5. METHODOLOGY
5.3 S AMPLING
5.3.1 Quantitative data collection
The initial aim was to include about 80-100 pairs of children/caregivers in the study, however this depended on the number of children and their caregivers admitted to the NRU in the time period of the study (beginning of August till end of November). As a result, 70 pairs were included in the initial interview on admittance and 30 pairs were followed-up. Of these, 3 children had deceased and these were all children who had absconded from the NRU before discharge and no follow-up interview was conducted. The other lost follow-ups were due to death of the child during the stay in the NRU (N= 12), but also to time limitation of the study (N= 25) as the follow- up interview was conducted 30-32 days after discharge. In this case, the children were discharged later than 30 days before or were still at the NRU at the end of the research period.
The participants were recruited through purposive sampling as they were selected as
participants based on one common characteristic which was that they were all admitted to one of the three NRUs due to severe malnutrition. The inclusion criteria’s were:
1) The caregiver was the primary caregiver of the child admitted. For the purpose of this study, primary caregiver was defined as the person caring fulltime for this child during the last three months.
2) The child was admitted not more than four days prior to the participation of the initial quantitative interview.
3) The caregiver gave informed written consent to participate in the study.
4) The child admitted was between 0-59 months of age.
(5) This admission was the first time the child was admitted to the NRU. This last inclusion criterion was discarded as several of the participants represented readmissions to the NRU and would therefore further limit the number of participants to the study.
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5.3.2 Qualitative data collection
The aim was to conduct qualitative interviews with every 7th caregiver participating in the quantitative study. However, as one of the chose participants refused to be interviewed and some of the children died and there was a time limitation, the participants were chosen as being every 7th judged to be the most suitable given these other constraints. A total of seven interviews were conducted with caregivers. The three homecraft workers interviewed were chosen by length of employment and location. The ones who had been employed the longest time in each of the three NRUs and who consented were interviewed.
5.3.3 Procedures for establishing contact with the informants
As mentioned previously, it was decided to conduct the study at the NRU at Mangochi DH in agreement with Dr. Ken Maleta and CHAM. The researcher was introduced to the District Health Officer as well as to the homecraft workers at this hospital. On the basis of the hospital reports from previous years, it was noticed that sampling from this NRU alone would not be sufficient to reach the aimed sample size of 80-100 pairs of children/caregivers given the time available for field research. The study setting was therefore expanded to include the two other NRU`s in Mangochi District, namely at St. Martins Hospital and Nkope H/C (see Section 2.4). With the help of the local supervisor, the researcher was granted permission from CHAM, as well as from the Medical Assistant in Charge of the two institutions. As the humanitarian organisation AAH is supporting the NRUs at Mangochi DH and St. Martin Hospital, information was given and permission granted from the NRU coordinator for AAH in Malawi. All key persons in this process were informed about the content of the study and given a copy of the research protocol to read for further information.
5.3.4 Selection and training of the research assistant
A research assistant was employed as an interpreter. As a female assistant was most
appropriate for this study, she was introduced to the researcher through the local supervisor and the Centre for Reproductive Health, College of Medicine at the University of Malawi,
32 whom she had been working with during previous research projects. The research assistant had previous experience from working with both Malawian and foreign researchers, both as interpreter and in the process of data collection.
The research assistant translated the questionnaires into the local languages Chichewa and Yao and was trained thoroughly. The purposes of the study and the importance of language used for the informants to understand the questions asked were discussed during this process.
The correct methods of conducting anthropometric measurement were also reviewed with the research assistant.
During all the interviews for the quantitative part, the researcher was present for answering any questions or in case clarifications were needed as these were conducted in the local language. For the qualitative part, the research assistants were translating the conversations between the researcher and the informants.
5.3.5 Information to the participants
The participants were given information about the purpose and the use of the information gathered, and the right to withdraw from the study at any time during the interviews. The participants were also being ensured that the information gathered would be treated
confidentially and would not be traceable back to them. This information was written in an informed consent form (see Appendix 1), and was provided in a simple language by the research assistant who read from this and described the purpose and arrangement of the study in the appropriate local language. When this was clear to the participant and she agreed to participate, both verbally and written consent was obtained. Most of the participants were illiterate and in this case the written consent was obtained by a thumb print.
5.3.6 Ethical considerations
This research project was performed in accordance to the Helsinki declaration on ethical principles for medical research involving human subjects of 1964 (50). Ethical clearance was
33 sought and approved from the Regional Ethical Committee in Norway and the Medical Research Ethical Committee in Malawi prior to the commencement of the study.
The Regional Ethical Committee in Norway approved the research project on the prerequisite that the researcher kept a logbook noting the participants who did and did not give consent.
This was due to the high levels of illiteracy and therefore difficulties with reading and signing the consent form. The Medical Research Ethical Committee in Malawi required the
participants who could not provide a written signature to sign by thumb printing.