researchafrica.rti.org: Sub-Saharan Africa

Malawi

HIV prevalence 15-49, 2007/2008 11.9%

Tuberculosis death rate 97/100,000 population

Malaria death rate (children under 5) 1,288/100,000 population

Malawi, a country of 12 million located in south-central Africa, faces a substantial health crisis due to an AIDS epidemic and a considerable increase in the prevalence of TB. Between 1985 and 1999 TB cases shot up from 5,000 to 25,000. According to the Panafrican News Agency, 25 Malawians are now dying of TB every day. Multi-drug resistant TB (MDRTB) has recently developed as a result of improper use of TB drugs. Malawi has instituted 100 percent DOTS coverage, and the national TB treatment success rate is 70.8 percent.

AIDS has increased Malawi’s crude death rate by 44 percent between 1990-2000,with a corresponding drop in life expectancy. In some urban areas of the country 30 percent of pregnant women are HIV positive, and 15 percent of all Malawian adults test positive for HIV. Four years ago there were already 270,000 AIDS orphans in the country. At least ten percent of the urban work force is expected to die of AIDS in the next ten years, further damaging a weak economy. In order to reduce mother-to-child-transmission of HIV, hospitals in Malawi are now delivering 10-12 percent of all babies by caesarian section.

Malawi has recently announced the release of its first national HIV/AIDS Policy. The new HIV/AIDS Policy includes guidance on prevention, and care and support of infected persons, as well as addresses human rights that are important for combating HIV/AIDS, such as a woman’s right to protection against marital rape.

Malaria is endemic in Malawi, and is the cause of 40 percent of deaths among Malawian children under 2. According to Population Services International, "Children under five suffer on average 9.7 malaria episodes per year, while adults suffer 6.1 such episodes."

Per capita Gross National Income (GNI) in Malawi is currently estimated to amount to around $160 annually. In 2000 population growth exceeded growth in GDP, further impoverishing the country. According to the International Monetary Fund, income distribution in Malawi is the most unequal in all of Africa; two thirds of Malawians live on an annual income of $40 or less. As a result, while at least 800,000 Malawians are living with HIV/AIDS, only a handful of patients in the country can afford expensive treatments such as triple-drug anti-retroviral therapy.

Sources: U.S. Agency for International Development (USAID), Panafrican News Agency, CIA Factbook, Medicins Sans Frontieres, University of Strathclyde Malawi Millennium Project, World Health Organization, Synergy Project; USAID

The stated objectives of Malawi's National Health Plan for 1999-2004 include achievement of the following:

Expanding the range and quality of health services for mothers children under the age of 5 years.
Providing better quality health care in all facilities.
Strengthening, expanding and integrating health services to the general population.
Increasing efficiency and equity in resource allocation.
Increasing access to health care facilities and basic services.
Increasing the quality of trained human resources increased, and improving the equality and efficiency of their distribution.
Strengthening collaboration and partnership in health sector.
Increasing the overall resources in the health sector.

In response to the development of drug resistance in malaria, Malawi was one of the first African nations to shift from the use of chloroquine to the use of sulphadoxine-pyramethamine. Malawi's Ministry of Health and Population (Community Health Sciences Unit) continues to study optimal drug policies to slow down the evolution of drug resistant parasites; collaborating institutions include the University of Malawi and the Wellcome Trust (UK). In late 2002 Malawi adopted Dafra Pharma's drug Arinate as a key part of its $29 million anti-malarial campaign.

Sources: Ministry of Health and Population home page, Beattie, Renshaw and Davies (1999), Multilateral Initiative on Malaria

Total population. mid-2009	14.2 (millions)
HIV prevalence 15-49, 2007/2008	11.9%
Tuberculosis death rate	97/100,000 population
Prevalence of tuberculosis per 100,000 population, 2000	539
Prevalence of tuberculosis per 100,000 population, 2004	501
% Tuberculosis detection rate under DOTS, 2001	41
% Tuberculosis detection rate under DOTS, 2004	40
% Tuberculosis treatment success rate under DOTS, 2000	73
% Tuberculosis treatment success rate under DOTS, 2003	74
Malaria death rate (children under 5)	1,288/100,000 population
GNI PPP Per Capita, 2008	830 (US$)
Life expectancy at birth	46 years
Infant mortality rate	80/1,000 live births
Total fertility rate	6.3 per woman
Crude birth rate	43/1,000 population
Crude death rate	12/1,000 population
Adult male literacy level	82% (pct. 15+ literate)
Adult female literacy level	71% (pct. 15+ literate)
Contraceptive prevalence rate, modern methods	39% of women in union
Estimated number of people living with HIV: Adults and Children, 2005	940,000
Estimated number of people living with HIV: Adults and children, end 2003	900,000
Estimated number of people living with HIV: Adults and children, end 2001	850,000
Estimated number of people living with HIV: Adults (15+), 2005	850,000
Estimated number of people living with HIV: Adults (15-49), end 2003	810,000
Estimated number of people living with HIV: Adults (15-49), end 2001	770,000
Estimated number of people living with HIV: Adults (15-49) rate (%), 2005	14.2%
Estimated number of people living with HIV: Adults (15-49) rate (%), 2003	14.3%
Estimated number of people living with HIV: Women (15+), 2005	500,000
Estimated number of people living with HIV: Women 15-49, end 2003	460,000
Estimated number of people living with HIV: Women 15-49, end 2001	440,000
Estimated number of people living with HIV: Children (0-14), 2005	91,000
Estimated number of people living with HIV: Children (0-14), end 2003	83,000
Estimated number of people living with HIV: Children (0-14), end 2001	77,000
Estimated number of AIDS deaths: Adults and children, 2005	78,000
AIDS deaths in adults and children, end 2003	84,000
AIDS deaths in adults and children, end 2001	75,000
Estimated number of orphans due to AIDS: Children (0-17), 2005	550,000
Orphans due to AIDS (0-17), living 2003	500,000
Orphans due to AIDS (0-17), living 2001	390,000
% Women (15-49), currently married or living with a partner, who have ever discussed AIDS prevention with their husband or partner	72%

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

Like many African nations, Malawi's national government has a three-tiered public health system, with 328 health centers providing basic health care, and more complicated treatment provided at 24 district hospitals. Difficult cases may be referred to one of Malawi’s four central hospitals: Lilongwe Central Hospital in the capital, Queen Elizabeth Central Hospital in Blantyre, Zomba Central Hospital in Zomba, and a fourth central hospital newly constructed in the northern city of Mzimba. The health infrastructure continues to be less well developed in the northern half of the country than in the south. Zomba Central Hospital was the site of a recent Johns Hopkins study that concluded that malnutrition contributed to in HIV+ patients with pulmonary TB.

The 64 bed Mwaiwathu Private Hospital in Blantyre provides some of the best medical treatment in the country, but is too expensive for all but the wealthiest businessmen and highest ranking government officials. The US Embassy has identified the Likuni Mission Hospital in Lilongwe as the best of the local hospitals.

The Christian Hospital Association of Malawi (CHAM) plays a critical role in augmenting the goverment's health system. Approximately 18 church-run hospitals and a larger number of clinics receive government financing to provide medical services for many parts of the country. In addition to medical services, CHAM provides medical training and education throughout Malawi.

Most of Malawi’s hospitals have TB wards, with a total of around 1,500 beds. A World Health Organization survey found that overcrowding in the central hospital TB wards had exceeded capacity by 64%, and patients without beds were given space on the floor. Fewer than half of the TB wards have full time nursing staff.

Sources: Malawi's Ministry of Health and Population; Bulletin of the World Health Organization, April 2001; Scottish Malawi Network, (Malawi Update, September 1998); Medecins Sans Frontieres

Malawi College of Medicine

The College of Medicine is a partner in the $40 million Gates Malaria Programme coordinated by the London School of Hygiene and Tropical Medicine.

The College of Medicine is also a member, in collaboration with Johns Hopkins University and the University of North Carolina, of HIVNET.

Ministry of Health, Malaria Control Programme

Malawi's Ministry of Health produced 18 scientific publications on malaria in the years 1995-1997; intervention trials and health services research are areas of special expertise.

Source: Beattie, Renshaw and Davies (1999)

National Tuberculosis Control Program, Community Health Sciences, Ministry of Health and Population

Anthony Harries of Malawi's National Tuberculosis Control Program has led or participated in several recent studies resulting in articles published in the International Journal of Tuberculosis and Lung Disease. These studies include:

A study of the management of TB cases at all 43 non-private (public and mission) hospitals in Malawi. PubMed abstract
A study of the operational research capacity of Malawi's network of hospital TB officers. PubMed abstract
A study of active TB case-finding in Malawi's Thyolo district, carried out in conjunction with Medecins sans Frontieres. The study concluded that greater use should be made of chest X-rays to diagnose TB in areas of TB/HIV coinfection; chest X-rays reduce mortality in such areas by identifying individuals likely to benefit from INH prophylaxis. PubMed abstract

Anthony Harries has suggested that anti-retroviral drug programs in Africa be modeled on and utilize much of the infrastructure of existing DOTS programs where that is possible. Source: Kaiser Daily HIV/AIDS Report, Aug-6-01

Dr. Felix Salaniponi of the TB Control Program is the PI on a Norwegian-funded study of MDR-TB in Malawi. Source: WHO MDR-TB Research Database

Severe Malaria in African Children (SMAC) site ( website )

Malawi is host to one of five centers in the SMAC clinical trials network.

Wellcome Trust Research Laboratories ( website )

The Wellcome Trust Research Laboratories, located at Queen Elizabeth Hospital in Blantyre, were opened in 1999 as a result of collaboration between the University of Liverpool, the Liverpool School of Tropical Medicine, the College of Medicine at the University of Malawi, and funding provided by the Wellcome Trust. Among other research projects, this laboratory has been involved in developing an anti-malarial drug to replace Fansidar.

The Global AIDS Program (GAP) of the CDC intends to significantly increase its involvement in Malawi's anti-AIDS program over the next several years, including:
- Assisting the Malawi AIDS Counseling and Resource Organization (MACRO) in extending its voluntary counseling and testing (VCT) program throughout the country.
- Supporting a pilot project for the prevention of HIV transmission to and through
... additional information

The Global Fund has approved $20.9 million to fight malaria in Malawi. The grant agreement has not yet been signed.
Source: Global Fund agreements and disbursements spreadsheet

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