Malawi Liverpool Wellcome Programme

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DIPLOMATIC stands for: using eviDence Implementation science and Clinical Trial PLatform to Optimise MATernal and new-born health in low Income Countries

DIPLO_ANC Study: Exploring approaches to sustain and scale ultrasound scanning during early pregnancy to improve the quality of antenatal care in Malawi, including for adolescent mothers

Background: Malawi has one of the highest rates of preterm births in the world, currently estimated at up to 18.1 percent. Low birth weight (LBW) is also high at 14 percent. There is also an inverse association between a mother’s age and the likelihood of pregnancy complications including preterm birth. Children born to adolescent mothers are more likely to experience several health problems such as low birthweight, stunting, and infant mortality. The main aim of DIPLOMATIC was to improve pregnancy care in Malawi and reduce preterm birth, stillbirth, and other adverse pregnancy outcomes. The DIPLOMATIC ANC focused on three streams/work packages:

First: The Ministry of Health (MoH) of Malawi is committed to the implementation of routine ultrasound dating in early pregnancy to reduce preterm birth and stillbirth. The DIPLOMATIC USS pilot study trained health staff in USS to establish gestational age, the number of foetuses, and Foetal viability. To scale up USS in Malawi, staff training will need to be rolled out widely across country. Standardized training tools becomes paramount. Through participatory workshops, the study aimed at developing a standardised ultrasound training manuals and identify health systems-related facilitators, barriers and strategies beyond the barriers and facilitators to USS in early pregnancy.

Second: There is a high prevalence of adolescent pregnancy and associated adverse birth outcomes in Malawi. This stream aimed at exploring provision of USS to adolescents and whether it encourages first trimester attendance.

Third: Malawi has committed to halving rates of neonatal mortality and stillbirth by 2030 and adopted World Health Organisation (WHO) guidance on antenatal care. This work package aimed to describe the quality of antenatal and pregnancy care being delivered against selected WHO guidance and co-create a quality improvement (QI) tool to improve the compliance with WHO recommendations and to empower midwives and pregnant women.


A mixed-methods research study with qualitative and quantitative methodologies. Qualitative methods include participatory workshops and interviews. Quantitative methods include records review, quantitative survey, and health economics cost consequence analysis.

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