Available courses

The Malawi Guidelines for Clinical Management of HIV in Children and Adults started being implemented in May 2016. It replaces all previous editions of the Malawi Antiretroviral therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) guidelines. This document is written for medical doctors, clinical officers, medical assistants, nurses, midwives, health surveillance assistants (HSAs) and medical records clerks who are working in public and private sector health facilities in Malawi. It is designed to be a practical guide for implementation of integrated HIV Services.

The guidelines have been compiled by the joint Technical Working Groups for PMTCT, ART, HIV testing and Paediatric HIV under the leadership of the Dept. for HIV and AIDS of the Ministry of Health. The guidelines are based on Malawi’s Revised Policy for PMTCT and ART which was endorsed by the Ministry of Health in June 2010 and which was prompted by the release of the 2010 Revision of the World Health Organisation (WHO) PMTCT and ART Guidelines. This 3rd Edition is an adaptation of the 2015 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.The protocols and policies presented in this document are adapted for health services in Malawi and follow a public health approach, aiming to provide the best possible services for the largest possible number of persons in need of these services.This document defines the framework for Malawi’s National HIV Programs. Considering public health benefits and risks, as well as funding and resource implications, deviations from these guidelines are not supported by the Ministry of Health.

This module has been developed in order to equip the reader/ learner with knowledge skills and appropriate attitudes in managing a woman with obstetric haemorrhage.

This module has been developed in order to assist you acquire knowledge, skills and appropriate attitudes in the use of partograph during labour and delivery.

Did you know that the partograph was first developed by Emmanuel Friedman in 1954? (Umezulike, Onah , & Okaro, 1999). What was it for? You will learn that he developed the partograph to provide a realistic tool for the study of human labour. This was done to rationalize the use of maternity services in Africa where the scarcity of resources required prioritization of cases for specialized obstetric care.

The main focus was to find ways of preventing prolonged labour because prolonged labour affects both the mother and foetus at all levels. Prolonged labour is the root of all problems that may come when a woman is in labour and thereafter.

The partograph mainly describes a normal pattern of cervical dilatation called cervical graph or cervical gram while the process of assessment was referred as cervimetry. Since then there has been several modifications on the partograph with an aim of improving maternal care. Most modifications occurred when WHO took control of maternal care in the world and ruled that partograph should be the universal tool for monitoring labour. You will be interested to know that, currently, Malawi is using the partograph which was last modified by WHO in 2000. Thereafter, Malawi made its modifications to suit Malawian situation which you will learn in this module.

This module on Partograph has one unit. We wish you well as you learn how the modified Partograph works in Malawi.

This module guides you in acquiring knowledge, skills and appropriate attitude in identifying and managing women with hypertensive disorders in pregnancy. Discussion in this module is limited to four categories of hypertension common in pregnancy which are; Gestational hypertension, chronic hypertension, pre-eclampsia and eclampsia. We wish you enjoyable time as you gain knowledge and competence in handling a woman with hypertensive disorders in pregnancy. 

INTRODUCTION AND DEFINITION OF TERMS

According to Malawi Confidential Maternal Death Report of 2012, hypertension is one of the major causes of maternal deaths and accounts for 13.7% of all maternal deaths. it is therefore, very important that pregnant mothers be closely monitored and managed in order to prevent maternal and neonatal deaths associated with hypertension.

Hypertension

This is an elevation of systolic blood pressure by 30 mmHg or more; or diastolic blood pressure by 15 mmHg.

Hypertension can also be defined as systolic blood pressure of more than or equal to 140 mmHg or diastolic blood pressure of more than or equal to 90 mmHg.

The reading should be taken at least on two occasions of 6 hours apart.

 Severe hypertension

This is an elevation of systolic blood pressure equal or more than 160 mmHg or diastolic blood pressure equal or more than 110 mmHg .

Proteinuria

This is the presence of protein in urine with a reading of a two (++) plus on one occasion, or one ( +) plus  on several occasions detected  on dipstick 

Gestational hypertension

This refers to hypertension onset after 20 weeks of pregnancy and without proteinuria

Chronic hypertension

Hypertension onset before 20 weeks gestation or prior to pregnancy

Pre-eclampsia

This is hypertension and proteinuria developing for the first time after 20 weeks gestation.

Eclampsia

This refers to hypertension and proteinuria in pregnancy complicated by convulsions.


This module has been developed to assist the learner in acquiring knowledge skills and appropriate attitudes in the management of a neonate with asphyxia. The module focuses on the causes and its management.

Asphyxia is the most common clinical conditions in the perinatal period and is an important cause of neonatal mortality in developing countries. As many as 10% of new born babies require some degree of resuscitation to stimulate breathing (Cunningham et al. 2005). According to the WHO, 4 to 9 million cases of neonatal asphyxia happen annually worldwide accounting for approximately 20% of all new born deaths. More than a million new born babies who survive asphyxia at birth develop long term problems such as cerebral palsy, mental retardation, seizures, hearing, speaking, visual and learning disabilities (Ricci, 2007).

In Malawi birth Asphyxia and birth trauma account for 28% of all neonatal deaths below the age of one month (published in Liu et al, Lancet 2014). Nearly 1 out of every 4 neonatal deaths in Malawi are a result of birth asphyxia (Hole, olmsted, Kimera & Chambarlain, 2012). It is therefore essential that you are equipped with knowledge and skills required to diagnose birth asphyxia but also institute appropriate and timely care. This can save the lives and avoid the neurological problems associated with birth asphyxia.

In this module, you will learn about birth asphyxia, it’s management, in particular new born resuscitation and post resuscitation management. We hope that through this you will approach the next patient that you encounter who has asphyxia with confidence and skill. Take your time in understanding issues in this Module and we wish you will have a pleasurable time.


This module will provide facility based health care workers with knowledge, skills and appropriate attitudes in managing premature/ preterm babies and low birthweight babies. The module will act as a guideline and a quick access to information on management of premature/preterm and low birth weight babies.  In particular you will also learn about Kangaroo Mother Care (KMC) which has proved to be a highly effective method of maintaining body heat of preterm babies, reducing mortality and improving neonatal outcomes.

According to the Malawi Demographic Health Survey (MDHS), 2010, neonatal mortality rate was at 31 per 1,000 live births and the MDHS, 2016 estimated it at 29 deaths per 1000 live births.  Although this is an improvement, we still have too many newborns dying. Prematurity accounts for 30% of the main causes of neonatal deaths apart from infection which accounts for 30%, and asphyxia accounting for 22% (MDHS, 2016)

The death rate in premature babies falls markedly with increasing weight and levels out at 2,500g which on average correlates with 36 weeks gestation. This is why the cardinal rule in obstetrics is to avoid delivery before 37 weeks’ gestation whenever possible.

This module will serve as a refresher to guide you in managing premature newborn babies,  providing support to their mothers, within the health facility and for continuity of care when the babies are discharged home.

The module has two units:

Unit 1 which looks at Prematurity and low birth weight babies

Unit 2 in which you will learn about Kangaroo mother care (KMC)

This nutrition module will provide knowledge and skills to health workers who are based in health facilities. The knowledge and skills will act as guidelines to provide intensive inpatient care for severe acute malnutrition at Nutrition Rehabilitation Centres.

Malawi has a population of 17 million people. Malnutrition is responsible for causing over half of all child mortalities in Malawi. The statistical rates of children experiencing effects of malnutrition in Malawi have remained unaltered since 1992. With 48% of children under the age of 5 experiencing various forms of stunted growth, 22% of children under weight and 5% have acute malnutrition, researchers revealed that it was due lack of adequate micronutrients (Malawi national nutrition policy, 2011). 

It is estimated that in every 4 seconds, a Malawian could be dying of a nutrition related problem (Malawi national nutrition policy, 2011). The government of Malawi developed the National Nutrition Policy to enhance government’s response towards the malnutrition crisis. The policy is intended to facilitate the standardization, coordination and improvement of quality of nutritional services so as to reduce the prevailing nutritional disorders. One of the 3 policies states ‘creation of an enabling environment that adequately provides for the delivery of nutrition services and implementation of the nutrition programmes, projects and interventions.

Therefore this nutrition module will serve as a refresher guide to better assist you in managing children who suffer from severe acute malnutrition , as well as provide the necessary support to their mothers within the health facility.


This module on Integrated Management of Childhood Illness (IMCI) has been developed for you to acquire knowledge, skills and appropriate attitude on the management of childhood illnesses. IMCI has three components which includes:introduction to IMCI, care of child aged 2 months up to 5 years and care of young infant aged up to 2 months.

COMPONENT ONE: INTRODUCTION TO INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

This component acts a background for you to understand better how to assess and classify illnesses, and identifying treatment and treat the child or infant of the problems. As such, the component has two Units, namely:

Unit 1: Integrated management of child illness strategy

Unit 2: IMCI case management process

 

COMPONENT TWO: CARE OF CHILD AGED 2 MONTHS UP TO 5 YEARS

This component is presented in 15 Units as follows:

Unit 3: Ask the mother about the child's problems

Unit 4: Check for general danger signs

Unit 5: Assess cough or difficulty breathing

Unit 6: Assess diarrhoea

Unit 7: Assess fever

Unit 8: Assess ear problem

Unit 9: Check for HIV infection

Unit 10: Check for acute malnutrition

Unit 11: Check for anaemia

Unit 12: Check immunization, vitamin A, and deworming status

Unit 13: Check other problems including mouth and gum conditions

Unit 14: Identify treatment

Unit 15: Treat the child

Unit 16: Counsel the mother

Unit 17: Follow up the child

 

COMPONENT THREE: CARE OF YOUNG INFANT AGED UP TO 2 MONTHS

Structurally, this component of IMCI is similar to component two only that this component deals with how to care for a young infant aged up to 2 months. The material in this component is presented in three parts, namely,

·      Assess and classify young infant 

·      Identify treatment for young infant, treat and counsel

·      Follow-up young infant.

You will learn these three parts through Units 1 to 6 as follows:

Unit 18: Check for very severe disease and local bacterial infection. 

Unit 19: Check for jaundice.

Unit 20: Assess the young infant’s diarrhoea.

Unit 21: Check young infant for HIV infection

Unit 22: Check for feeding problem or low weight.

Unit 23: Check the young infant's immunization and assess any other problems

UNIT 24: Identify treatment for young infant, treat and counsel

UNIT 25: Follow up the young infant 

We wish you a pleasant time as you study this Module to enrich yourself on knowledge and skills in caring for children and infants.