Low-income African Countries Research Articles

Poverty and development interventions that address behavioural risk factors of non-communicable diseases in low and lower middle income countries: a systematic review

BackgroundNon-communicable diseases (NCDs) disproportionately affect low and lower middle income countries (LLMICs), where 80% of global NCD deaths occur. LLMICs are the primary focus of interventions to address development and poverty indicators. We aimed to synthesise the evidence of the impact of these interventions on the four primary behavioural risk factors for NCDs—unhealthy diets, physical inactivity, tobacco use, and alcohol use. MethodsUsing a comprehensive search strategy we systematically searched four online databases (Medline, Embase, Web of Science, and Global Health) for primary research conducted in LLMICS, published between Jan 1, 1990, and Feb 15, 2016, with no language restriction. Studies involved development or poverty interventions that reported on outcomes relating to the four behavioural risk factors for NCDs. We extracted summary level data on study design, population, health outcomes, and potential confounders. The study is registered with PROSPERO, number CRD42016039030. FindingsFrom 2172 search results, 26 studies published between 1999 and 2015 met our inclusion criteria. Quality of included studies was poor and heterogeneity of outcome measures required narrative synthesis. Included studies were conducted in 24 LLMICs, with 12 from low-income African countries. One study measured physical activity, 26 measured dietary components, and none measured alcohol or tobacco use. Most papers (n=23) involved agricultural interventions. Primary outcome measures included micronutrient intake, child stunting, and dietary diversity with a focus on preventing undernutrition in women and children. Intensive agricultural interventions were associated with improved calorie, vitamin, fruit, and vegetable intake. However, the impact of interventions often relied on participants' land ownership or communicable disease status, or the study did not measure unhealthy food consumption. Only three studies measured adult obesity, two of which indicated that increased income and consequential food affordability had the potential to increase obesity. InterpretationAlthough many interventions addressing poverty and development have potential to affect NCD behavioural risk factors, most fail to measure or report these outcomes. Existing evidence suggests a positive impact of agricultural-based food security programmes on the intake of nutrients, fruits, and vegetables. However, studies investigating the effect of improved income on obesity tend to show an increased risk. Embedding an assessment of the impact of NCDs into development programmes is crucial in the context of the UN Sustainable Development Goals and the rapid epidemiological transitions facing LLMICs. FundingThis project was commissioned by WHO (2015/577190-0). KW and NT are supported by a grant from the British Heart Foundation (006/P&C/CORE/2013/OXFSTATS). The authors alone are responsible for the views expressed in this abstract and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Investigating ICT infrastructure to develop an information society in India

The information society (IS) can be defined as a society that will witness creation, storage, processing, and distribution of information as major source of economic and cultural activity. IS has also been defined in social, economic, technological, and cultural domains. This study peruses the technological parameter into consideration to look into the role information and communication technology (ICT) infrastructure can play to build and promote IS in India. India's progress on millennium development goals (MDGs) is scrutinized to benchmark with average rates of various economies around the world. Extensive literature survey has been conducted to contextualize IS in India. In three of the important parameters of MDGs, India struggles in the bottom of the benchmarked nations in terms of internet users and telephone lines. However, its performance in mobile density has surpassed low-income, South Asian, and sub-Saharan African countries. India must invest in these technologies to perform better, as UN considers these three parameters on a par with literacy, water, sanitation, etc. A large portion of the population in the country, specially in rural areas, is not able to access ICT infrastructure that if often characterized as poor in quality. There is consistent need from the government to dedicate a larger sum of ICT expenditure on its mega project `National e-Governance Plan' (NeGP). However, just like an oasis in the desert, India remains one of the most affordable nations to offer prices for fixed lines, mobile telephones, and the internet. In terms of ICT usage, India also attains the distinction of highest uses of mobile telephone (minutes/user per month). These strengths can definitely uplift the sagging morale of the Indian economy to get on the path of contemporary IS.

How and what knowledge do universities and academics transfer to industry in African low-income countries? Evidence from the stage of university-industry linkages in Mozambique

Drawing from the Mozambican case, this paper addresses the stage of university-industry linkages (UILs) in Sub-Saharan Africa, from the perspective of universities. The paper examines the kind of knowledge universities transfer to industry, the knowledge channels used, the incentives and barriers faced, including influencing contextual conditions. The findings suggest that UILs in Mozambique weak and informal, and that academics engage with companies mainly through DUI-innovation model and exchange of embodied knowledge, particularly ideas in informal meetings, internship/employment for students, consultancies for academics, rather than through disembodied knowledge, such as patents and technology prototypes, embedded in R&D and STI-innovation model.

Population Impact and Effectiveness of Monovalent Rotavirus Vaccination in Urban Malawian Children 3 Years After Vaccine Introduction: Ecological and Case-Control Analyses.

Background. Rotavirus vaccines have been introduced in many low-income African countries including Malawi in 2012. Despite early evidence of vaccine impact, determining persistence of protection beyond infancy, the utility of the vaccine against specific rotavirus genotypes, and effectiveness in vulnerable subgroups is important.Methods. We compared rotavirus prevalence in diarrheal stool and hospitalization incidence before and following rotavirus vaccine introduction in Malawi. Using case-control analysis, we derived vaccine effectiveness (VE) in the second year of life and for human immunodeficiency virus (HIV)–exposed and stunted children.Results. Rotavirus prevalence declined concurrent with increasing vaccine coverage, and in 2015 was 24% compared with prevaccine mean baseline in 1997–2011 of 32%. Since vaccine introduction, population rotavirus hospitalization incidence declined in infants by 54.2% (95% confidence interval [CI], 32.8–68.8), but did not fall in older children. Comparing 241 rotavirus cases with 692 test-negative controls, VE was 70.6% (95% CI, 33.6%–87.0%) and 31.7% (95% CI, −140.6% to 80.6%) in the first and second year of life, respectively, whereas mean age of rotavirus cases increased from 9.3 to 11.8 months. Despite higher VE against G1P[8] than against other genotypes, no resurgence of nonvaccine genotypes has occurred. VE did not differ significantly by nutritional status (78.1% [95% CI, 5.6%–94.9%] in 257 well-nourished and 27.8% [95% CI, −99.5% to 73.9%] in 205 stunted children; P = .12), or by HIV exposure (60.5% [95% CI, 13.3%–82.0%] in 745 HIV-unexposed and 42.2% [95% CI, −106.9% to 83.8%] in 174 exposed children; P = .91).Conclusions. Rotavirus vaccination in Malawi has resulted in reductions in disease burden in infants <12 months, but not in older children. Despite differences in genotype-specific VE, no genotype has emerged to suggest vaccine escape. VE was not demonstrably affected by HIV exposure or stunting.

Financial Development, Economic Growth and Poverty Level in Selected Low-income Sub-Sahara African Countries (1980-2012).

The study examines the interactions among financial development, economic growth and poverty level in twelve selected low-income sub-Sahara African countries (SSA) between1980 and 2012. The study employed annual data from 1980 to 2012 obtained from World Bank Development Indicators (WDI). Cointegration test was applied to determine the long run relationship among these three key variables while panel vector autoregression Model analysis was conducted to examine the dynamic interactions among financial development, economic growth and poverty level with particular reference to economic growth as a channel linking financial development and poverty. The evidence obtained in this study shows that increase in financial development reduces economic growth and ultimately increases poverty level in low income countries. This suggests that economic growth is a weak channel connecting financial development and poverty level in all these SSA countries. It is therefore suggested that policy makers should re-design feasible financial sector reforms that would establish sound economic linkages with existing key sectors in these SSA economies which would eventually translate into reduction in poverty level. Of particular importance is the sectoral allocation of credits to key sectors of the economy like energy sector, infrastructural sector, among others.

Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis.

In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings. We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals. Compared with the 2009-11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17-29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48-49%, and admissions specific to rotavirus captured by active surveillance fell by 61-70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group. The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings. Gavi, the Vaccine Alliance and the Government of Rwanda.

Foreign aid on economic growth in Africa: A comparison of low and middle-income countries

Previous empirical studies on the effects of foreign aid on economic growth have generated mixed results that make it difficult to draw policy recommendations. The main reason for such mixed results is the choice of a single aggregate list of countries, regardless of the disparities in levels of development. This study therefore fills the development gap by disaggregating the African data into a panel of 20 middle- income and 19 low- income African countries over a period of 15 years between 1995 and 2010, and employing a dynamic generalized method of moments (GMM) model to address the dynamic nature of economic growth as well as the problems of endogeneity. The results of this study support the theoretical hypothesis that a positive relationship between aid and GDP growth exists, but only for low-income African countries, not middle-income ones. On the other hand, the study reveals that middle- income African countries tend to experience a greater impact on their economic growth from foreign direct investment (FDI) and natural resources revenues, mainly oil exports. This implies that the frequent criticism that foreign aid has not contributed to economic growth is flawed, at least in the case of low-income African countries. In fact, foreign aid has played a critical role in stimulating economic growth in such countries through supplementing domestic sources of finance such as savings, thus increasing the amount of investment and capital stock in them.

Foreign Direct Investment and Economic Development in Low Income African Countries

Low income economies are characterized with high investment returns and therefore should attract foreign investment to primarily fill the existing gaps of productive factors which vividly reveals the basis for their underdeveloped status. The main objective of the study is to ascertain the impact of flow of FDI on the economic development of the host African countries characterized with low income per capita. Panel data were utilized for 39 African countries, 20 of which were low income countries. The results indicates that FDI had significant impact on the economic development of the host African countries, by enhancing the development of the host sector and reducing gradually dependence on foreign capital, which resulted in increased income per capita, better education, living standards and the wellbeing of the host economies. The study concludes by recommending that government of the host economies should guide the sector of FDI inflow, and ensure that policies are in place to enhance domestic investment development in such sectors. This will gradually bring about the closure of existing proactive factors and hence economic development.

Barriers to Cervical Cancer Screening in Burkina Faso: Needs for Patient and Professional Education.

Cervical cancer is among the leading causes of cancer deaths for women in low-income African countries, such as Burkina Faso. Given that cervical cancer is a preventable disease through early detection and vaccination, this study aimed at understanding the barriers to cervical cancer early detection in Ouagadougou, the capital city of Burkina Faso. Women seeking screening and treatment for cervical cancer (n = 351) during the period of May-August 2014, at the Yalgado Ouedraogo University Hospital, were interviewed about their knowledge, attitudes, and practices toward cervical cancer. Interview questions elicited information about sociodemographic of participants, history of screening, knowledge of cervical cancer, and attitudes toward cervical screening. Scores were assigned to responses of questions and knowledge, and tertitles of distributions were used for comparison. A multivariate logistic regression was performed to predict cervical screening. Study participants were relatively young (37.5 ± 10.7years) and predominately resident of urban areas (83.8%), and over half had no or less than high school education. Over 90% of participants had heard about cervical cancer, and about 55% of them had intermediate-level knowledge of the disease, its screening, and/or risk factors. Knowledge level was lower among rural than urban residents. Predictors of screening included higher level of education (odds ratio (OR) = 2.2; 95% confidence interval (CI) 1.48-3.23), older age (OR = 1.1; 95% CI 1.06-1.12), higher socioeconomic standard (SES) (OR = 1.5; 95% CI 1-2.37), urban residence (OR = 2.0; 95% CI 1.19-3.25), encouragement for screening by a health care worker (1.98; 95% CI 1.06-3.69), and employment (OR = 1.9; 95% CI 1.13-3.11). Low awareness and socioeconomic barriers lead to underutilization of screening services of women. Motivation and education by healthcare workers are important factors for increasing screening rates. Organized patient and professional education programs in gynecologic services are warranted for improving screening in Burkina Faso and other low-resource countries in Africa.

Ebola and the need for restructuring pharmaceutical incentives.

Ebola and the need for restructuring pharmaceutical incentives.

Foreign aid on economic growth in Africa : a comparison of low and middle-income countries

Previous empirical studies on the effects of foreign aid on economic growth have generated mixed results that make it difficult to draw policy recommendations. The main reason for such mixed results is the choice of a single aggregate list of countries, regardless of the disparities in levels of development. This study therefore fills the development gap by disaggregating the African data into a panel of 20 middle- income and 19 low- income African countries over a period of 15 years between 1995 and 2010, and employing a dynamic generalized method of moments (GMM) model to address the dynamic nature of economic growth as well as the problems of endogeneity. The results of this study support the theoretical hypothesis that a positive relationship between aid and GDP growth exists, but only for low-income African countries, not middle-income ones. On the other hand, the study reveals that middle- income African countries tend to experience a greater impact on their economic growth from foreign direct investment (FDI) and natural resources revenues, mainly oil exports. This implies that the frequent criticism that foreign aid has not contributed to economic growth is flawed, at least in the case of low-income African countries. In fact, foreign aid has played a critical role in stimulating economic growth in such countries through supplementing domestic sources of finance such as savings, thus increasing the amount of investment and capital stock in them.

High rate of detection of G8P[6] rotavirus in children with acute gastroenteritis in São Tomé and Príncipe.

The burden of rotavirus infections greatly affects the low-income African countries. In the absence of epidemiological data on pediatric diarrhea in São Tomé and Príncipe (STP), a study was conducted from August to December 2011. Rotavirus antigen was detected in 36.7% of the collected fecal samples (87/237). G8P[6] was identified as the predominant genotype (71.1% detection rate), while G1P[8] represented only 8.4%. Phylogenetic analysis of VP7 G8 strains showed clustering within lineage G8d, while VP4 P[6] strains clustered within lineage 1a. Our results represent the first report on rotavirus from STP and show one of the highest detection rates of G8 rotaviruses worldwide.

Bank Efficiency and Openness in Africa: Do Income Levels Matter?

This paper integrates a previously missing wealth-effect component in the openness-finance debate. From a panel of 29 low and middle income African countries with data spanning from 1987 to 2008, we provide evidence that openness (trade and financial) triggers less bank efficiency in low income countries than in their middle income counterparts. These findings justify the absence of a banking comparative advantage and consequently, the issue of over-liquidity resulting from low funding of economic operators with mobilized financial deposits. In terms of policy implications, globalization increases economic cost of banks in sampled countries, with trade openness more detrimental than financial openness. Banks in middle income countries play a greater role in financing activities resulting from trade openness than those in low income countries. Also, a lot needs to be done on the improvement of infrastructures that curtails information asymmetry in the banking industry.

International Issues: Expanding neurologic education to resource-poor countries

It is well-recognized that there is a disparity in health care resources and availability in low- and middle-income countries, often due to a combination of poverty, lack of clean water, inadequate nutrition, and political conflict. Yet it seems less attention is given to challenges specific to the provision of medical education in such developing nations. Besides war, famine, drought, and the AIDS epidemic, eastern African nations carry a heavy burden of neurologic disease1 and insufficient infectious disease programs,2 coupled with a paucity of subspecialty-trained providers. Over the past decade, there has been increasing concern over the so-called “brain drain”—the ongoing relocation of African doctors to more profitable parts of the world,3 presumably due to the challenges inherent to practicing in resource-limited settings. This is exemplified by the estimated 0.03 neurologists per 100,000 people in low-income African countries (compared to 1 to 10 per 100,000 in Western countries), and further by the lack of neurologists in all of sub-Saharan Africa.4 Similar estimates in sub-Saharan Africa suggest that there is only 1 neurosurgeon for every 4,000,000 people, with dedicated neurologic and neurosurgical services available in only a few private centers—institutions that are financially inaccessible to 90% of the population due to the nonexistence of health insurance systems.5

Establishing of cancer units in low or middle income African countries: Angolan experience--a preliminary report.

IntroductionThe number of cancer cases and related deaths worldwide is expected to double over the next 20-30 years. African countries will be the most affected by the burden of cancer. The improving economic situation of Angola creates conditions for an increase in life expectancy which by itself is associated with an increased risk of oncological diseases. Because cancer therapy requires a multidisciplinary approach, trained health professionals, satisfactory infrastructure and appropriate facilities, the availability of effective cancer therapy is a difficult task that requires support. The aim of this article is to share our experience achieved in the establishment of cancer units in Angola and to validate our checklist for this action.MethodsThe survey method was a questionnaire addressed to Angolan cancer units, in order to evaluate the usefulness and feasibility of a checklist developed by the authors - The Cancer Units Assessment Checklist for low or middle income African countries - which was used previously in the establishment of those units. Afterwards, the crucial steps taken for the establishing of the main sites of each cancer unit considering, facilities, resources and professionals, were also recorded.ResultsAll cancer units reported that the checklist was a useful tool in the development of the cancer program for the improvement of the unit or the establishing of cancer unit sites. This instrument helped identifying resources, defining the best practice and identifying barriers. Local experts, who know the best practices in oncology and who are recognized by the local heads, are also important and they proved to be the major facilitators.ConclusionThe fight against cancer has just started in Angola. The training, education, advocacy and legislation are ongoing. According to our results, the assessment checklist for the establishment of cancer units is a useful instrument.

Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: An epidemiological study

BackgroundReliable mortality data are sparse for developing countries. Furthermore, risk factor prevalence information is hardly available and thus not taken into consideration when estimating mortality. MethodsThe authors used a validated, statistical model combined with representative smoking prevalence from WHO STEPS surveys to estimate lung cancer mortality for six Sub-Saharan African countries (Benin, Malawi, Mozambique, Niger, Sierra Leone, Swaziland). Results were compared to a reference database (GLOBOCAN). Using different smoking prevalence scenarios, future lung cancer deaths were estimated. ResultsThe prevalence of current moderate smoking among males ranged from 8.7% to 34.6%. Prevalence was much lower among females. For all countries considered, our mortality estimates were higher than GLOBOCAN estimates that do not consider prevalence: Overall, we estimated 2405 lung cancer deaths for 2008 compared to 531 deaths estimated by GLOBOCAN. Up to 2030, lung cancer deaths are expected to increase in general and by over 100% in Benin and Niger. Even under the assumption of decrease in smoking prevalence, lung cancer mortality will rise. ConclusionOn the bases of detailed smoking prevalence information, our findings implicate a higher lung cancer burden in low income countries. The epidemiologic transition in African low-income countries alludes to the need for targeted health prevention efforts.

Continuing Distance Education: A Capacity-Building Tool for the De-isolation of Care Professionals and Researchers

There are large disparities in access to health-care professionals (HCP) in low-income African countries, leading to imbalanced and suboptimal health delivery. Part of the difficulty is recruiting and retaining care professionals to work in isolated settings. To evaluate the impact of distance continuing education as a way to build capacity, increase satisfaction and enhance the performance of care professionals in these isolated health-care facilities. Care professionals using RAFT (Telemedicine Network in French-speaking Africa) in isolated care facilities. Within RAFT, an organizational framework and computer-based tools have been developed and evolved to provide useful, qualitative, applicable training material. The activity, satisfaction, perceptions and impact of RAFT on remote health-care workers are being monitored. RAFT's potential to improve the recruitment, satisfaction and retention of care professionals in remote settings is widely recognized; however, the actual impact on the performance and quality of care remains to be demonstrated.

ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics.

IntroductionAfter almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability.MethodsUsing patient-level data from medical records (n=120/site), we estimated the cost of providing ART at three treatment sites in the Rift Valley Province of Kenya (a clinic at a government hospital, a hospital run by a large agricultural company and a mission hospital). Costs included ARV and non-ARV drugs, laboratory tests, salaries to personnel providing patient care, and infrastructure and other fixed costs. We report the average cost per patient during the first 12 months after ART initiation, stratified by site, and the average cost per patient achieving the primary outcome, retention in care 12 months after treatment initiation.ResultsThe cost per patient initiated on ART was $206, $252 and $213 at Sites 1, 2 and 3, respectively. The proportion of patients remaining in care at 12 months was similar across all sites (0.82, 0.80 and 0.84). Average costs for the subset of patients who remained in care at 12 months was also similar (Site 1, $229; Site 2, $287; Site 3, $237). Patients not retained in care cost substantially less (Site 1, $104; Site 2, $113; Site 3, $88). For the subset of patients who remained in care at 12 months, ART medications accounted for 51%, 44% and 50% of the costs, with the remaining costs split between non-ART medications (15%, 11%, 10%), laboratory tests (14%, 15%, 15%), salaries to personnel providing patient care (9%, 11%, 12%) and fixed costs (11%, 18%, 13%).ConclusionsAt all three sites, 12-month retention in care compared favourably to retention rates reported in the literature from other low-income African countries. The cost of providing treatment was very low, averaging $224 in the first year, less than $20/month. The cost of antiretroviral medications, roughly $120 per year, accounted for approximately half of the total costs per patient retained in care after 12 months.

Construction and characterization of human rotavirus recombinant VP8* subunit parenteral vaccine candidates

Two currently licensed live oral rotavirus vaccines (Rotarix® and RotaTeq®) are highly efficacious against severe rotavirus diarrhea. However, the efficacy of such vaccines in selected low-income African and Asian countries is much lower than that in middle or high-income countries. Additionally, these two vaccines have recently been associated with rare case of intussusception in vaccinated infants. We developed a novel recombinant subunit parenteral rotavirus vaccine which may be more effective in low-income countries and also avert the potential problem of intussusception. Truncated recombinant VP8* (ΔVP8*) protein of human rotavirus strain Wa P[8], DS-1 P[4] or 1076 P[6] expressed in Escherichia coli was highly soluble and was generated in high yield. Guinea pigs hyperimmunized intramuscularly with each of the ΔVP8* proteins (i.e., P[8], P[4] or P[6]) developed high levels of homotypic as well as variable levels of heterotypic neutralizing antibodies. Moreover, the selected ΔVP8* proteins when administered to mice at a clinically relevant dosage, route and schedule, elicited high levels of serum anti-VP8* IgG and/or neutralizing antibodies. Our data indicated that the ΔVP8* proteins may be a plausible additional candidate as new parenteral rotavirus vaccines.

Newborn survival in Malawi: a decade of change and future implications

Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV and low health worker density. With neonatal deaths becoming an increasing proportion of under-five deaths, addressing newborn survival is critical for achieving MDG 4. We examine change for newborn survival in the decade 2000-10, analysing mortality and coverage indicators whilst considering other contextual factors. We assess national and donor funding, as well as policy and programme change for newborn survival using standard analyses and tools being applied as part of a multi-country analysis. Compared with the 1990s, progress towards MDG 4 and 5 accelerated considerably from 2000 to 2010. Malawi's neonatal mortality rate (NMR) reduced slower than annual reductions in mortality for children 1-59 months and maternal mortality (NMR reduced 3.5% annually). Yet, the NMR reduced at greater pace than the regional and global averages. A significant increase in facility births and other health system changes, including increased human resources, likely contributed to this decline. High level attention for maternal health and associated comprehensive policy change has provided a platform for a small group of technical and programme experts to link in high impact interventions for newborn survival. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi.