Public Health Institute of Malawi

Refugees living in camps may be particularly vulnerable to infectious disease outbreaks because of factors such as overcrowding, inconsistent preventive healthcare, and limited water, sanitation, and hygiene services. Due to...

ABSTRACTBackground and AimsAccess to healthcare services is a public health challenge worldwide. Although governments continue to channelscarce resources to enhance service provision, the World Health Organization estimates that about half the world's population lacks essential access. This global context underscores persistent gaps even where investments are made. Public health spending often fails to achieve its aim of helping poor and vulnerable people, creating a critical disconnect between resource allocation and actual service reach. This study examines inequality in public health spending and access to healthcare services in Zimbabwe.MethodsThe study achieves the objective using 2017 government health expenditure from the Ministry of Health and Child Care and data from the 2017 Prices, Income, Consumption, and Expenditure Survey. To ensure consistency between spending patterns and household experiences, the empirical model is based on the concentration index and re‐centered influence functions. The study estimates inequality in public health spending using the standard concentration index, while Erreygers concentration index measures the inequality in access to healthcare services. Oaxaca–Blinder‐RIF decomposition is also used to decompose the differences in the concentration index between urban and rural populations.ResultsThe results show that, on average, public health spending in Zimbabwe is pro‐poor for public clinics and pro‐rich for public hospitals. This divergence reflects how different tiers of the health system serve different socioeconomic groups. Despite benefits from government health spending, inequality in the availability and affordability remains a problem, with the affluent continuing to benefit from well‐resourced facilities. Affordability and availability of healthcare services are pro‐rich, much greater in urban than in rural areas. Moreover, the decomposition analysis highlighted that inequality in the affordability and availability between urban and rural populations is largely not explained by the traditional variables, suggesting the influence of deeper systemic and institutional factors.ConclusionZimbabwe needs to aim for universal health coverage, with good quality, affordable care for all, regardless of geographical location or socioeconomic status. Achieving this requires not only sustaining but strategically strengthening current efforts. There is room to improve and augment efforts to achieve universal health coverage without leaving anyone behind. Broader health financing mechanisms and infrastructure investments should be explored to bridge the gap in access to services. Policymakers should, therefore, improve resource allocations in the health sector to achieve equality in government spending and access to healthcare services, ensuring that investment translate into equitable health outcomes for all.

Malawi experienced its deadliest cholera outbreak in 2022, reporting over 50,000 cases and more than 1,700 deaths. This situation was further exacerbated by the Tropical Cyclone Freddy, which caused widespread damage to health infrastructure and strained Malawi’s limited healthcare resources. Despite the scale of the outbreak, no evaluations were conducted to identify risk factors associated with cholera-related mortality among hospitalized individuals. This study filled that gap by characterizing the clinical and treatment-related factors contributing to cholera mortality in Malawi. A retrospective matched case-control study was conducted in August 2023 across four high-burden cholera districts: Blantyre, Mangochi, Lilongwe, and Nkhatabay. Medical records of 174 laboratory-confirmed cholera patients admitted between March 2022 and September 2023 were reviewed, including 87 matched pairs of deceased (cases) and surviving (controls) patients by age group and district. Data were extracted using a standardized mortality audit tool capturing socio-demographic characteristics, care-seeking behaviour, clinical status, and treatment received. Conditional logistic regression was used to identify factors associated with cholera mortality. Inadequate intravenous fluid management within the first 6 hours of admission was the strongest predictor of mortality (adjusted OR = 45.26, 95% CI: 9.09–225.30, p < 0.001). Other factors such as clinical status on admission showed a trend toward association but did not reach statistical significance. Timely and appropriate intravenous fluid administration within the first 6 hours of care is critical to reducing cholera mortality. We highlight an urgent need to strengthen the early response capacity in cholera treatment units, particularly during climate-related public health emergencies.

<bold>Background</bold> Despite reported high prevalence of abnormal spirometry in Malawi, data remain limited in rural areas, and comparisons between communities are warranted. <bold>Aim</bold> To characterise lung function in two community-based populations in Malawi: rural Karonga and urban Lilongwe. <bold>Methods</bold> We performed hand-held spirometry using the Vitalograph COPD-6 on participants aged ≥15 within a cross-sectional study conducted by the Malawi Epidemiology and Intervention Research Unit. We described FEV1, FEV6, and FEV1/FEV6 ratio by age, sex and site, and associations with common exposures for lung disease. <bold>Results</bold> Spirometry has been performed on 3,111 participants to date (mean age 33.8, SD:15.6; 54.5% female), with 53 excluded due to invalid data. Age, sex and smoking status did not differ by site; mean height was higher in Lilongwe (164cm vs 161cm; p=0.032). Medians (IQR) were 2.35L (1.91L–2.87L) for FEV1; 2.57L (2.05L–3.09L) for FEV6; and 0.96 (0.9–1) for FEV1/FEV6. FEV1 and FEV6 were higher in the urban than rural site (consistent with higher mean height) but FEV1/FEV6 was lower, adjusted for age and sex (adjusted mean FEV1/FEV6 0.94 (Karonga), 0.90 (Lilongwe), p<0.0001). Using an FEV1/FEV6 of <0.73, 169 (5.53%) participants had obstruction. In multivariable logistic regression, odds of obstruction were higher in the urban site (OR 2.5, 95% CI 1.76–3.55, p<0.001), with increasing age (OR 1.02 per year, 95% CI:1.01–1.03, p<0.001), and ever smoking tobacco (OR 2.1, 95% CI:1.17–3.63, p=0.01). The OR for obstruction for women was 1.35, 95% CI 0.95–1.93, p=0.098. History of TB was not associated with obstruction. <bold>Conclusion</bold> Despite higher lung volumes, prevalence of obstruction was higher in the urban than rural setting

Non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory conditions are the leading causes of death globally, largely driven by modifiable lifestyle factors. With growing interest in dietary strategies for NCDs prevention and management, functional foods like watercress (Nasturtium officinale) have attracted attention for their rich phytochemical content and potential health benefits. This narrative review synthesizes 88 sources published between 2019 and March 2025, exploring the effects of watercress bioactive compounds on major NCDs. Watercress is abundant in glucosinolates, isothiocyanates (especially phenethyl isothiocyanate), flavonoids, vitamins, and minerals. These compounds contribute to antioxidant, anti-inflammatory, and metabolic regulatory effects. Preclinical and clinical studies show that watercress supplementation may improve lipid profiles, reduce oxidative stress, and modulate inflammation in cardiovascular and respiratory conditions. It also appears to enhance insulin function and reduce blood glucose levels. In cancer models, watercress extracts exhibit antiproliferative, pro-apoptotic, and chemoprotective properties, with selective toxicity towards cancer cells and protective effects on normal cells. These findings highlight the therapeutic potential of watercress as a dietary adjunct in NCDs prevention and management, supporting the need for further clinical research.

PurposeDifferentiated service delivery (DSD) models for antiretroviral therapy (ART) for HIV aim to increase patient-centeredness, a concept that incorporates patient choice of service delivery options. We explored choice in DSD model enrollment at 42 public sector clinics in Malawi, South Africa, and Zambia.MethodsFrom 09/2022-05/2023, we surveyed people receiving HIV treatment to ask if they had a choice about DSD model enrollment and healthcare providers about their practices in offering choice. We estimated risk differences for ART clients’ self-reported offer of choice and report risk differences. We thematically analyzed open-ended questions and report key themes.ResultsWe enrolled 1049 people receiving HIV treatment (Malawi 409, South Africa 362, Zambia 278) and 404 providers (Malawi 110, South Africa 175, Zambia 119). The proportion of study participants indicating that they had been offered a choice ranged from 4% in Malawi to 17% in Zambia to 47% in South Africa. Over 90% of people receiving HIV treatment in all three countries reported that they were happy to be enrolled in their current DSD model. Participants from urban (ARD 0.94 [0.90–0.99]) and medium-volume facilities (2000–4000 ART clients, 0.91 [0.84–0.98]) were slightly less likely to be offered DSD enrollment. Participants in community-based models 1.21 [1.12–1.30] and those satisfied with their current model 1.06 [1.01–1.13] were more likely to be offered a choice. Among providers, 64% in Malawi, 80% in South Africa, and 59% in Zambia said they offered clients the choice to enroll in DSD or remain in conventional care.ConclusionAs of 2023, relatively few people receiving HIV treatment in Malawi, South Africa, and Zambia reported being offered a choice about enrolling in a DSD model, despite most providers reporting offering such a choice. The value of patient choice in improving clinical outcomes and satisfaction should be explored further.

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.