What We Do
MaiKhanda means Mother-Baby in Chichewa. One word capturing our vision – that all mothers in Malawi are able to give birth safely, providing their babies with a healthy start to life. For the last 10 years MaiKhanda has been saving the lives of mothers and their babies in some of the poorest communities in Malawi.
Inarguably, Malawi is one of the poorer countries in sub-Saharan Africa. It has a gross domestic product (GDP) of $343 per capita, and 39% of the population live below the poverty line. There is a high rate of population growth, predominantly due to the high, though falling, total fertility rate (now estimated at 5.7) and low contraceptive prevalence (42%). Malawi was severely affected by the HIV epidemic, with prevalence among adults aged 15–49 estimated at 11%.
In 2004, the maternal mortality rate (MMR) was estimated at 984 deaths per 100,000 live births – one of the highest rates in Africa. Data from 2006 revised this figure down to 807, and 2010 data indicate a further reduction to 675.8 Indeed, there are indications from recent studies of a secular trend of declining maternal mortality. The rate in high-income countries is nine deaths per 100,000 live births. The majority (99%) of maternal deaths worldwide occur in low and middle-income countries. In sub-Saharan Africa, the lifetime risk of maternal death is one in 16, whereas in high-income nations, it is only one in 2,800. Almost half (45%) of post-partum deaths occur within 24 hours. Major causes of maternal death are: severe bleeding, infections, unsafe abortions, eclampsia and obstructed labour.
Similarly, the majority (98%) of neonatal deaths occur in low and middle-income nations. In these countries, the risk of death in the neonatal period is six times greater than in high-income countries. Neonatal mortality rates in these countries are declining, but slowly. In 2006, neonatal mortality in Malawi was estimated at 33 deaths per 1,000 live births and in 2010, 31 deaths per 1,000 live births.
The main direct causes of neonatal death are estimated to be pre-term birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. In Malawi, the uptake of antenatal care is very high at 98% for at least one antenatal visit, although women undergoing the recommended four visits is lower at 46%.
Institutional deliveries were at 57% at the beginning of the programme, but at 73% as of 2010. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Policies aimed at improving neonatal survival rates have only recently been implemented in Malawi.
In 2005, Malawi developed a ‘Road Map’ to accelerate the attainment of the Millennium Development Goals relating to maternal and child health. This was updated in 2011. The MaiKhanda programme is aligned with the key objectives of the Road Map.
Malawi spends 13%9 of its GDP on healthcare, which is lower than the 15% the Abuja Declaration recommends. Healthcare is mostly managed by the government. There is a critical shortage of qualified health workers and Malawi continues to lag behind neighbouring countries in this regard. These aforementioned problems compelled a dedicated group of Malawians based in Lilongwe to ask themselves hard questions; whether the greatest gains can be achieved by educating and empowering communities or by improving healthcare systems? Or as a handful studies in Latin America and Asia have suggested that community mobilisation can lead to reductions in neonatal (and in some cases maternal) mortality? At the same time bearing in mind that Healthcare system quality improvement approaches, on the other hand, are relatively new and largely untested in Africa.
As part of this debate, the team questioned whether, in fact, this needed to be an either/or choice. Could more be achieved if we adopted a twin-track strategy of working with healthcare services and the communities they serve? In response to that, In 2006 a five year programme with a consortium of international experts to try to answer this question was instituted. That marks the birth of MaiKhanda Trust.
National Statistical Office (NSO) and ICF Macro. 2011.Malawi Demographic and Health Survey 2010. Zomba, Malawi and Calverton, Maryland, USA: NSO and ICF Macro.