Su, YanfangNgongoma, Luyanda Z2024-09-092024-09-092024Ngongoma_washington_0250O_27165.pdfhttps://hdl.handle.net/1773/51687Thesis (Master's)--University of Washington, 2024This study examines the association between power supply and the availability and functionality of ultrasound (USS) equipment in Malawi's healthcare facilities, using data from the 2019 Harmonized Health Facility Assessment (HHFA). A cross-sectional design was utilized, analyzing 1,052 facilities across Malawi's three-tiered healthcare system. Key variables included power access, reliability, usage, and generator availability, with statistical models adjusted for facility level, ownership, and geographic location. The results show a significant association between complete power access and higher odds of functional USS equipment. Facilities with complete power access had over eight times higher odds of functional USS equipment (OR = 8.26, CI 3.58 - 19.04, p < 0.001) than those without power access. Partial power access was associated with lower odds of functional USS equipment (OR = 0.13, CI 0.056 - 0.319, p < 0.001). Facilities that used electricity specifically for medical devices had higher odds of functional USS equipment (OR = 2.83, p < 0.001). Power reliability was also crucial; facilities with fewer than 2 hours of power interruptions per day had higher odds of functional USS (OR = 1.97, p < 0.001). However, generator availability showed a less consistent association, with facilities having generators being less likely to have functional USS equipment (OR = 0.42, p = 0.009). Disparities were observed across facility levels, regions, and ownership types, with secondary and rural facilities showing superior USS functionality compared to primary and urban facilities. Christian Health Association of Malawi (CHAM) and NGO-owned facilities outperformed government-owned facilities in equipment functionality, with CHAM facilities showing 58.9% functional USS compared to 46.4% in government facilities. The study highlights the potential of handheld point-of-care ultrasound (HPOCUS) devices to address power-related constraints, offering a promising solution for resource-limited settings. However, the cross-sectional nature of the data limits causal inferences, and future research should consider additional contextual factors such as workforce and financing. Overall, targeted investments in power infrastructure and innovative diagnostic technologies are essential for improving healthcare delivery in Malawi and similar low-resource settings.application/pdfen-USCC BY-NC-NDInnovationMalawiOrganizational Readiness for changePower supplyUltrasoundPublic healthGlobal HealthThesis