An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi
Maternal and perinatal morbidity and mortality remain high in Malawi, partially due to gaps in the coverage and quality of health services. We developed an individual-based model of maternal and perinatal health and healthcare in Malawi, situated in a 'whole-health system, all-disease' framework (Thanzi La Onse). We modelled sixteen scenarios estimating the impact of current and improved coverage and quality of antenatal, intrapartum, and postnatal services from 2023 to 2030. Whilst current service delivery is inferred to avert morbidity and mortality, the largest reductions in the stillbirth, maternal and neonatal mortality rates were observed when the use and quality of all services was maximised concurrently (a 10%, 52% and 57% reduction respectively). When services were considered in isolation, generally, increased coverage without quality improvement did not impact mortality or DALYs. In only three scenarios was a sufficient reduction in neonatal mortality observed to achieve target 3.2 of the United Nation's Sustainable Development Goals (SDG), and in no scenarios was a reduction in maternal mortality sufficient to achieve SDG target 3.1 observed, reaffirming that system wide investments are essential to achieve these goals.
Authors
- Cally J Tann (ORCID: https://orcid.org/0000-0003-0131-4952)
- Kondwani Kawaza (ORCID: https://orcid.org/0000-0002-9432-4916)
- Andrew N. Phillips (ORCID: https://orcid.org/0000-0003-2384-4807)
- Bingling She (ORCID: https://orcid.org/0000-0001-5976-8987)
- Helen Allott (ORCID: https://orcid.org/0000-0001-9336-2737)
- Tara D. Mangal (ORCID: https://orcid.org/0000-0001-9222-8632)
- Dominic Nkhoma (ORCID: https://orcid.org/0000-0001-6125-6630)
- Valentina Cambiano (ORCID: https://orcid.org/0000-0003-0700-105X)
- Paul Revill (ORCID: https://orcid.org/0000-0001-8632-0600)
- Eva Janoušková (ORCID: https://orcid.org/0000-0002-4104-0119)
- Sakshi Mohan (ORCID: https://orcid.org/0000-0002-1268-1769)
- Emmanuel Mnjowe (ORCID: https://orcid.org/0009-0006-4624-9727)
- Matthew M. Graham (ORCID: https://orcid.org/0000-0001-9104-7960)
- Ines Li Lin (ORCID: https://orcid.org/0000-0002-1945-3208)
- Timothy B. Hallett (ORCID: https://orcid.org/0000-0002-9681-0424)
- Joseph Mfutso‐Bengo (ORCID: https://orcid.org/0000-0001-9396-3700)
- Margherita Molaro (ORCID: https://orcid.org/0000-0002-1841-4274)
- Fannie Kachale
- Joseph H. Collins (ORCID: https://orcid.org/0000-0003-4801-7218)
- Pakwanja Twea (ORCID: https://orcid.org/0000-0003-0917-8190)
- Mosé Giordano (ORCID: https://orcid.org/0000-0002-7218-2873)
- Asif U. Tamuri (ORCID: https://orcid.org/0000-0001-6633-3789)
- Tim Colbourn (ORCID: https://orcid.org/0000-0002-6917-6552)
- Alison Rodger (ORCID: https://orcid.org/0000-0001-8817-4651)
- Wingston Ng’ambi
Institutions
- The George Institute for Global Health (GB)
- Liverpool School of Tropical Medicine (GB)
- Kamuzu Central Hospital (MW)
- Public Health Institute of Malawi (MW)
- London School of Hygiene & Tropical Medicine (GB)
- Ministry of Health (MW)
- Queen Elizabeth Central Hospital (MW)
- Kamuzu University of Health Sciences (MW)
- University College London (GB)
- Imperial College London (GB)
- University of York (GB)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-04-25
- DOI
- https://doi.org/10.1038/s41467-025-59060-2
- Citations
- 4
- Primary Topic
- Global Maternal and Child Health
- Type
- article
- Field-Weighted Citation Impact
- 13.98
Funders
- Wellcome
- Wellcome Trust
- UK Research and Innovation