Improving clinical care and education for chronic diseases in Malawi

The logo for the partnership is symbolic of the work we do.  Swallows travel from Malawi to Ireland each Spring and return to Malawi each Autumn.  In a similar way we hope that people and ideas will travel between Malawi and Ireland to improve healthcare for all involved.

The Gorey-Malawi Health Partnership was formed in May 2016 and is the clinical partner of the gHealth Research Group

Following a detailed needs assessment undertaken in May 2016 the area of chronic diseases (or non-communicable diseases (NCDs) as they are called in Malawi) was identified as an area of great need for Malawian healthcare.   Indeed the WHO has  estimated that 16 million people die prematurely worldwide – before the age of 70 – from heart and lung diseases, stroke, cancer and diabetes.   NCDs are now the leading causes of death globally, and nearly three quarters of these deaths occur in low and middle income countries.

Malawi is one of the poorest countries in the world and has a population of 16 million people.  A survey conducted by the WHO in 2009 showed that 33% of people aged 25-64 years had high blood pressure but 75% were unaware of this.  It was estimated that 5.6% of the population had diabetes and 5.1% had asthma and yet there are no programmes for the prevention and control of asthma.   The Palms GP Surgery has been developing initiatives to improve the care of these conditions with its partners in Europe and Malawi.

What do we want to do?

The Palms GP Surgery with its academic partners in Europe and clinical partners in Malawi has been developing research and practical implementation strategies over the past 12 months.  Two visits have been made to Malawi.  Reciprocal visits to the Palms GP Surgery from the Director of Non Communicable Diseases in the Malawian Ministry of Health and the Director of Education form Mzuzu Central Hospital.  Our Malawian partners have identified asthma as a priority need and we have agreed to this as our initial working project.  This will focus on two area in Northern Malawi – Mzuzu, which is the major city of Northern Malawi, and Livingstonia which is in a remote rural area.  This will allow development of strategies relevant to all contexts in Malawi.  Following the development of this intitiative it will allow expansion to other conditions such as heart disease, diabetes and hypertension.

How big is the problem?

The WHO have estimated that 5.1% of the population have asthma. Mzuzu Central Hospital is the tertiary referral hospital for the Northern region of Malawi. They have approximately 2,500 people with asthma attending their services. However there is no structured care. Statistics form the hospital show that medication supply is a major issue. Basic medications are commonly not available. For example salbutamol inhalers were only available 100 days out of the last 365 days and steroid inhalers needed to prevent asthma attacks were available 30 days out of 365 days.

The health system in Malawi is designed to manage acute presentations of disease.  There is limited data on management or follow-up of identified chronic diseases.  In order to improve the situation  and develop more robust management systems in Malawi we propose a number of capacity building initiatives.

Research and Training Centre

A site for a research and training centre in Mzuzu would provide research and training facilites, biobanking facilities and clinical support services.

Fellow in Non Communicable Diseases

This one year fellowship would employ a Clinical Officer full-time for one year where they would have a defined role in providing NCD care, undertaking research in NCD care, and educating other staff members in the region. They would also spend time in Ireland in the Palms GP Surgery and our partners in allied hospitals in Ireland developing clinical skills and research projects. We have great interest from Mzuzu Central Hospital and Livingstonia Hospital in the creation of fellowships in these areas.

Baseline studies

There is limited information on the prevalence, current clinical care, community beliefs and causes of NCDs such as asthma in Malawi. There is a need for research in this area to help develop appropiate initatives and care for different contexts in Malawi

Hot Topics training courses

There is limited education in Malawi on NCD care. Hot Topics training courses would allow clinicians from Ireland to travel to Malawi to provide intensive training initiatives in NCD care in the Northern region.

Medication Supply

Medication supply is a major issue in Malawi as outlined above. The provision of sustainable and affordable supplies of appropiate medications such as inhalers is a focus of our work.

Mr Master Chisale, Mzuzu Central Hospital reviewing inhaler technique with Dr Peter Harrington in the Palms Surgery.