Collins, Joseph H; (2023) An individual-based model of maternal and perinatal health and healthcare utilisation in Malawi. Doctoral thesis (Ph.D), UCL (University College London).

Text jcollins_thesis_final_edited_fig_104_removed.pdf - Accepted Version Access restricted to UCL open access staff until 1 December 2024. Download (17MB)

Abstract

The aim of this Ph.D. was to estimate the effect of improved coverage and quality of maternity services on maternal and perinatal outcomes in Malawi, using an individual-based mathematical model. Literature detailing the application of models in the evaluation of such interventions within sub-Saharan Africa (SSA) was mapped through a systematic scoping review, highlighting a dearth of individual-based approaches. To achieve the primary aim of the Ph.D., a novel individual-based model of maternal and perinatal health and healthcare utilisation was developed, coded in Python, situated within a ‘whole-system, all-disease’ framework representing Malawi’s population, most of the disease burden, and the entire health system – the Thanzi La Onse (TLO) model. The maternal and perinatal health model (MPHM) was parameterised using data from Malawi and nearby settings and is calibrated to several key data sources population-level epidemiological and health systems outcomes in Malawi. Using the MPHM, a series of counterfactual scenarios in which coverage and quality of antenatal, intrapartum, and postpartum care were increased from 2023 to 2030 were compared to a ‘status quo’ scenario, where assumptions relating to service availability remained unchanged. Results indicate that improved service delivery could substantially improve the health of mothers and newborns in Malawi. Most notably, increased coverage and quality of postnatal care was predicted to reduce maternal mortality by 31.2% (104.6 (95% CI 88.5-120.7) fewer deaths per 100,000 live births), whilst improved availability of high-quality intrapartum care could reduce neonatal mortality by around 22.7% (3.9 (95% CI (3.6, 4.1) fewer deaths per 1000 live births). Through ongoing collaboration with partners in Malawi and the UK, and further developments to the TLO model as part of the Thanzi La Mawa project, it is hoped that the MPHM will be able to contribute toward substantial and sustainable improvements in the health of mothers and newborns in Malawi.

Download activity - last month

Export as JSONXMLCSV

Download activity - last 12 months

Export as XMLJSONCSV

Downloads by country - last 12 months

Export as JSONXMLCSV

Archive Staff Only

View Item