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

TY - JOUR

T1 - An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi

AU - Collins, Joseph H

AU - Allott, Helen

AU - Ng'ambi, Wingston

AU - Lin, Ines Li

AU - Giordano, Mosè

AU - Graham, Matthew M

AU - Janoušková, Eva

AU - Kachale, Fannie

AU - Kawaza, Kondwani

AU - Mangal, Tara D

AU - Mfutso-Bengo, Joseph

AU - Mnjowe, Emmanuel

AU - Mohan, Sakshi

AU - Molaro, Margherita

AU - Nkhoma, Dominic

AU - Revill, Paul

AU - Rodger, Alison

AU - She, Bingling

AU - Tamuri, Asif U

AU - Tann, Cally J

AU - Twea, Pakwanja D

AU - Cambiano, Valentina

AU - Hallett, Timothy B

AU - Phillips, Andrew N

AU - Colbourn, Tim

N1 - © 2025. The Author(s).

PY - 2025/4/25

Y1 - 2025/4/25

N2 - 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.

AB - 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.

KW - Malawi/epidemiology

KW - Humans

KW - Female

KW - Pregnancy

KW - Maternal Health Services/statistics & numerical data

KW - Infant, Newborn

KW - Maternal Mortality/trends

KW - Infant Mortality/trends

KW - Delivery of Health Care

KW - Infant

KW - Adult

U2 - 10.1038/s41467-025-59060-2

DO - 10.1038/s41467-025-59060-2

M3 - Article

C2 - 40280923

SN - 2041-1723

VL - 16

JO - Nature Communications

JF - Nature Communications

IS - 1

M1 - 3925

ER -