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

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, Emmanuel Mnjowe, Sakshi Mohan, Margherita Molaro, Dominic Nkhoma, Paul Revill, Alison Rodger, Bingling She, Asif U. Tamuri, Cally J. Tann, Pakwanja D. Twea, Valentina Cambiano, Timothy B. Hallett, Andrew N. Phillips and Tim Colbourn
Additional contact information
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
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

Nature Communications, 2025, vol. 16, issue 1, 1-21

Abstract: 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.

Date: 2025
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DOI: 10.1038/s41467-025-59060-2

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