ArticleBMJ global health2026
More than a lack of resources: a mixed-methods assessment of the barriers and facilitators to infection prevention practices in three low-resource maternity units in Malawi.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMaternal sepsis is a leading cause of maternal mortality and morbidity. Caesarean section is a risk factor for infection, particularly in low-resource settings. This study aimed to identify barriers and facilitators to recommended infection prevention (IP) practices prior to implementation of a complex intervention to improve IP during caesarean section in a low-resource setting.
methodsThis was a mixed methods study conducted in three semi-rural maternity hospitals in Malawi between June and December 2022. Participants were healthcare workers (HCWs) and women undergoing caesarean section. Data collection included case note review, weekly surveys and ethnographic participant observation to assess resource availability for IP and adherence to recommended IP practice. Preliminary data were integrated and used to inform in-depth interviews with HCWs to further explain findings. Inductively coded themes from interviews were mapped to the Communication-Opportunity-Motivation-Behaviour (COM-B)/Theoretical Domains Framework (TDF) model.
resultsWe found a lack of resources and suboptimal infrastructure for IP across the facilities, with many basic items available only intermittently. Observation revealed significant gaps in recommended IP practices, including hand hygiene, aseptic technique during vaginal examination, surgical scrubbing and sterile practice in the operating theatre. Scarcity of resources and infrastructure functioned as both direct and indirect barriers to IP due to their impact on staff motivation (reflective and automatic). Having 'passion' for patients, regular senior supervision and 'reminders' acted as facilitators to recommended IP practice.
conclusionOur study demonstrates that adherence to recommended IP practice is determined by more than the availability of resources; the indirect impact of scarcity on staff motivation also played an important role. The study identified further barriers and facilitators to general IP practices, the understanding of which was subsequently used in the selection and development of a complex behaviour change intervention to improve IP practices in the same facilities.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.