ABSTRACT

Malawi, as a low and middle income country (LMIC), with one of the lowest per capita gross domestic products, faces challenges in the provision of healthcare to its citizens. According to the Centers for Disease Control (CDC), leading causes of death include but are not limited to, lower respiratory disease, stroke, cancer, neonatal disorders, and nutritional deficiencies. Feeding and swallowing disorders can present as a symptom to any of these medical diagnoses. Currently, there are no known studies focusing on the service provision for feeding and swallowing disorders in Malawi.

This pilot study was designed to provide a baseline on how feeding and swallowing disorders are currently being provided for in an emerging country like Malawi. Malawian healthcare professionals who see patients with feeding and swallowing disorders completed a survey and interview pertaining to their personal demographics, caseload, opinions, experiences, and treatment recommendations regarding the management of swallowing disorders (dysphagia).

Results indicate a wide range of occupations (Otolaryngoloists, Rehabilitation Technicians, Audiology Technicians, and Nurses) are involved in feeding and swallowing care. Participants expressed a high obligation to provide services for feeding and swallowing disorders, as well as a high concern for their patients. Generally, participants expressed high confidence in their treatment abilities, which did not correspond to knowledge of treatment recommendations that meet U.S. standards of care. Specifically, there was no variation in treatment recommendations across severities and a general lack of resources and tools for assessing and treating dysphagia. Treatment recommendations tended to align with resources currently available in Malawi.

Implications for the utilization of NGOs (non-governmental organizations) and the education of healthcare providers on feeding and swallowing disorders in the social and cultural contexts of this country are discussed.

Latino parents of children with feeding disorders completed a survey about their experiences accessing support and the cultural competence of their providers. This work is a follow-up project to a presented American Speech and Hearing Association Conference poster (Stats-Caldwell, Lindsay, Van Vuren, 2017). That project revealed caregivers’ use of social media and indicated an overall perceived lack of support from providers. In the present survey, Latino caregivers identified the resources they consult and rated the level of helpfulness in addition to the types of supports they sought and received from these resources. Results indicate a considerable reliance on pediatricians in both frequency of consultation and helpfulness ratings. No significant difference was seen between the frequency of consultation between pediatricians, speech-language pathologists and other service providers. No significant difference was found in the helpfulness ratings between speech-language pathologists and topic-specific social media pages, nor speech-language pathologists and grandmothers. Participants indicated reliance on social media for informational resources. The influence of social media is discussed. The cultural implications of treating this population are also reviewed.