Recognition and action towards meningitis amongst patients, their families and health providers in Blantyre, Malawi

Barriers to diagnosis in sub-Saharan Africa

Scientific version
  • Researchers:
    Dr Macpherson Mallewa, Dr Nicola Desmond, Prof David Lalloo, Prof Elizabeth Molyneux, Prof Robert Heyderman
  • Start Date:
    01 June 2010
  • Category:
  • Location:
    Liverpool School of Tropical Medicine, Liverpool, UK
Recognition and action towards meningitis amongst patients, their families and health providers in Blantyre, Malawi
Completed February 2012

What was this project about?

In order to gain a full understanding of when and where people seek treatment for severe illness such as meningitis, this study explored how communities in Blantyre, Malawi, understand the symptoms of meningitis and how social factors affect recognition of severe illness and willingness or ability to take action.

The research team, based at the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW) in Blantyre, investigated the pathways that urban residents follow in reaching appropriate care and the potential barriers both in the community and at primary health clinics.


Why was it important?

Presenting late at hospital is common in cases of acute bacterial meningitis in sub-Saharan African countries such as Malawi and results in high rates of death and disability. 

Recognition of illness is the first stage in seeking care. In contexts where illness is common and 70% of treatment is carried out in the home, it is important that carers are able to recognise particularly severe illness such as meningitis and act on it.   


Recognition in the community

Community plays a big part in making the decision to seek treatment. It is rare for only one individual to make the decision to go to hospital or the local clinic. 
o Respected elders or other family
o Neighbours
Symptoms associated with severe illness included
o Inability to eat
o Inability to work 
o Failure in mobility (failure to sit in infants or stand in adults)
o Some are associated with meningitis while others aren’t.

Recognition at primary health clinics

Many cases of meningitis are misdiagnosed and treated as malaria (7/9 infant cases, 5/8 adult cases)
Other factors affected timely diagnosis
o Diagnosis without examination
o Lack of follow up
o Lack of drugs
o Long waiting times

Barriers to action

Male reluctance to seek healthcare (concepts of wellness and masculinity)
Perceptions of health services (patients were worried about inconsistent availability of medical professionals and long waiting times)
Financial constraints
Gender and social positioning (e.g. mother needing husband’s advice)
Priority focus on maternal health at clinics (follow up maternal deaths but not others, nurses and ambulance drivers prioritise complications during birth)
Individual case studies in this research are drawn from those meningitis cases who made it to QECH and it is difficult to estimate how many people don’t actually get that far. 


The results of the study were published in July 2013

PLoS One 2013 Jul 4;8(7):e68163
Desmond NA, Nyirende D, Dube Q, Mallewa M, Molyneux E, Lalloo DG, Heyderman RS

It was also presented as a scientific poster at the MRF Conference in London 2011. 

Desmond NA, Nyirende D, Molyneux E, Mallewa M, Lalloo DG, Heyderman R

And presented orally at our conference in 2013.

Dr Nicola Desmond
Day one, 16.45pm

As a result of this research, Meningitis Research Foundation has partnered with MLW to implement the Action Meningitis project. This project, with a dedicated MRF Project Manager based in Malawi, is raising awareness of signs and symptoms in the community and implementing triage in local health clinics.