitative data. This should help to ensure that challenges are understood and addressed...
In Malawi, HIV and malnutrition are two of the most common causes of childhood morbidity and mort... more In Malawi, HIV and malnutrition are two of the most common causes of childhood morbidity and mortality. This qualitative study based in Nutrition Rehabilitation Units (NRU) in HIV-endemic Malawi explores caregiver's (staff and family) perspectives on quality of care for severely malnourished children. Three carer focus groups and 30 carer and staff in-depth interviews were conducted in two NRUs. The interviews and data analysis used a grounded theory approach, using both male and female Malawian researchers. Trustworthiness was enhanced through the researchers' prolonged engagement with the study setting and participants. The use of multiple methods - interviews, focus groups and observation - allowed for triangulation of the data. Data was then cross-referenced between staff and family caregiver reports. The analysis generated five themes. 'We have different blood' referring to staff attitudes and underperformance, 'What wrong did I do to God?' referring to stigma and chronic illness, 'My other children back home' referring to the carer's multiple responsibilities and challenges, 'Always in short supply' referring to resources available in the NRU (milk, medicine, space, hygiene) and 'you are always lagging behind' referring to the need for change and participants recommendations. Quality of care is a complex issue, bound by resources and capacity, influenced by stigma and hierarchy and limited by caregivers' conflicting responsibilities. Valuing and involving caregivers is essential in improving quality of care. Care should be patient and family centred and HIV services should be integrated into malnutrition care at the hospital and community level.
Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) ... more Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) internationally as researchers seek to understand the experiences, needs and perspectives of people living with TB and/or HIV as well as their carers within the community and health sector. Conducting FGDs in resource-poor settings with vulnerable participants who are living with diseases that are frequently
Background Qualitative research networks (QRNs) bring together researchers from diverse contexts ... more Background Qualitative research networks (QRNs) bring together researchers from diverse contexts working on multi-country studies. The networks may themselves form a consortium or may contribute to a wider research agenda within a consortium with colleagues from other disciplines. The purpose of a QRN is to ensure robust methods and processes that enable comparisons across contexts. Under the Self-Testing Africa (STAR) initiative and the REACHOUT project on community health systems, QRNs were established, bringing together researchers across countries to coordinate multi-country qualitative research and to ensure robust methods and processes allowing comparisons across contexts. QRNs face both practical challenges in facilitating this iterative exchange process across sites and conceptual challenges interpreting findings between contexts. This paper distils key lessons and reflections from both QRN experiences on how to conduct trustworthy qualitative research across different conte...
The current study identifies young people's preferences for HIV self-testing (HIVST) delivery... more The current study identifies young people's preferences for HIV self-testing (HIVST) delivery, determines the relative strength of preferences and explores underlying behaviors and perceptions to inform youth-friendly services in southern Africa. A mixed methods design was adopted in Malawi and Zimbabwe and includes focus group discussions, in-depth interviews and discrete choice experiments. The current study was conducted during the formative phase of cluster-randomized trials of oral-fluid HIVST distribution. Young people aged 16-25 years were purposively selected for in-depth interviews (n = 15) in Malawi and 12 focus group discussions (n = 107) across countries. Representative samples of young people in both countries (n = 341) were administered discrete choice experiments on HIVST delivery, with data analyzed to estimate relative preferences. The qualitative results provided additional depth and were triangulated with the quantitative findings. There was strong concordance...
Background: National health research for development (R4D) platforms in lower income countries (L... more Background: National health research for development (R4D) platforms in lower income countries (LICs) are few. The Health Research Capacity Strengthening Initiative (HRCSI, 2008–2013) was a national systems-strengthening programme in Malawi involved in national priority setting, decision-making on funding, and health research actor mobilization.
Methods: We adopted a retrospective mixed-methods evaluation approach, starting with information gleaned from reports (HRCSI and Malawian) and databases (HRCSI). A framework of a health research system (actors and components) guided report review and interview guide development. From a list of 173 individuals involved in HRCSI, 30 interviewees were selected within categories of stakeholders. Interviews were conducted face-to-face or via telephone/Skype over 1 month, documented with extensive notes. Analysis of emerging themes was iterative among co-evaluators, with synthesis according to the implementation stage.
Results: Major HRCSI outputs included (1) National research priority-setting: through the production of themed background papers by Malawian health researchers and broad consultation, HRCSI led the development of a National Health Research Agenda (2012–2016), widely regarded as one of HRCSI’s foremost achievements. (2) Institutional research capacity: there was an overwhelming view that HRCSI had produced a step-change in the number of high calibre scientists in Malawi and in fostering research interest among young Malawians, providing support for around 56 MSc and PhD students, and over 400 undergraduate health-related projects. (3) Knowledge sharing: HRCSI supported research dissemination through national and institutional meetings by sponsoring attendance at conferences and through close relationships with individuals in the print media for disseminating information. (4) Sustainability: From 2011–2013, HRCSI significantly improved research systems, processes and leadership in Malawi, but further strengthening was needed for HRCSI to be effectively integrated into government structures and sustained long-term. Overall, HRCSI carried out many components relevant to a national health research system coordinating platform, and became competent at managing over half of 12 areas of performance for research councils. Debate about its location and challenges to sustainability remain open questions.
Conclusions: More experimentation in the setting-up of national health R4D platforms to promote country ‘ownership’ is needed, accompanied by evaluation processes that facilitate learning and knowledge exchange of better practices among key actors in health R4D systems.
Keywords: Capacity development, Developing countries, Qualitative methods, Research councils, Research management
In 2006 the World Health Organization described the status of prevention of mother to child trans... more In 2006 the World Health Organization described the status of prevention of mother to child transmission (PMTCT) service implementation as unacceptable, with an urgent need for a renewed public health approach to improve access. For PMTCT to be effective it needs to be accessible, acceptable and affordable; however research in Africa into accessibility, uptake and acceptability of PMTCT services has been predominately urban based and usually focusing on women who deliver in hospitals. The importance of involving other community members to strengthen both PMTCT uptake and adherence, and to support women emotionally, has been advocated. Urban men's and rural traditional birth attendants' (TBAs) involvement have improved uptake of HIV testing and of nevirapine. A qualitative study was carried out in a rural district of Malawi's central region to explore the views about and perceptions of PMTCT antiretroviral treatment. Semi-structured interviews and focus group discussions ...
Malawi is currently facing a serious HIV/AIDS crisis. In 2002 Malawi received funding from the Gl... more Malawi is currently facing a serious HIV/AIDS crisis. In 2002 Malawi received funding from the Global Fund for HIV/AIDS Tuberculosis and Malaria (GFTAM) to start an ART program that will support 80 000 people on ART for five years. This is not enough; it is estimated that currently about 170 000 people need anti-retroviral therapy (ART) and there is still a critical shortage of resources. Furthermore ART services need to be delivered equitably and in a way that strengthens existing health systems. It remains difficult to make clear conclusions or recommendations about the current situation in Malawi because there is no detailed disaggregated HIV prevalence data and also because the ART programme is still in its infancy. Nonetheless this paper proposes ongoing monitoring and evaluation of equity and impacts on existing health systems. The results should be widely disseminated and complemented by qualitative data. This should help to ensure that challenges are understood and addressed...
In Malawi, HIV and malnutrition are two of the most common causes of childhood morbidity and mort... more In Malawi, HIV and malnutrition are two of the most common causes of childhood morbidity and mortality. This qualitative study based in Nutrition Rehabilitation Units (NRU) in HIV-endemic Malawi explores caregiver's (staff and family) perspectives on quality of care for severely malnourished children. Three carer focus groups and 30 carer and staff in-depth interviews were conducted in two NRUs. The interviews and data analysis used a grounded theory approach, using both male and female Malawian researchers. Trustworthiness was enhanced through the researchers' prolonged engagement with the study setting and participants. The use of multiple methods - interviews, focus groups and observation - allowed for triangulation of the data. Data was then cross-referenced between staff and family caregiver reports. The analysis generated five themes. 'We have different blood' referring to staff attitudes and underperformance, 'What wrong did I do to God?' referring to stigma and chronic illness, 'My other children back home' referring to the carer's multiple responsibilities and challenges, 'Always in short supply' referring to resources available in the NRU (milk, medicine, space, hygiene) and 'you are always lagging behind' referring to the need for change and participants recommendations. Quality of care is a complex issue, bound by resources and capacity, influenced by stigma and hierarchy and limited by caregivers' conflicting responsibilities. Valuing and involving caregivers is essential in improving quality of care. Care should be patient and family centred and HIV services should be integrated into malnutrition care at the hospital and community level.
Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) ... more Focus group discussions (FGD) are gaining in popularity in research on HIV and tuberculosis (TB) internationally as researchers seek to understand the experiences, needs and perspectives of people living with TB and/or HIV as well as their carers within the community and health sector. Conducting FGDs in resource-poor settings with vulnerable participants who are living with diseases that are frequently
Background Qualitative research networks (QRNs) bring together researchers from diverse contexts ... more Background Qualitative research networks (QRNs) bring together researchers from diverse contexts working on multi-country studies. The networks may themselves form a consortium or may contribute to a wider research agenda within a consortium with colleagues from other disciplines. The purpose of a QRN is to ensure robust methods and processes that enable comparisons across contexts. Under the Self-Testing Africa (STAR) initiative and the REACHOUT project on community health systems, QRNs were established, bringing together researchers across countries to coordinate multi-country qualitative research and to ensure robust methods and processes allowing comparisons across contexts. QRNs face both practical challenges in facilitating this iterative exchange process across sites and conceptual challenges interpreting findings between contexts. This paper distils key lessons and reflections from both QRN experiences on how to conduct trustworthy qualitative research across different conte...
The current study identifies young people's preferences for HIV self-testing (HIVST) delivery... more The current study identifies young people's preferences for HIV self-testing (HIVST) delivery, determines the relative strength of preferences and explores underlying behaviors and perceptions to inform youth-friendly services in southern Africa. A mixed methods design was adopted in Malawi and Zimbabwe and includes focus group discussions, in-depth interviews and discrete choice experiments. The current study was conducted during the formative phase of cluster-randomized trials of oral-fluid HIVST distribution. Young people aged 16-25 years were purposively selected for in-depth interviews (n = 15) in Malawi and 12 focus group discussions (n = 107) across countries. Representative samples of young people in both countries (n = 341) were administered discrete choice experiments on HIVST delivery, with data analyzed to estimate relative preferences. The qualitative results provided additional depth and were triangulated with the quantitative findings. There was strong concordance...
Background: National health research for development (R4D) platforms in lower income countries (L... more Background: National health research for development (R4D) platforms in lower income countries (LICs) are few. The Health Research Capacity Strengthening Initiative (HRCSI, 2008–2013) was a national systems-strengthening programme in Malawi involved in national priority setting, decision-making on funding, and health research actor mobilization.
Methods: We adopted a retrospective mixed-methods evaluation approach, starting with information gleaned from reports (HRCSI and Malawian) and databases (HRCSI). A framework of a health research system (actors and components) guided report review and interview guide development. From a list of 173 individuals involved in HRCSI, 30 interviewees were selected within categories of stakeholders. Interviews were conducted face-to-face or via telephone/Skype over 1 month, documented with extensive notes. Analysis of emerging themes was iterative among co-evaluators, with synthesis according to the implementation stage.
Results: Major HRCSI outputs included (1) National research priority-setting: through the production of themed background papers by Malawian health researchers and broad consultation, HRCSI led the development of a National Health Research Agenda (2012–2016), widely regarded as one of HRCSI’s foremost achievements. (2) Institutional research capacity: there was an overwhelming view that HRCSI had produced a step-change in the number of high calibre scientists in Malawi and in fostering research interest among young Malawians, providing support for around 56 MSc and PhD students, and over 400 undergraduate health-related projects. (3) Knowledge sharing: HRCSI supported research dissemination through national and institutional meetings by sponsoring attendance at conferences and through close relationships with individuals in the print media for disseminating information. (4) Sustainability: From 2011–2013, HRCSI significantly improved research systems, processes and leadership in Malawi, but further strengthening was needed for HRCSI to be effectively integrated into government structures and sustained long-term. Overall, HRCSI carried out many components relevant to a national health research system coordinating platform, and became competent at managing over half of 12 areas of performance for research councils. Debate about its location and challenges to sustainability remain open questions.
Conclusions: More experimentation in the setting-up of national health R4D platforms to promote country ‘ownership’ is needed, accompanied by evaluation processes that facilitate learning and knowledge exchange of better practices among key actors in health R4D systems.
Keywords: Capacity development, Developing countries, Qualitative methods, Research councils, Research management
In 2006 the World Health Organization described the status of prevention of mother to child trans... more In 2006 the World Health Organization described the status of prevention of mother to child transmission (PMTCT) service implementation as unacceptable, with an urgent need for a renewed public health approach to improve access. For PMTCT to be effective it needs to be accessible, acceptable and affordable; however research in Africa into accessibility, uptake and acceptability of PMTCT services has been predominately urban based and usually focusing on women who deliver in hospitals. The importance of involving other community members to strengthen both PMTCT uptake and adherence, and to support women emotionally, has been advocated. Urban men's and rural traditional birth attendants' (TBAs) involvement have improved uptake of HIV testing and of nevirapine. A qualitative study was carried out in a rural district of Malawi's central region to explore the views about and perceptions of PMTCT antiretroviral treatment. Semi-structured interviews and focus group discussions ...
Uploads
Papers by Dr. Lot Nyirenda
The Health Research Capacity Strengthening Initiative (HRCSI, 2008–2013) was a national systems-strengthening
programme in Malawi involved in national priority setting, decision-making on funding, and health research actor
mobilization.
Methods: We adopted a retrospective mixed-methods evaluation approach, starting with information gleaned from
reports (HRCSI and Malawian) and databases (HRCSI). A framework of a health research system (actors and components) guided report review and interview guide development. From a list of 173 individuals involved in HRCSI, 30 interviewees were selected within categories of stakeholders. Interviews were conducted face-to-face or via telephone/Skype over 1 month, documented with extensive notes. Analysis of emerging themes was iterative among co-evaluators, with synthesis according to the implementation stage.
Results: Major HRCSI outputs included (1) National research priority-setting: through the production of themed
background papers by Malawian health researchers and broad consultation, HRCSI led the development of a National
Health Research Agenda (2012–2016), widely regarded as one of HRCSI’s foremost achievements. (2) Institutional
research capacity: there was an overwhelming view that HRCSI had produced a step-change in the number of high
calibre scientists in Malawi and in fostering research interest among young Malawians, providing support for around 56
MSc and PhD students, and over 400 undergraduate health-related projects. (3) Knowledge sharing: HRCSI supported
research dissemination through national and institutional meetings by sponsoring attendance at conferences and
through close relationships with individuals in the print media for disseminating information. (4) Sustainability: From
2011–2013, HRCSI significantly improved research systems, processes and leadership in Malawi, but further strengthening was needed for HRCSI to be effectively integrated into government structures and sustained long-term. Overall, HRCSI carried out many components relevant to a national health research system coordinating platform, and became competent at managing over half of 12 areas of performance for research councils. Debate about its location and challenges to sustainability remain open questions.
Conclusions: More experimentation in the setting-up of national health R4D platforms to promote country ‘ownership’
is needed, accompanied by evaluation processes that facilitate learning and knowledge exchange of better practices among key actors in health R4D systems.
Keywords: Capacity development, Developing countries, Qualitative methods, Research councils, Research management
The Health Research Capacity Strengthening Initiative (HRCSI, 2008–2013) was a national systems-strengthening
programme in Malawi involved in national priority setting, decision-making on funding, and health research actor
mobilization.
Methods: We adopted a retrospective mixed-methods evaluation approach, starting with information gleaned from
reports (HRCSI and Malawian) and databases (HRCSI). A framework of a health research system (actors and components) guided report review and interview guide development. From a list of 173 individuals involved in HRCSI, 30 interviewees were selected within categories of stakeholders. Interviews were conducted face-to-face or via telephone/Skype over 1 month, documented with extensive notes. Analysis of emerging themes was iterative among co-evaluators, with synthesis according to the implementation stage.
Results: Major HRCSI outputs included (1) National research priority-setting: through the production of themed
background papers by Malawian health researchers and broad consultation, HRCSI led the development of a National
Health Research Agenda (2012–2016), widely regarded as one of HRCSI’s foremost achievements. (2) Institutional
research capacity: there was an overwhelming view that HRCSI had produced a step-change in the number of high
calibre scientists in Malawi and in fostering research interest among young Malawians, providing support for around 56
MSc and PhD students, and over 400 undergraduate health-related projects. (3) Knowledge sharing: HRCSI supported
research dissemination through national and institutional meetings by sponsoring attendance at conferences and
through close relationships with individuals in the print media for disseminating information. (4) Sustainability: From
2011–2013, HRCSI significantly improved research systems, processes and leadership in Malawi, but further strengthening was needed for HRCSI to be effectively integrated into government structures and sustained long-term. Overall, HRCSI carried out many components relevant to a national health research system coordinating platform, and became competent at managing over half of 12 areas of performance for research councils. Debate about its location and challenges to sustainability remain open questions.
Conclusions: More experimentation in the setting-up of national health R4D platforms to promote country ‘ownership’
is needed, accompanied by evaluation processes that facilitate learning and knowledge exchange of better practices among key actors in health R4D systems.
Keywords: Capacity development, Developing countries, Qualitative methods, Research councils, Research management