The potential impact of declining development assistance for health on population health in Malawi: A modelling study.

Background: Development assistance for health (DAH) to Malawi will likely decrease as a fraction of Gross Domestic Product (GDP) in the next few decades. Given the country's significant reliance on DAH for the delivery of its healthcare services, estimating the impact that this could have on health projections for the country is particularly urgent.

Methods And Findings: We use the Malawi-specific, individual-based "all diseases-whole health-system" Thanzi La Onse model to estimate the impact that declining DAH could have on health system capacities, proxied by the availability of human resources for health, and consequently on population health outcomes, in the period 2019-2040.

The impact and cost-effectiveness of pulse oximetry and oxygen on acute lower respiratory infection outcomes in children in Malawi: a modelling study.

Background: acute lower respiratory infections (ALRIs) are the leading global cause of post-neonatal death in children younger than 5 years. The impact, cost, and cost-effectiveness of routine pulse oximetry and oxygen on ALRI outcomes at scale remain unquantified.

Methods: We evaluate the impact and cost-effectiveness of scaling up pulse oximetry and oxygen on childhood ALRI outcomes in Malawi using a new and detailed individual-based model, together with a comprehensive costing assessment for 2024 that includes both capital and operational expenditures.

Development and validation of a novel clinical risk score to predict hypoxaemia in children with pneumonia using the WHO PREPARE dataset.

Background: Hypoxaemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxaemia in 2-59-month-old children with pneumonia.

Non-specific effects of routine vaccinations on child survival between 12-59 months of age in Jigawa, Nigeria: A secondary analysis of the INSPIRING Jigawa trial.

Nigeria contributes a substantial number of under-5 deaths and 'zero dose' children (i.e. children with no routine vaccinations) to the global burden each year.

Modelling health outcomes of a decade of HIV, malaria and tuberculosis initiatives, Malawi.

Objective: To estimate the outcome of programmes on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis and malaria in Malawi across multiple health domains.

Methods: We used an integrated epidemiological and health system model to estimate the impact of HIV/AIDS, tuberculosis and malaria programmes in Malawi from 2010 to 2019. We incorporated interacting disease dynamics, intervention effects and health system use in the model.

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

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.

Pulse oximetry and oxygen services for under-five children with community-acquired pneumonia attending primary and secondary level health facilities in Lagos, Nigeria (INSPIRING-Lagos): a pre-implementation and post implementation study.

Introduction: Childhood pneumonia is a leading cause of child mortality in Nigeria and poor quality of care is a persistent issue. We aimed to understand whether introducing primary care stabilisation rooms equipped with pulse oximetry and oxygen systems alongside healthcare worker (HCW) training improved the quality of care for children with pneumonia in Lagos State.

Methods: : Ikorodu local government area, Lagos.

Do global health networks facilitate innovation, learning and sharing? A qualitative analysis of the Quality-of-Care Network in Bangladesh, Ethiopia, Malawi, and Uganda.

The Quality-of-Care Network (QCN), launched by WHO and partners, links global and national actors across several countries to improve maternal and newborn health. We conducted a prospective qualitative study to examine how QCN in Bangladesh, Ethiopia, Malawi and Uganda facilitated learning, sharing, and innovation within and between network countries. We conducted 227 key informant interviews with QCN actors at global, national, and facility levels iteratively in two to four rounds from June 2019 to March 2022.

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review.

Introduction: Mathematical modelling is a commonly utilised tool to predict the impact of policy on health outcomes globally. Given the persistently high levels of maternal and perinatal morbidity and mortality in sub-Saharan Africa, mathematical modelling is a potentially valuable tool to guide strategic planning for health and improve outcomes.

Methods: The aim of this scoping review was to explore the characteristics of mathematical models and modelling studies evaluating the impact of maternal and/or perinatal healthcare interventions or services on health-related outcomes in the region.

Building a culture of quality in maternal and newborn health: experience from the quality, equity and dignity network in Ethiopia.

Background: Building a culture of quality is vital for sustaining high-quality healthcare, emphasising shared values and continuous improvement. The Quality Equity and Dignity (QED) network was a global initiative working toward this objective, focusing on maternal and newborn health. This paper aims to describe how QED influenced five identified attributes of quality culture in Ethiopia: leadership, people-centered interventions, collaboration, rewards, and ownership towards building and sustaining a culture of quality in healthcare establishments.

Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse).

Background: In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services.

Exploring the feeding practices of mothers of under-five children and how household members influence exclusive breastfeeding in Jigawa State, Nigeria - A qualitative study.

Child nutrition interventions in low-income settings are variably effective as strategies often focus on primary caregivers, with less attention given to other household members. This study explored the influence of household members on exclusive breastfeeding and the feeding practices of mothers of under-five children in Jigawa State, Northern Nigeria. As part of a cluster randomised controlled trial in Jigawa State, we conducted an ethnographic process evaluation.

A new approach to Health Benefits Package design: an application of the Thanzi La Onse model in Malawi.

An efficient allocation of limited resources in low-income settings offers the opportunity to improve population-health outcomes given the available health system capacity. Efforts to achieve this are often framed through the lens of "health benefits packages" (HBPs), which seek to establish which services the public healthcare system should include in its provision. Analytic approaches widely used to weigh evidence in support of different interventions and inform the broader HBP deliberative process however have limitations.

Health workforce needs in Malawi: analysis of the Thanzi La Onse integrated epidemiological model of care.

Background: To make the best use of health resources, it is crucial to understand the healthcare needs of a population-including how needs will evolve and respond to changing epidemiological context and patient behaviour-and how this compares to the capabilities to deliver healthcare with the existing workforce. Existing approaches to planning either rely on using observed healthcare demand from a fixed historical period or using models to estimate healthcare needs within a narrow domain (e.g.

How to evaluate a multi-country implementation-focused network: Reflections from the Quality of Care Network (QCN) evaluation.

Learning about how to evaluate implementation-focused networks is important as they become more commonly used. This research evaluated the emergence, legitimacy and effectiveness of a multi-country Quality of Care Network (QCN) aiming to improve maternal, newborn and child health (MNCH) outcomes. We examined the QCN global level, national and local level interfaces in four case study countries.

Factors shaping network emergence: A cross-country comparison of quality of care networks in Bangladesh, Ethiopia, Malawi, and Uganda.

The Quality-of-Care Network (QCN) was conceptualized by the World Health Organization (WHO) and other global partners to facilitate learning on and improve quality of care for maternal and newborn health within and across low and middle-income countries. However, there was significant variance in the speed and extent to which QCN formed in the involved countries. This paper investigates the factors that shaped QCN's differential emergence in Bangladesh, Ethiopia, Malawi, and Uganda.

COVID-19 knowledge and practices in Jigawa State, Nigeria: A cross-sectional survey conducted during the second wave.

Population knowledge of COVID-19 and adherence to prevention measures may not be equitably distributed, limiting the success of public health measures. We aimed to understand whether COVID-19 knowledge differed by socio-economic status in a rural low-income setting of Jigawa State, Nigeria. We conducted a secondary analysis of the baseline cross-sectional survey of the INSPIRING cluster randomised controlled trial in Kiyawa Local Government Area, Jigawa State, from January-June 2021.

Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care.

Pulse oximeters are essential for assessing blood oxygen levels in emergency departments, operating theatres, and hospital wards. However, although the role of pulse oximeters in detecting hypoxaemia and guiding oxygen therapy is widely recognised, their role in primary care settings is less clear. In this Viewpoint, we argue that pulse oximeters have a crucial role in risk-stratification in both hospital and primary care or outpatient settings.

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Background: Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited.

'Let him die in peace': understanding caregiver's refusal of medical oxygen treatment for children in Nigeria.

Introduction: Efforts to improve oxygen access have focused mainly on the supply side, but it is important to understand demand barriers, such as oxygen refusal among caregivers. We therefore aimed to understand caregiver, community and healthcare provider (HCP) perspectives and experiences of medical oxygen treatments and how these shape oxygen acceptance among caregivers of sick children in Lagos and Jigawa states, which are two contrasting settings in Nigeria.

Methods: Between April 2022 and January 2023, we conducted an exploratory qualitative study using reflexive thematic analysis, involving semistructured interviews with caregivers (Jigawa=18 and Lagos=7), HCPs (Jigawa=7 and Lagos=6) and community group discussions (Jigawa=4 and Lagos=5).

'That is because we are alone': A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India.

This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers ( = 134). Data were analysed in NVivo 11.