Kamuzu Central Hospital

Musculoskeletal (MSK) injuries pose a significant health burden across sub-Saharan Africa (SSA). Despite this, regional research output is limited, constrained by insufficient infrastructure, limited funding, and underdeveloped research capacity. This bibliometric analysis examined research outputs and collaboration patterns in MSK injury research across three SSA countries, representing a spectrum of income levels: low, lower-middle, and upper-middle income. MSK injury research articles from Malawi (MLW), South Africa (SA), and Tanzania (TZN), published between January 2014 and April 2024, were identified using Web of Science and Scopus databases, and cross-referenced with ResearchGate. Data were analyzed descriptively in Excel, and institutional coauthorship and collaboration networks were mapped using VOSviewer. A total of 329 articles were published across MLW (n = 98), SA (n = 141), and TZN (n = 90) between January 2014 and April 2024. We report a steady increase in the number of publications from 2014, with a research focus on fracture management, outcomes, and lower limb injuries. Most of the research was published in partnership with high-income countries (HICs) (SA: 51%, MLW: 98%, TZN: 87%), with high-income country (HIC) institutions dominating first and last authorship in MLW (68% and 61%) and TZN (59% and 69%) publications. Most studies were descriptive and based on secondary records. Institutional networks showed strong regional collaboration in SA, international focus in MLW, and limited connectivity in TZN. MSK injury research is increasing across MLW, SA, and TZN, but remains largely HIC-led and descriptive, particularly in lower-income countries. Strengthening local leadership, regional collaboration, and research capacity is essential for more sustainable and context-specific evidence generation.

The World Health Organization (WHO) recommends that a pregnant woman get an ultrasound scan (USS) as part of routine antenatal care. The Scale-up and normalization of ultrasound scanning still lag in low- and middle-income countries (LMIC), including Malawi. This study assessed barriers, facilitators, and strategies for scaling up and enhancing the normalization of ultrasound scanning during pregnancy in Malawi. Method We conducted one qualitative participatory workshop in each of Malawi’s administrative regional cities, including one workshop in the southern region on 17–18 May 2022, one in the Central region on 20–21 May 2022, and one in the Northen region on 23–24 May 2022. Forty USS trained and untrained midwives, one maternal and neonatal Zonal manager from the Ministry of Health (MoH), two District Nursing Officers (DNO), three district safe motherhood coordinators, and two Tutors from Nursing and Midwifery training institutions participated in the workshops to explore barriers, facilitators, and strategies and develop a training manual for scaling up ultrasound scanning in routine antenatal care (ANC) in Malawi. In addition, a validation workshop was conducted centrally in the central region, on September 22–23, 2022, with four representatives from the Ministry of Health, one from regulatory bodies, three from training institutions, one sonographer, and 10 district and Principal Nursing Officers (PNO) and midwives to validate the manual, which was developed with input from workshop participants. Data was audio recorded throughout the discussion, coded, and thematically analysed using NVivo 12 software. Results The barriers to normalization of USS in routine care include limited capacity and resources, such as a lack of USS-trained staff, infrastructure, including electricity interruptions, and misconceptions. The facilitators to normalization include political will to offer USS, availability of resources including trained midwives, restructuring of service provision, task sharing, revisions of staff allocations, and service integration. The strategies include preservice and on-the-job training, support and supervision, increased availability of resources, improved facility infrastructure, and community sensitization. Conclusion Scaling up of ultrasound is possible in Malawi. Staff training, community sensitization, and adequate human and material resources, including a standardised training manual, should be considered when planning USS scale-up and normalization into routine ANC.

ABSTRACT Background Most births worldwide (>80%) occur in health care facilities, yet 2.3 million newborns die annually. If the know – do gap between evidence and implementation was closed, an estimated 752,000 newborn deaths could be prevented per year. To bridge this gap, we describe the co-design of the Implementation Toolkit for Small and Sick Newborn Care (Newborn Toolkit), a web platform and linked community of global implementers, facilitated by NEST360 and UNICEF. The Newborn Toolkit enables access to practical, curated resources, including tools for peer learning and adaptation to country contexts. Methods A systematic three step process was followed. Step 1) Structure: We used an organising framework of WHO and UNICEF ten core components for health systems strengthening. We then reviewed relevant knowledge management platforms to identify elements facilitating user engagement. Step 2) Content: >300 implementers collated publications and tools for ten core components. Step 3) Refining and building community: User data analytics and surveys plus direct feedback from the global communities of practice provided data to improve website and webinar content. Results Step 1) Structure: In 2020, the Newborn Toolkit website structure was co-designed based on the ten core components. Step 2) Content: Working groups, organised by core components, collated over 1,100 resources in 15 languages. Step 3) Refining and building community: Cross-country learning was facilitated through 45 webinars with multi-disciplinary speakers from all continents including caregivers, clinicians, non-governmental organisation representatives, engineers, and data scientists. French language translation and engagement was added between 2023-2025. Unique user counts increased with 28,146 in 2023 to 62,561 in 2025 from 198 countries and territories. The most viewed content includes WHO guidelines, neonatal floor plans, the ABC device costing tool, and data tools. Conclusions Given the urgency for accelerated progress for newborn survival by 2030, rapid implementation of proven solutions is needed. It is crucial that implementers can access evidence and tools to adapt for their specific context, rather than “reinventing the wheel”. Systems change is complex, requiring novel approaches to make it doable, such as standard, simplified action pathways available on the Newborn Toolkit. Gaps to address include evidence availability in multiple languages. KEY FINDINGS WHAT WAS KNOWN? 2.3 million neonatal deaths are estimated annually and 65 countries are at-risk of missing Sustainable Development Goal 3.2 of reducing the number of neonatal deaths to less than 12 per 1,000 live births by 2030 There exists a know–do gap in global newborn health referring to the inability to translate evidence, what is known to work, into practice to improve health outcomes for WHO-UNICEF level-2 Small and Sick Newborn Care Frameworks based on country experiences have been created to guide health systems strengthening such as the WHO/UNICEF core components; however, operationalisation is needed Evidence, guidelines, and resources for Small and Sick Newborn Care were available; however, there existed a gap in knowledge management platforms dedicated to enabling evidence-based implementation of health systems strengthening interventions in low-resource settings WHAT WAS DONE THAT IS NEW? We co-designed a knowledge management platform for resources including tools, readings, and case studies to bridge the know–do gap for Small and Sick Newborn Care in low-resource settings Content and resources on the site were organised according to the ten WHO/UNICEF core components for health systems strengthening plus infection prevention and control This platform was operationalised and scaled by linking to, and engaging with, a global community of practice We applied a continuous learning and feedback integration approach to develop and refine content, enable accessibility including by language, and tailor engagement initiatives to implementer needs informed by website user and webinar data analytics WHAT WAS FOUND? The platform hosts over 1,100 tools and readings with resources available in 15 languages Between 2021–2025, this platform had 157,452 unique users, from 198 countries and territories 45 webinars were hosted between 2022–2025 showcasing implementation case studies and facilitating cross-country learning Knowledge management and targeted engagement can enable uptake of information by organising content in practical, digestible, and feasible formats WHAT NEXT? The know–do gap in Small and Sick Newborn Care needs to be closed. Providing up-to-date, relevant evidence that adapts to emerging knowledge and local learning, alongside leadership and financial inputs, could facilitate quality care delivery through data-driven decision making Bridging language barriers, through content translation, is a priority and crucial to enable wider access to up-to-date evidence

OBJECTIVE: To (1) examine Malawian physical therapists' knowledge and beliefs about osteoarthritis (OA), and their perceived capabilities to deliver an OA management program to people with knee and hip OA, and (2) identify barriers and facilitators for an OA management program in Malawi. DESIGN: Two-phased mixed-methods formative evaluation. METHODS: In phase 1, Malawian physical therapists participated in the Good Life with osteoArthritis in Denmark (GLA:D) Australia training course and answered quantitative precourse and postcourse questions that were descriptively summarized, and analysed using McNemar's test, where appropriate. In phase 2, semistructured focus groups generated qualitative data that were thematically analyzed and mapped to the Consolidated Framework for Implementation Research. Mixed-methods data were integrated through triangulation. RESULTS: Eleven Malawian physical therapists (9 [82%] female, 10 [91%] with 5-10 years of clinical experience) participated. From pretraining to posttraining course, participants' knowledge of OA management (percentage change) increased regarding the benefits of therapeutic exercise (91%), importance of weight management (82%), and acceptable symptoms profile (73%). Participants' confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organization of GLA:D, adaptability of the program, and OA awareness and education among other health professionals. CONCLUSION: Knowledge, confidence, and beliefs in managing knee and hip OA improved post-GLA:D training in Malawian physical therapists. Increasing education of physical therapists, other health professionals, and the public about evidence-based OA management and making contextual adaptions to the GLA:D training and program structure may facilitate implementation of OA management program, such as GLA:D, in low- and-middle-income countries. J Orthop Sports Phys Ther 2026;56(3):193-208. Epub 4 February 2026. doi:10.2519/jospt.2026.13317.

In Malawi, adolescents and young people face significant health system barriers when accessing sexual reproductive health services, including post-abortion care. Overall, 60% of all abortion cases result in complications requiring medical treatment, a burden that disproportionately affects young girls. This study aimed to explore the lived experiences of adolescent girls and young women receiving post-abortion care at Thyolo district hospital, a secondary hospital located in southern Malawi. An interpretive phenomenological design was employed with 15 participants selected through purposive sampling. Data was collected through in-depth interviews and analysed using inductive thematic analysis. The social ecological model was adopted as a conceptual lens for discussing the results. Participants described intense emotional responses such as shame, fear, confusion, and relief upon recognising the need for post-abortion care. Family and social support, healthcare referral systems and guidance, transportation, and socioeconomic status significantly influenced the decision to seek care. In addition, community bylaws, perceived benefits, and prior experiences also shaped their decisions to utilise care. Adolescent girls and young women’s interactions with their environment shape their experience of post-abortion care. Therefore, aside from strengthening referral and diagnostic systems, improving young women’s experiences of post-abortion care necessitates multilevel interventions that combine community and healthcare provider sensitisation.

ABSTRACT Introduction Tobacco smoking among school-going adolescents poses a major global public health challenge, contributing significantly to future disease burden. Understanding the prevalence and determinants of cigarette smoking in this group is critical for effective interventions. Methods This study analyzed data from the Global Youth Tobacco Surveys collected between 2001 and 2021, covering 439, 322 school-going adolescents aged 11 to 19 across 45 African countries. Descriptive statistics estimated smoking prevalence by age, sex, school grade, country, and survey year. Predictive modelling identified independent correlates of current cigarette smoking under complex two-stage cluster sampling. Results Overall, 23.8% (95% CI: 20.20-27.57) of adolescents reported cigarette smoking. Prevalence increased with age, rising from 9.5% at 12 years to 22.4% at 18 years. Boys smoked more than girls (14.0% vs. 7.3%). Smoking varied widely across countries, with the highest rates in Burkina Faso 48.9%, and South Africa (18.9%), and the lowest in Angola (1.5%, 95% CI: 0.86-2.13), Eritrea (2.1%). Use of other tobacco products strongly increased the prevalence of cigarette smoking for smokeless chew (35%, 95% CI: 29.6–40.3). Being taught in school about the effects of smoking showed protective effects, while ownership of tobacco-branded items increased smoking likelihood (17.8%, 95% CI: 17.52-18.13). Smoking prevalence declined over time, with lowest rates in recent years (3.5% in 2020). Conclusion Cigarette smoking among school-going adolescents in Africa is a growing public health concern influenced by factors such as age, gender, country, behavior, and media exposure. Urgent, youth-focused tobacco control strategies especially targeting males and older teens are needed. Strengthening school-based education and implementing tobacco control policies among students can help reduce smoking rates. These findings offer vital evidence to inform global tobacco control efforts within the African context

Persistent human-to-mosquito parasite transmission hinders malaria control in high burden settings. Understanding the human transmission reservoir can support the design of targeted interventions to reduce transmission. In a year-long cohort study in rural Malawi, we used molecular methods to detect all Plasmodium falciparum (Pf) infections and those containing gametocytes, the parasite stage required for transmission, longitudinally at routine surveillance and sick visits. Using population-level analyses, we determined the demographic, temporal, and spatial clustering of infections containing gametocytes and gametocyte density, which predicts transmission. Here we show that gametocytes are not randomly distributed among the population or among individuals with Pf infections; gametocytes are detected in only 23% of the population. Among all participants, school-age children have significantly higher incidence of gametocyte-containing infections and high-density gametocyte infections compared to other groups. The presence of school-age children is a key driver of gametocyte frequencies and densities within households, even after adjusting for Pf infection levels. Based on the total gametocyte abundance in the population, we estimate that clearing infections from asymptomatic school-age children in the rainy season would decrease gametocyte abundance by 67% in the population. School-age children are the primary driver of ongoing Pf transmission in Malawi and interventions targeting school-age children are needed to effectively reduce Pf infection risk at a population level.

Patients with major trauma face high rates of coagulopathy, hemorrhage, and organ failure, with prehospital resuscitation strategies critical for stabilization. Comparative evidence on prehospital blood [red blood cells (RBCs) and plasma] and non-blood [intravenous crystalloids and dextran, intravenous crystalloids only, and tranexamic acid (TXA)] resuscitation strategies remains limited and inconclusive. To evaluate and compare the efficacy of prehospital blood and non-blood resuscitation strategies in patients with major trauma using network meta-analysis. Network meta-analysis of randomized controlled trials (RCTs). Databases: PubMed, CINAHL, Cochrane Library, and Web of Science and reference lists of relevant previous studies. Participants: patients with major trauma. Prehospital blood (RBC + plasma, RBC, and plasma) and non-blood (intravenous crystalloids + dextran, intravenous crystalloids only, and TXA) resuscitation strategies. Study outcomes were 24-h and 28-day mortality. Data analysis was performed using Frequentist and Bayesian frameworks on MetaInsight, an R-Language web-based analytical platform, presenting odds ratio (OR) and corresponding 95% confidence interval (95% CI). Ranking of prehospital resuscitation strategies was confirmed by the surface under cumulative ranking. A total of 15 RCTs involving 7504 participants were included. Compared with intravenous crystalloids only, RBC + plasma (OR: 0.68, 95% CI: 0.38-1.22), plasma (OR: 0.72, 95% CI: 0.46-1.16), TXA (OR: 0.73, 95% CI: 0.52-1.04), RBC (OR: 0.81, 95% CI: 0.22-3.08), and intravenous crystalloids + dextran (OR: 0.91, 95% CI: 0.65-1.28) demonstrated no significant difference in reducing 24-h mortality. Similarly, TXA (OR: 0.83, 95% CI: 0.35-1.92), intravenous crystalloids + dextran (OR: 0.84, 95% CI: 0.46-1.52), RBC + plasma (OR: 0.88, 95% CI: 0.21-3.73), RBC (OR: 0.94, 95% CI: 0.10-8.64), and plasma (OR: 0.97, 95% CI: 0.38-2.46) revealed no significant difference in reducing 28-day mortality compared with intravenous crystalloids only. Based on ranking probabilities, RBC + plasma (65.8%) for 24-h mortality and TXA (74.6%) for 28-day mortality were ranked highest. Prehospital blood (RBC + plasma, RBC, and plasma) and non-blood (intravenous crystalloids + dextran and TXA) resuscitation strategies were associated with comparable nonsignificant effects on early and late mortality. Current evidence is insufficient to support the superiority of a single prehospital intervention with future large-scale RCTs needed to clarify role of prehospital blood and non-blood resuscitation strategies.

Community-wide flooding in high HIV-burdened districts affects continuity of HIV care, especially in resource-limited countries in sub-Saharan Africa. We explored the lived experiences of antiretroviral therapy (ART) clients and health care workers (HCWs) in Malawi to understand challenges and potential solutions for ART delivery during floods. This was a mixed methods study. In quantitative analysis, we used routine program data from Partners in Hope (PIH) to compare interruption in treatment (IIT) (>28 days without medication) cases in months with and without flooding, October 2021 to December 2023, to understand how flooding influences IIT. In qualitative analysis, we conducted in-depth interviews (IDIs) with ART clients and focus group discussions (FGDs) with HCWs from from six health facilities impacted by flooding in Chikwawa, Nsanje and Mulanje districts. We analyzed data in Atlas.Ti. IIT was far higher in flooding periods. Across 49,152 IIT cases, IIT increased by 24% during the first flooding period and by 23% during the second flooding period. 23 ART clients completed IDIs between July and August 2024: 13 female, median age 40 years, predominantly subsistence farmers (n = 21). A total of 9/23 clients experienced IIT. Flooding negatively impacted nearly all IDI participants: 17/23 lost homes and had to relocate, mainly to government camps. Most clients lost crops, livestock, and ART medication. Many clients travelled to find income and despite uncertainties they were motivated to remain in care. In six FGDs with 34 HCWs, HCWs described facility-level ART stock-outs and loss of medical records, limited stakeholder coordination and the absence of guidelines for HIV services during emergencies. HCWs were also impacted but received little support. IIT cases greatly increased during flooding periods, with both clients and HCWs facing multiple challenges to ART service provision. National flooding guidelines, coordination of stakeholder response, adequate planning and seasonal six-month ART dispensing could improve retention.