Knowledge, Attitude, And Practices Of Healthcare Workers On Gastroschisis Pre-referral Management Interventions In Central Malawi

Knowledge, Attitude, And Practices Of Healthcare Workers On Gastroschisis Pre-referral Management Interventions In Central Malawi

Martin A Chigwede, Bip Nandi , Amarylis Mapurisa , Miranda Amundsen
Kamuzu Central Hospital, Lilongwe, Malawi; British Columbia Women’s Hospital, British Columbia, Canada

Background
Gastroschisis affects an estimated 16,000 neonates in Sub-Saharan Africa, posing significant management challenges. In Malawi, tertiary hospitals have adopted bedside silo placement and delayed closure techniques, but knowledge gaps and inconsistent pre-referral management practices among healthcare workers (HCWs) in primary care settings remain. This study aimed to assess HCWs’ knowledge, attitudes, and practices (KAP) regarding gastroschisis pre-referral management in Central Malawi to identify barriers and inform targeted interventions.

Method
The study deployed a convergent mixed-methods design. A structured, self-administered survey was distributed to 134 HCWs that were purposefully sampled across 14 facilities that were selected based on the gastroschisis case referral frequency. Data was analyzed using descriptive statistics, with composite scores being calculated to calculate overall categories in the knowledge, attitude, and practices sections. And tests of associations, chi-square tests were done to statistically analyze the association between the variables. Qualitative data was analyzed using thematic content analysis.

Results
From the study, healthcare workers demonstrated high knowledge (mean = 7.04/9) and positive attitudes (mean = 4.44/5), but moderate practices (mean = 3.98/5), with systemic challenges, resource constraints, and inconsistent protocol adherence hindering pre-referral gastroschisis management.

Conclusion
The results indicate that healthcare workers in central Malawi are knowledgeable and motivated to manage gastroschisis cases effectively. However, gaps in practice, coupled with systemic challenges such as resource limitations and inconsistent protocol adherence, hinder optimal outcomes. Addressing these barriers through targeted training, resource allocation, and standardized guidelines is essential to improving neonatal survival and advancing gastroschisis care in Malawi.

Keywords: Pediatric Surgery, Abdominal wall defects, Gastroschisis, Malawi, Pre-referral management