Malawi

NCD BRITE - Building Research capacity, Implementation and Translation Expertise for non-communicable diseases

TREIN
Group of people working together with a few looking at the camera.

The burden of NCDs such as Hypertension and Diabetes among adults living in Malawi is high and expected to increase over time… By expanding implementation science capacity locally, we can hopefully adapt or develop strategies to effectively prevent, control and treat these conditions.

Project summary

The proposed program will build long-term, sustainable heart, lung, blood and sleeping diseases and disorders (HLBS) focused late-stage translation phase 4 research (T4TR) capacity in Malawi and will utilize this capacity together with research infrastructure and diseases burden needs assessments, to design a Malawi specific HLBS T4TR research plan.

The trans-disciplinary consortium is purposefully designed to build capacity within the University of Malawi-College of Medicine (COM), the only public medical school in the country, and the Malawi Ministry of Health (MoH), to ensure sustainability.

Nurse holds up chart to educate a patient.
Patient is being educated by community health nurse in Malawi.

Project goals

  1. To develop non-communicable diseases (NCD)-focused implementation research capacity through short courses, mentored research awards and an internship placement program.
  2. To conduct detailed assessments of the burden and risk-factors of priority for NCDs in Malawi.
  3. To assess the research infrastructure needed to inform, implement and evaluate NCD interventions.
  4. To create a national implementation research agenda for priority NCDs in Malawi.
Members of the Dignitas Malawi team walking into the research center compounds smiling at the camera
Dignitas Malawi team members arriving back at campus from a field visit.

Current status

The NCD BRITE Malawi project had conducted its first steering committee meeting on February 2018. The initial implementation short course planning conducted in 2018 attended by 7 people was successful.

There is a second round of short courses planned in January 2019 for10 attendees. Three internship placements are currently offered in the NCD BRITE consortium organization for a period of 6 months, two mentored research awards are provided to fellows working on NCD focused research projects. Two manuscripts have been accepted for the upcoming Global Heart journal supplement publications.

Finally, a protocol for a needs assessment for phase 1 is currently being planned.

Location

Malawi is a low-income country in south-eastern Africa with a high burden of infectious diseases such as malaria, tuberculosis, and HIV. The prevalence of NCDs such as hypertension and diabetes in the adult general population is increasing and was recently estimated to be 33% and 6% respectively. Both conditions are mostly undiagnosed and therefore untreated.

Moreover, at least 40% of Malawian adults had abnormal lung function which is largely restrictive, and risk factors for chronic respiratory diseases including exposure to biomass smoke are widespread. Despite a gradually increasing number of studies, comprehensive insight into burden, main risk factors and economic impact of NCDs remains limited.

Strategy

Needs Assessment Phase I: Research Infrastructure

NCD BRITE will conduct a detailed NCD-focused implementation research infrastructure needs assessment that will concentrate on: Government of Malawi and other health funding partner commitments to NCD-focused implementation research funding, existence and quality of locally-relevant NCD-focused implementation research programs, presence of skills and expertise to conduct implementation research ethics and governance structures, laboratory capacity to support sample analyses, database and programming capacity, infrastructure related to Information Communication Technology to support implementation research and the availability of NCD-focused implementation research mentors. Gaps identified during this assessment exercise will be discussed with stakeholders, and deficiencies in the infrastructure needed to conduct implementation research will be prioritized.

Needs Assessment Phase II: Disease Burden Of Priority NCDs

We will extract and synthesize data from partner organizations currently engaging in NCD burden research in Malawi to come up with pooled estimates for chronic NCDs that are prioritized within NCD BRITE and their risk factors. We will also undertake detailed literature searches to describe the burden of selected conditions in the region and will contact relevant authors for systematic data acquisition. This comprehensive disease burden assessment will be presented to national stakeholders for further refinement and harmonized with the NCD-focused implementation research infrastructure needs assessment work to design locally relevant, evidence-based interventions.

A comprehensive, actionable, Malawi specific implementation research plan for priority NCDs

The available information from the two needs assessment phases will be utilized in national research priority workshops that will involve researchers, health care workers and policymakers to create a national NCD research agenda, adding specific priority NCDs content to the agenda. The central position of the MOH within NCD BRITE will drive the utilization of the needs assessments for informing the NCD research and will work towards further sustainability of overall NCD policy and planning.

White two story building with brown roofing showing a building at University of Malawi.
University of Malawi, College of Medicine Blantyre, Malawi.

Dissemination

The NCD BRITE dissemination plan during each phase 1 and 2 of the project needs assessment is as follows:

The Knowledge Translation Platform Malawi (KTPMalawi), a joint initiative of Dignitas International and the MoH, will engage national-level policymakers, researchers, implementers and civil society members in a coordinated approach to the utilization of health-sector research in Malawi through evidence synthesis and policy dialogues.

Internationally, we will focus our dissemination efforts through the semi-annual TREIN meetings and repository, and the NCD Alliance and the WHO’s Global Non-communicable Disease Network. We will aim to disseminate findings through international conferences including the International Society of Hypertension and the Pan-African Thoracic Society conferences.

We will publish findings from the needs assessment in open-access peer-reviewed journals and through national and international conference presentations.

The T4TR research plan will be published in a national open-access peer-reviewed journal and a detailed report of T4TR will be submitted to national regulatory and ethics committees including COM’s research and ethics committee, The Health Sciences Research Committee, and COM’s research and publication committee.

Team Members

Our project has the support of 2 Principal Investigators, 6 Research Team members and 5 trainees.

All teams members facing forward and smiling.
  • Moffat J Nyirenda

    Moffat J Nyirenda

    Principal Investigator Malawi project

    Dr. Nyirenda is the Principal Investigator of the Malawi project and is a Professor of Medicine (Global Non-Communicable Diseases) at the London School of Hygiene and Tropical Medicine.

  • Mina C. Hosseinipour

    Mina C. Hosseinipour

    Principal Investigator Malawi project

    Dr. Mina Hosseinipour is a Co-PI on the Malawi project. Dr. Mina Hosseinipour, the Scientific Director of the Univerity of North Carolina (UNC) Project-Malawi, Professor of Medicine at UNC-Chapel Hill and Honorary Faculty at the University of the Malawi College of Medicine.

  • Adamson Muula

    Professor of Public Health and Epidemiology The University of Malawi, College of Medicine
  • Alemayehu Amberbir

    Medical Epidemiologist Dignitas International.
  • Collins Mitambo

    Ministry of Health and Population
  • Emily Wroe

    Associate Director of Policy & Implementation, NCD Synergies & Chief Health Systems Adviser Partners in health, Malawi
  • Enoch Ndarama Mentored Research Awardee Partners in Health
  • Steve Manyozo Mentored Research Awardee College of Medicine, Department of Public Health
  • Brown Khongo Internship holder Partners in Health
  • Joseph Kimangila Internship holder Malawi Epidemiology and Intervention Research Unit
  • Treasure Mkaliainga Internship holder University of North Carolina

Publications and References

These references document the history of research studies by this team.

  • Njuguna B, Vorkoper S, Patel P, Reid MJA, Vedanthan R, Pfaff C, Park PH, Fischer L, Laktabai J, Pastakia SD. Models of integration of HIV and non-communicable disease care in sub-Saharan Africa. AIDS. 2018 Jul 1;32 Suppl 1:S33-S42.

  • Amberbir A, Lin S, Berman J, Muula A, Jacoby D, Wroe E, Maliwichi-Nyirenda C, Mwapasa V, Crampin A, Makwero M, Singogo E, Phiri S, Gordon SB, Tobe SW, Masiye J, Newsome B, Hosseinipour M, Nyirenda MJ, van Oosterhout JJ. Systematic reviews of hypertension and diabetes burden, risk factors and interventions for prevention and control in Malawi: The NCD BRITE Consortium. (Global Heart, accepted for publication)

  • JJ van Oosterhout, M Hosseinipour, AS Muula, A Amberbir, E Wroe, J Berman, C Maliwichi-Nyirenda, V Mwapasa, A Crampin, M Makwero, E Singogo, S Gopal, U Baker, S Phiri, SB Gordon, S Tobe, J Chiwanda, J Masiye, J Parks, C Mitambo, L Dullie, B Newsome, M Nyirenda. The Malawi NCD BRITE consortium - Building Research capacity, Implementation and Translation Expertise for non-communicable diseases (Global Heart, accepted for publication)