Perspectives On Multimorbidity Care Provision In Malawi Hospitals

02 Apr 20264 min read0 viewsJournal Feed

GIST

by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M.

Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally.

In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity.

Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach.

We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital.

Clinical Editorial

Multimorbidity in Malawi: study scope and design

This qualitative, interpretivist study examines how public hospital-based healthcare workers in Blantyre and Chiradzulu perceive patient pathways and service organization for multimorbidity.
The investigation combines extended fieldwork with mixed observation and interviews conducted across two district and central hospital settings.

Study setting, population, and methods

Settings: Queen Elizabeth Central Hospital and Chiradzulu District Hospital in Malawi.
Population: healthcare workers from multiple cadres involved in patient care for multimorbidity.
Design and data collection: 13 days of clinical observation at each site, complemented by 13 days of observation plus semi-structured in-depth interviews with purposively sampled healthcare workers (n = 22) spanning the two facilities.
Analysis: thematic analysis was employed to illuminate how care is organized and how services are delivered from the workers’ perspectives.

Characterization of care delivery for multimorbidity

Both hospitals reported provision of services for inpatients and outpatients with multimorbidity, including components such as screening, management, prevention of secondary conditions, and rehabilitation.
Diagnostic and treatment delays for multimorbidity were linked to frequent stockouts of medications and consumables required for diagnostic testing of non-communicable diseases at the hospital level.
Some healthcare workers lacked adequate knowledge, skills, or formal guidelines to manage multimorbidity comprehensively.

Contextual drivers and potential leverage points

HIV care is comparatively well-resourced relative to other chronic conditions, highlighting resource inequities in chronic disease management.
The study implies potential improvements by strengthening supply chains, expanding training for healthcare workers, and enhancing monitoring and evaluation tools to support better management of non-communicable diseases, leveraging lessons from HIV program experiences.

Limitations and uncertainty

The findings are derived from a qualitative, cross-sectional study at two facilities and reflect perceptions of healthcare workers; they do not quantify outcomes or establish causal relationships.
The reporting acknowledges stockouts and knowledge/guideline gaps as observed contributors but does not provide detailed prevalence or intensity measures.

Practical relevance and open questions

The authors suggest that aligning resource allocation and education with multimorbidity needs could improve person-centered care, drawing on HIV program strengths as a potential model.