MLW began by focusing on priority health issues in Malawi and cerebral malaria was selected as the first major challenge.
MLW has a vision of science driving health and wellbeing in Malawi. This is bold, ambitious, and challenging as Malawi is faced with challenges related to population density, climate change and environmental degradation, nutrition, education, and endemic diseases including HIV, TB, and malaria. MLW scientists have courage, commitment, energy, and belief – with these combined with excellent funding, facilities, and partnerships, we achieve great things.
The MLW mission is to conduct high quality research to improve health and to train the next generation of researchers.
Research is nurtured in six Themes –
These Themes catalyse the interactions between our 15 Research Groups, six Associate Research Groups and three Research Support Units. Themes are a natural transition from the previous two large programme aims which were (1) To prevent deaths in hospital and (2) to prevent disease in the community. The change has been driven by growth, diversity and the ideas generated by a new generation of leaders. Training in MLW is from junior scientist to Group Head and from operations staff recruit to Department Head. Nine of the Research Group Heads as well as the Director were previously trainees at MLW.
MLW is an affiliate of the College of Medicine (CoM). Legally it is part of the College of Medicine.
There are four key management groups in MLW (Senior Management Team [SMT] , Research Strategy Group [RSG], Research Support Units [RSUs] and Operations Heads of Department [HODs]).
These key groups support each other through a framework of monthly, quarterly and bi-annual meetings.
The Research Strategy Group (RSG)
The Research Strategy Group (RSG) reviews and accepts all new projects. RSG includes the Director, Deputy Director, Chief Operating Officer, Heads of Groups including Associate Director, and Heads of Research Support Units (Clinical, Laboratories, Data & Statistics). A major measure of each Research Group strength and value is demonstrated by provision of specific expert oversight and quality assurance to particular Core Facilities.
There are several Operational Departments (Finance; HR; IT; Data; Laboratory; Clinical Services; Health and Safety; Chikwawa and other Field Sites; Communications and Public Engagement; and Facilities). These are each headed by a Departmental Head who takes full responsibility for their department.
Some of Our Achievements
MLW hosted the first large-scale population-based HIV self-testing study globally, defining and evaluating a semi-supervised volunteer distribution model that is now recommended by WHO and UNAIDS as safe, accurate, highly scalable and associated with increased demand for ART. Regional scale up through a large implementation research grant from UNITAID ($46 million) is now supporting interdisciplinary research accompanying 2.7 million HIV self-tests in Southern Africa, including Malawi.
Mwandumba’s lab has developed novel approaches to detecting HIV infection at single cell level, allowing isolation of high quality nu-cleic acids from pure populations of HIV-infected cells and detection of unique compartmental reservoirs, and enabling novel study of HIV clearance from different body compartments.
(PIs: Corbett, Desmond, Mwandumba, Jambo)
- Recognition of need of new modalities of HIV testing, particularly for under served groups such as adolescents and men
- First demonstration of feasibility, safety and preference for self testing in certain groups
- Cost effectiveness, encouragement of linkage to care and minimal social harms all demonstrated
- Influenced national and international policy and uptake of self testing into national and international guidelines
Since demonstrating reduction in undiagnosed TB in Zimbabwe, leading to WHO policy change in 2013, Liz Corbett (WT Senior Fellow) introduced spatial and enhanced TB recording in Blantyre. Our 2011-16 database of >12,000 TB cases confirms population-level impact from active case-finding, suggesting lasting behaviour change as a key mechanism, and quantitative support for an emerging theme of marginalisation of male needs.
In the lab, we have described incomplete restoration of anti-TB immunity in HIV-infected patients on ART, supporting need for prolonged preventive therapy for HIV patients.
(PIs: Corbett, MacPherson)
MLW supports the only respiratory virus surveillance in Malawi. We have demonstrated that 58% of severe hospitalised influenza in adults is attributable to HIV, pregnant women are at major risk (Ho PhD 2016) and amongst children with severe respiratory syndromes, RSV and Influenza are major causes but multiple viral co-infections may be a major driver of this syndrome in Malawi. MLW has led post-vaccine surveillance in Blantyre, Mchinji and Karonga since 2011 and has recently shown limited herd effect associated with pneumococcal conjugate vaccine implemen-tation. Mucosal studies have shown increased carriage of pneumococci in HIV infected adults on HAART, continued early acquisition of pneumococci by young infants with siblings a major reservoir of transmissible pneumococci. This has very significant national implications for disease control.
Respiratory infections are the most common cause of adult admission to QECH. A large cohort study has shown that mortality is associated with clinical features including hypoxia, anaemia and failure to stand. Follow-up work showed that only 10% of hypoxic cases were routinely provided oxygen and 90% of hypoxic cases were corrected with simple concentrator oxygen supply. Poor prognosis in pneumonia is also associated with TB or lack of a specific aetiology (Aston PhD 2017).
(PIs: Everett, French)
MLW has published the largest study of chronic lung disease in Africa and made the novel observation that 38% of Malawians have abnormal spirometry, mainly restrictive (small) lungs. Small lungs are associated with chronic lung disease and acute pneumonia (Jary – Thorax in press) and the high observed prevalence indicates that as the population ages, a large burden of pneumonia driven by underlying lung disease will present. The largest intervention study ever to reduce household air pollution has been published; use of an improved cook stove had no effect in reducing childhood pneumonia.
(PIs: Gordon S, Rylance)
Stroke is common, severe and particularly disabling for Malawians given the lack of rehabilitation specialty care. The association of stroke with a high prevalence of hypertension in the elderly is expected, but novel recent MLW studies have identified HIV as the leading correlate of hospitalised stroke in younger adults. Current work continues to explore the association between inflammation and stroke in this population.
(PIs: Mwandumba, Benjamin)
In the last seven years, MLW has established a leading position in both typhoid and invasive non-typhoidal Salmonella (iNTS) disease, modelling disease incidence and publishing the first estimate of the global burden of iNTS disease. Experimental medicine studies uncovering the cellular and molecular basis of pathogenesis proved the value of early ART initiation and treatment to penetrate intracellular niches, improving case fatality. Data on disruptions of cellular and antibody defence have driven design and evaluation of the three current candidate iNTS vaccines. Phylogenomic descriptions of three Salmonella epidemics have demonstrated the critical role of multidrug antimicrobial resistance in transmission, and altered national antimicrobial policy, improving outcomes. Understanding the niche adaptions of genomically micro-evolved African Salmonella strains is driving fundamental studies of bacterial biology.
(PIs: Gordon M, Feasey)
MLW has been at the leading edge of pneumococcal science for the past 20 years, growing to a world-leading collaborative group which includes hospital based studies, controlled hu-man infection model (CHIM), pathogen genom-ics, mucosal immunity, community surveillance and large vaccine studies with synergistic sup-port from two MRC programme grants. We have described the burden of pneumococcal disease by syndrome in adults and children and the critical interaction with HIV. Serotype specific protection was shown in HIV infected adults using conjugate vaccine. MLW sci-entists advised GAVI in the Malawi introduc-tion of the 13-valent pneumococcal conjugate vaccine in 2012 and established a national net-work for infant vaccine programme evaluation. Recent discovery science has identified key characteristics of the bacteria that control recombination in the genome and shown specific pneumococcal genes associated with progression from sepsis to meningitis with recombinant protein vaccines derived from these genes able to protect murine models from meningitis. The CHIM model has allowed efficient vac-cine testing and given unique insight into the mucosal regulation of carriage and lung defence, nasal microbiota regulation and pulmonary response to vaccination.
(PIs: Gordon S, French)
Landmark meningitis studies at MLW defined the high burden and high case fatality rate of cryptococcal and pneumococcal meningitis and the important contribution of group B strepto-coccus to neonatal disease. Subsequent high impact clinical intervention trials have tested adjunctive therapies in bacterial and cryptococcal meningitis and emphasised the impact of early health seeking behaviour, nursing care and appropriate antibiotics – but outcomes remain poor . A trivalent glycoconjugate Group B streptococcal vaccine was evaluated in an early phase study in HIV-infected women confirming immunogenicity. Initial studies of health seek-ing behaviour in meningitis led to subsequent MRF funded work on improving the response to severe illness in children in primary health care systems through use of an Emergency Triage As-sessment and Treatment (ETAT) package using digital health technology. This successful approach is now being rolled out nationally and is included in the new Malawi Essential Health Package.
(PIs: Desmond, Heyderman, Lalloo)
In work spanning 20 years, MLW has completed several landmark studies of rotavirus gastroenteritis. These include the most comprehensive clinical description of rotavirus and HIV infec-tion ever undertaken; the first clinical trial of a modern rotavirus vaccine in Africa leading to a global vaccine recommendation; and the first description from a low income country of real-world impact of routine rotavirus vac-cination including ~ 40% reduction in child deaths due to diarrhoea (unpublished]. The biological basis of reduced vaccine perfor-mance compared with high income countries is currently being explored.
(PIs: Bar-Zeev, Cunliffe)
MLW has a 25 year history of world-class severe malaria research which has helped to define those at greatest risk of death, improved our understanding of severe disease and patho-physiology, including the importance of retin-opathy and improved outcomes in patients with cerebral malaria. Work on the Paediatric Research Ward (PRW) has identified increased brain volume as a major contributor to death in children with stringently defined cerebral malaria imaged with MRI; 37% of retinopathy-positive children with CM and in-creased brain volume do not survive.
(PIs: Taylor, Mwapasa, Terlouw)
- Surveillance of diarrhoeal disease in Malawi since 1996
- Published first detailed estimates of contribution of rotavirus to diarrhoea in children (including HIV positive)
- First rotavirus trial (2010) led to WHO recommendation for use
- Malawi surveillance data supported case to GAVI for financial support
- Post-introduction surveillance demon-strated real world effectiveness of vaccine, cost-effectiveness and efficacy of accelerated schedules
- Recent work demonstrating reduction in diarrhoeal deaths
- Current work looking at failures, house-hold transmission and planned new vaccine trials
Malawi’s success in achieving MDG targets for reduction is child mortality can be partly attributed to a 37% reduction in malaria mortality. MLW researcher have contributed substantial to the evidence base on malaria case management, including the switch to ACT’s for uncomplicated malaria and parenteral artesunate for severe malaria and epidemiological work has strongly informed and influenced malaria control and national policy in Malawi. We have now developed novel surveil-lance methodologies for affordable fine-scale mapping to demonstrate heterogeneity in transmission – an understanding of this is critical for improving control.
Work on PKPD dose-optimization of antimalarials in vulnerable subgroups has been influen-tial in changing WHO treatment guidelines for DHA-PPQ, the main candidate drug for mass drug administration in southern and eastern Africa. Results of a major trial examining anti-malarial and antiretroviral interactions are currently being analysed.
The MLW Programme is a longstanding partnership between the College of Medicine, the Liverpool School of Tropical Medicine (LSTM) and the University of Liverpool (UoL) core-funded by the Wellcome Trust.
Here is how we work with our various partners:
The University of Malawi’s College of Medicine (COM) is the country’s largest medical school with an intake of 115 students per year and a faculty of 134. COM has a research strategy that focuses on developing the scientific talent and building the capacity and infra-structure to undertake research programmes addressing the major diseases of Malawi. Six priority areas have been identified by COM: Maternal and adolescent health, Bioethics, Health systems, Nutrition and Early Child Development, HIV Clinical Trials and Implementation Science and Malaria Prevention and Treatment and there is an emphasis on translational research which can improve health outcomes in Malawi in the near future. COM provides institutional support for MLW in areas such as training, ethical approvals, and scientific collaboration.visit website
LSTM and UoL are both internationally recognised as leaders in tropical and global health research. LSTM’s research activity is almost exclusively focused on the tropics and MLW represents its major overseas clinical research base. LSTM’s strategy is based on translational research to improve the health of populations in resource poor countries. An extensive research portfolio (currently over £400 million funding) extends from basic parasite biology to health delivery and policy research and includes a number of major consortia such as the DfID funded Centre for Neglected Tropical Diseases and the IVCC, a not for profit product development partnership committed to improving the effectiveness of vector control products. There is a particular focus on areas of strength in Neglected Tropical Diseases, Malaria and Vector borne diseases, Maternal and newborn health, Lung health and tuberculosis, and Antimicrobial resistance research. Substantial expertise in clinical trials, systematic reviews and health delivery research (£3 million CARHD develop-ment) underpin many of these initiatives. LSTM provides operational support in procurement, travel support and logistics, operational oversight, consolidating financial reporting, expert advice on construction projects and operations support for IT and Finance.visit website
The UoL strategic plan 2026 highlights the need to continue to grow international collaborative work as a central element of the university’s mission. Infection is one of the three re-search themes in which Liverpool will provide global leadership. To deliver this strategy, the Institute for Infection and Global Health (IGH) was established in 2010, bringing together leading medical, veterinary and basic scientists from across the University. Five areas of future strategic focus have been high-lighted; Environmental Change, Food Security, Antimicrobial Resistance, Diagnostic tests and Vaccines. Four of these five areas involve cur-rent major activity and investment in partner-ship with MLW with advanced plans to develop projects on zoonotic infections/food security. The Institute houses the Centre for Global Vaccine Research which connects to MLW as its major overseas partner. IGH acts links substantial expertise in infection pharmacology, AMR, HIV and TB, paediatrics, molecular biology, public health and epidemiology within other UoL institutes to research programmes in Malawi. Both UoL and LSTM provide substantial senior scientific support.visit website
Wellcome exists to improve health by helping great ideas thrive in four ways: funding scientists and researchers, leading in global responses to some of today’s biggest health challenges, working with policy makers to ensure that good research is well supported, and engaging the public so that people are more aware of science and health research. The Wellcome Trust (WT) provides about 60% of MLW’s funding, half of this through Core support and half from additional WT grants. WT also supports MLW scientifically by senior input and operationally.visit website