'I don't want all my babies to go to the grave': perceptions of preterm birth in Southern Malawi.
OBJECTIVE
to investigate perceptions of preterm birth, infections in pregnancy and perinatal mortality among women, men and health-care providers in Namitambo, Southern Malawi.


METHODS
a qualitative study using focus-group discussions, critical incidence narrative and key informant interviews. The framework approach to qualitative analysis was used.


METHODS
Namitambo, a rural area in southern Malawi.


METHODS
women who have experienced preterm delivery, groups of mothers, fathers and grandmothers, health-care providers, traditional birth attendants and healers.


RESULTS
four key inter-related themes grounded in community interpretative frameworks emerged: (1) community conceptualisations of preterm birth (the different terminologies used); (2) perceived causes of preterm birth (i.e. both 'modern' and 'traditional; illnesses, violence, witchcraft, ideas relating to impurity, heavy work, inadequate food and inappropriate use of medicine); (3) perceived strategies to prevent preterm birth (i.e. using formal health services, treatment for sexually transmitted infections, using condoms and stopping violence); and (4) barriers to realising these strategies, such as lack of food, money and women's autonomy in health seeking.


CONCLUSIONS
similarities and differences exist in understanding between healthcare providers and the community. Additional dialogue and action is needed within the health sector and community to address the problem of preterm births. This includes strategies to enable health-care providers and community members to reflect on their perceptions and practices (e.g. through action research and interactive drama); identify and build on areas of common concern (i.e. poor pregnancy outcome) and enter into partnerships with non-formal providers. Action is also needed beyond the health sector (e.g. in campaigns to reduce gender-based violence).
Tolhurst
Rachel
R
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Theobald
Sally
S
Kayira
Edith
E
Ntonya
Chikondi
C
Kafulafula
George
G
Nielson
Jim
J
van den Broek
Nynke
N
D000328:Adult; D000739:Anecdotes as Topic; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008295:Malawi; D008425:Maternal Behavior / Q000523:psychology*; D008519:Medicine, Traditional; D008880:Midwifery / Q000379:methods*; D009035:Mothers / Q000523:psychology; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D007752:Obstetric Labor, Premature / Q000451:nursing* / Q000517:prevention & control / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods; D012307:Risk Factors; D012424:Rural Population; D012649:Self Concept; D012944:Social Support; D012959:Socioeconomic Factors