Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under five mortality by two-thirds between 1990 and 2015. However, neonatal morality rates are declining the slowest, even though rates of facility births are increasing. Preterm birth is a risk factor in over 50% of all neonatal deaths, and over one in every ten births in Malawi is born premature (10.5%) leading to an estimated 68,386 preterm babies in the year 2014 alone. Newborn health can be greatly improved with quality facility-based care.
Malawi has recommended the use of various proven low cost measures in their hospitals to reduce the rate of newborn deaths. However, these have not been widely implemented. The “Integrating a neonatal healthcare package of Malawi” project was an innovative collaboration between clinicians, qualitative and health systems researchers and health economists in Malawi and Canada. With a focus on implementation science and quality improvement, the project aimed to understand barriers and facilitators of practice to strengthen neonatal care at health facilities in Malawian central and district hospitals. This project explored the barriers and facilitators of implementation to 1) bubble continuous positive airway pressure (CPAP) to help babies breathe, 2) LED phototherapy to manage neonatal jaundice, 3) infant warming devices to keep babies warm, 4) kangaroo mother care where skin-to-skin contact with mothers is a low technology alternative to incubators, and 5) lactation support by medical staff to help mothers exclusively breastfeed. This project has resulted in 19 publications to date in peer-reviewed academic journals, of which nearly 75% (14 of 19) were trainee led.
Publications and presentations:
*Song JT, Kinshella MW, Kawaza K, Goldfarb DM. Neonatal Intensive Care Unit Interventions to Improve Breastfeeding Rates at Discharge Among Preterm and Low Birth Weight Infants: A Systematic Review and Meta-Analysis. Breastfeeding Medicine. 2023 Feb 15. https://doi.org/10.1089/bfm.2022.0151
*Suwedi-Kapesa LC, Kinshella MW, Vidler M, Dube Q, Goldfarb DM, Kawaza K, Nyondo-Mipando AL. Lessons Learned in Conducting Qualitative Healthcare Research Interviews in Malawi: A Qualitative Evaluation. International Journal of Qualitative Methods. 2023 Jan 22. https://doi.org/10.1177/16094069231153610
*Piccolo O, Kinshella MW, Salimu S, Vidler M, Banda M, Dube Q, Kawaza K, Goldfarb DM, Nyondo-Mipando AL. Healthcare worker perspectives on mother’s insufficient milk supply in Malawi. International Breastfeeding Journal. 2022 Dec; 17(1):14. https://doi.org/10.1186/s13006-022-00460-1
*Kinshella MW, Salimu S, Vidler M, Banda M, Molyneux EM, Dube Q, Goldfarb DM, Kawaza K, Nyondo-Mipando AL. Beyond early initiation: A qualitative study on the challenges of hospital-based postpartum breastfeeding support. PLOS Global Public Health. 2022 Nov; 2(11):e0001266. https://doi.org/10.1371/journal.pgph.0001266
*Kinshella MW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Hiwa T, Vidler M, Molyneux EM, Dube Q. Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals. BMC Pediatrics. 2022 Jun; 367:22. https://doi.org/10.1186/s12887-022-03430-y
*Ong AJ, Kinshella MW, Salimu S, Vidler M, Elango R, Banda M, Dube Q, Goldfarb D, Kawaza K, Nyondo-Mipando AL. Perceptions of expressed breast milk for preterm infants in Malawian hospitals: A qualitative study. Journal of Neonatal Nursing. 2022 Apr; 28(2):113-7. https://doi.org/10.1016/j.jnn.2021.08.006
Nyondo-Mipando AL, Kinshella MW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Hiwa T, Vidler M. Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi. International Breastfeeding Journal. 2021 Dec;16(1):72. https://doi.org/10.1186/s13006-021-00418-9
*Kinshella MW, Salimu S, Pickerill K, Vidler M, Banda M, Newberry L, Dube Q, Molyneux EM, Goldfarb DM, Kawaza K, Nyondo-Mipando AL. “Like works of our hands are giving testimony!” A qualitative study on kangaroo mother care and health worker empowerment in southern Malawi. African Journal of Reproductive Health. 2021 Oct;25(3s):65-73. http://doi.org/10.29063/ajrh2021/v25i3s.7
*Kinshella MW, Nyondo-Mipando AL, Dube Q, Goldfarb DM, Kawaza K. Facility assessment and qualitative analysis of health worker perspectives on neonatal health in Malawi. BMC Research Notes. 2021 Jul; 14(1):267. https://doi.org/10.1186/s13104-021-05679-5
Nyondo-Mipando AL, Kinshella MW, Hiwa T, Salimu S, Banda M, Vidler M, Molyneux E, Dube Q, Goldfarb DM, Kawaza K. Mothers' quality of life delivering kangaroo mother care at Malawian hospitals: a qualitative study. Health Quality of Life Outcomes. 2021 Jul; 19(1):186. https://doi.org/10.1186/s12955-021-01823-8
*Kinshella MW, Prasad S, Hiwa T, Vidler M, Nyondo-Mipando AL, Dube Q, Goldfarb D, Kawaza K. Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review. Global Health Research and Policy. 2021 Jul; 6(1): 21. https://doi.org/10.1186/s41256-021-00206-2
*Kinshella MW, Hiwa T, Pickerill K, Vidler M, Dube Q, Goldfarb D, Nyondo-Mipando D, Kawaza K. Barriers and facilitators of facility-based kangaroo mother care in sub-Saharan Africa: a systematic review. BMC Pregnancy and Childbirth. 2021 Mar; 21(1):176. https://doi.org/10.1186/s12884-021-03646-3
Nyondo-Mipando AL, Kinshella MW, Salimu S, Banda M, Newberry L, Njirammadazi J, Hiwa T, Brandina C, Chikoti F, Chirambo L, Mwaungulu E, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb D, Kawaza K. “It brought hope and peace in my heart:” Caregivers perceptions on kangaroo mother care services in Malawi. BMC Pediatrics. 2020 Dec; 20(1):541. https://doi.org/10.1186/s12887-020-02443-9
*Kinshella MW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Njirammadzi J, Hiwa T, Vidler M, Molyneux E, Dube Q, Mfutso-Bengo J, Goldfarb D, Kawaza K, Nyondo-Mipando AL. “So sometimes, it looks like it’s a neglected ward”: Health worker perspectives on barriers and facilitators to implementing hospital-based kangaroo mother care in southern Malawi. PLOS One. 2020 Dec; 15(12):e0243770. https://doi.org/10.1371/journal.pone.0243770
*Kinshella MW, Salimu S, Hiwa T, Banda M, Vidler M, Newberry L, Dube Q, Molyneux E, Goldfarb DM, Kawaza K. Nyondo-Mipando AM. Scaling up newborn care technologies from tertiary to secondary-level hospitals in Malawi: An implementation case study of health professional perspectives on bubble CPAP. Implementation Science Communications. 2020 Nov; 1(1):100 https://doi.org/10.1186/s43058-020-00092-8
*Kinshella MW, Walker CR, Hiwa T, Vidler M, Nyondo-Mipando AM, Dube Q, Goldfarb DM, Kawaza K. Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review. Public Health Reviews. 2020 Apr;41:6. https://doi.org/10.1186/s40985-020-00124-7
*Salimu S, Kinshella ML, Vidler M, Banda M, Newberry L, Dube Q, Molyneux E, Goldfarb D, Kawaza K, Nyondo-Mipano, AM. Health workers’ views on factors affecting caregiver engagement with bubble CPAP. BMC Pediatrics. 2020 Apr;20(1):180. https://doi.org/10.1186/s12887-020-02088-8
Kawaza K, Kinshella MW, Hiwa T, Njirammadzi J, Banda M, Vidler M, Newberry L, Nyondo-Mipando AL, Dube Q, Molyneux E, Goldfarb D. Assessing quality of newborn care at district facilities in Malawi. BMC Health Services Research. 2020;20(1):227. https://doi.org/10.1186/s12913-020-5065-2
Nyondo-Mipando AM, Kinshella MW, Bohne C, Suwedi-Kapesa LC, Salimu S, Banda M, Newberry L, Njirammadzi J, Hiwa T, Chiwaya B, Chikodi F, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K. Mijovic H. Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi. PLOS One. 2020;15(2):e0228915. https://doi.org/10.1371/journal.pone.0228915
Hiwa T, Makwero C, Nyondo-Mipando L, Kawaza K. Improving the quality of kangaroo mother care and breastfeeding support at district hospitals in Malawi. Stakeholders meeting with Malawian District Health Management Teams; 2021 Mar 31; Blantyre, Malawi.
Kinshella MW, Omar S, Goldfarb D, Dube Q, Nyondo-Mipando L, Kawaza K. Integrating neonatal healthcare package for Malawi - policy brief: An IMCHA project to strengthen newborn care in low-resourced hospitals. Policy brief and abstract booklet for Malawi Ministry of Health stakeholders; 2021 Mar 30.
Makiya F, Banda M. Improving the quality of kangaroo mother care and breastfeeding support at district hospitals in Malawi. Stakeholders presentation to Mulanje District Health Management Team and Healthcare Workers at Mulanje Hospital; 2020 Nov 21; Mulanje, Malawi.
Makiya F, Banda M. Improving the quality of kangaroo mother care and breastfeeding support at district hospitals in Malawi. Stakeholders presentation to Phalombe District Health Management Team and Healthcare Workers at Phalombe Hospital; 2020 Nov 19; Phalombe, Malawi.
Makiya F, Banda M. Improving the quality of kangaroo mother care and breastfeeding support at district hospitals in Malawi. Stakeholders presentation to Chikwawa District Health Management Team and Healthcare Workers at Chikwawa Hospital; 2020 Nov 18; Chikwawa, Malawi.
Makwero C, Hiwa T, Nyondo-Mipando L, Dube Q, Kawaza K. Integrating a neonatal healthcare package for Malawi. Stakeholders meeting with AMREF and Malawi Ministry of Health; 2020 Sep 24; Mangochi, Malawi.
Piccolo O, Salimu S, Prasad S, Ong AJ, Kinshella MW. Determinants of Breastfeeding in Malawi. Stakeholders presentation to Malawi Ministry of Health, International Development Research Centre (IDRC) and Canadian Institutes of Health Research (CIHR); 2020 Sep 24; Vancouver, Canada.
Facilitated the “Impact Now: Improving maternal, newborn and child health in Africa through innovative solutions” meeting; 2019 Nov 18-20; Stellenboch, South Africa.
Partnership with the Paediatric And Child Health Association of Malawi (PACHA) to mobilize our IMCHA project findings through healthcare worker refresher training on Care of Young Infants and Neonates (COIN); 2020 Jun 8-9; Chintheche Hospital, Malawi.
Facilitated a symposium entitled “Lessons learned from the implementation of new essential maternal and newborn interventions in low- and middle-income countries” at 24th Canadian Conference on Global Health; 2018 Nov 19-21; Toronto, Canada.
Nyondo-Mipando L. Pathways of Delays: Qualitative Analysis of Health Care Providers’ Perceptions of Using Bubble CPAP. Stakeholders presentation at Queen Elizabeth Central Hospital, Blantyre, Malawi Paediatric Rounds; 2018 Oct 3; Blantyre, Malawi
Kinshella MW. Witnessing lifesaving neonatal innovations in Malawi. BMC Blog Network: On Health. 2018 Oct 4; Available online at: https://blogs.biomedcentral.com/on-health/2018/10/04/witnessing-lifesaving-neonatal-innovations-malawi/ (2018)
Li E, Rochefort R, Verdun I, Kinshella MW. Barriers and facilitators of implementing bubble continuous positive airway pressure and kangaroo mother care in Malawi. Poster session presented at: Multidisciplinary Undergraduate Research Conference; 2021 Mar 20-21; Vancouver, Canada.
Ong AJ, Kinshella MW, Elango R, Nyondo-Mipando AL. Caregivers' and healthcare workers' perceptions of expressed breastmilk in Malawi. Poster session presented at: Sixth Annual Women's Health Research Symposium; 2021 Mar 3; Vancouver, Canada.
Piccolo O, Kinshella MW, Goldfarb D, Nyondo-Mipando AL. Reasons given by health care workers and caregivers for breastmilk insufficiency in Malawi. Poster session presented at: Sixth Annual Women's Health Research Symposium; 2021 Mar 3; Vancouver, Canada.
Kinshella MW, Prasad S, Hiwa T, Vidler M, Nyondo-Mipando AL, Dube Q, Goldfarb D, Kawaza K. A systematic review to understand health facility-based barriers and facilitators for early and exclusive breastfeeding in sub-Saharan Africa. Poster session presented at: Sixth Annual Women's Health Research Symposium; 2021 Mar 3; Vancouver, Canada.
Kinshella MW. Health professional and caregivers perspectives on implementing kangaroo mother care (KMC) in Malawian hospitals: Lessons learned from the IMCHA project. Presented at: Global Health & Innovation Online Lunch and Learn, Centre for International Child Health; 2020 Jun 25 ; Vancouver, Canada
Kinshella MW, Walker C, Hiwa-Maliro T, Vidler M, Dube Q, Goldfarb D, Kawaza K. Barriers and facilitators to bubble CPAP implementation in sub-Saharan Africa. Poster session presented at: First Annual Global Health Conference; 2019 Jan 24; Vancouver, Canada
Walker C, Kinshella MW, Hiwa-Maliro T, Vidler M, Dube Q, Goldfarb D, Kawaza K. A systematic review of phototherapy to manage neonatal jaundice barriers and facilitators in low- and middle-income countries. Poster session presented at: First Annual Global Health Conference; 2019 Jan 24; Vancouver, Canada
Hiwa-Maliro T, Kinshella MW, Walker C, Vidler M, Dube Q, Goldfarb D, Kawaza K. Implementing the lactation support and kangaroo mother care quality improvement project at three district level hospitals in Malaw. Poster session presented at: First Annual Global Health Conference; 2019 Jan 24; Vancouver, Canada
Nyondo-Mipando L. Barriers and facilitators to implementing lifesaving neonatal innovations in Malawi. Presented to: BC Children’s Hospital Research Institute Seminar; 2018 Nov 26; Vancouver, Canada
Nyondo-Mipando L, Kinshella MW, Hiwa-Maliro T, Goldfarb D, Kawaza K. Barriers and facilitators to implementing bubble continuous airway pressure in Malawi (Lessons learned from the implementation of new essential maternal and newborn interventions in LMICs panel). Presented at: 24th Canadian Conference on Global Health; 2018 Nov 19-21; Toronto, Canada.
Kinshella MW, Hiwa-Maliro T, Goldfarb D, Kawaza K. Neonatal care services at district facilities in Malawi: Availability and quality of care from four rural health facilities (Lessons learned from the implementation of new essential maternal and newborn interventions in LMICs panel). Presented at: 24th Canadian Conference on Global Health; 2018 Nov 19-21; Toronto, Canada.