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An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi

Author

Listed:
  • Joseph H. Collins

    (University College London)

  • Helen Allott

    (Liverpool School of Tropical Medicine)

  • Wingston Ng’ambi

    (Kamuzu University of Health Sciences)

  • Ines Li Lin

    (University College London)

  • Mosè Giordano

    (University College London)

  • Matthew M. Graham

    (University College London)

  • Eva Janoušková

    (University College London)

  • Fannie Kachale

    (Malawi Ministry of Health)

  • Kondwani Kawaza

    (Kamuzu University of Health Sciences
    Queen Elizabeth Central Hospital)

  • Tara D. Mangal

    (Imperial College London)

  • Joseph Mfutso-Bengo

    (Kamuzu University of Health Sciences)

  • Emmanuel Mnjowe

    (Kamuzu University of Health Sciences)

  • Sakshi Mohan

    (University of York)

  • Margherita Molaro

    (Imperial College London)

  • Dominic Nkhoma

    (Kamuzu University of Health Sciences)

  • Paul Revill

    (University of York)

  • Alison Rodger

    (University College London)

  • Bingling She

    (Imperial College London)

  • Asif U. Tamuri

    (University College London)

  • Cally J. Tann

    (London School of Hygiene and Tropical Medicine)

  • Pakwanja D. Twea

    (Malawi Ministry of Health)

  • Valentina Cambiano

    (University College London)

  • Timothy B. Hallett

    (Imperial College London)

  • Andrew N. Phillips

    (University College London)

  • Tim Colbourn

    (University College London)

Abstract

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.

Suggested Citation

  • Joseph H. Collins & Helen Allott & Wingston Ng’ambi & Ines Li Lin & Mosè Giordano & Matthew M. Graham & Eva Janoušková & Fannie Kachale & Kondwani Kawaza & Tara D. Mangal & Joseph Mfutso-Bengo & Emman, 2025. "An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi," Nature Communications, Nature, vol. 16(1), pages 1-21, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-59060-2
    DOI: 10.1038/s41467-025-59060-2
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    References listed on IDEAS

    as
    1. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
    2. Nompumelelo Malaza & Matladi Masete & Sumaiya Adam & Stephanie Dias & Thembeka Nyawo & Carmen Pheiffer, 2022. "A Systematic Review to Compare Adverse Pregnancy Outcomes in Women with Pregestational Diabetes and Gestational Diabetes," IJERPH, MDPI, vol. 19(17), pages 1-15, August.
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