Improving the prioritisation and treatment of children with life-threatening illnesses in Malawi

Children in Malawi are dying from meningitis and other life threatening illnesses because they are not being treated early enough. The speed with which meningitis can progress means it’s particularly important for people with this disease to be diagnosed and treated quickly.

MRF funded research showed that many children in Malawi were dying while they waited in queues at health centres or when they were travelling between the clinic and the hospital. Clinics were run based on unsystematic triage systems prioritising those that come first rather than the urgency of the child’s condition.

Since 2012, with funding from the Scottish Government, MRF has been working with the Malawi Ministry of Health and the Malawi-Liverpool-Wellcome Trust (MLW) to adapt a system normally used in hospitals for use in primary health clinics in two districts. This ensures that children are seen based on the severity of their symptoms, not the order that they arrive to seek care. As a result, when children with life-threatening illnesses - including meningitis - arrive at participating clinics, they are now prioritised for assessment and treatment faster than before and with better health outcomes. The project works at community, clinic and policy levels.

"In the past we used to have a lot of deaths at the facility but now it has reduced. Before the triage, they would just wait in the queue, based on first come first served basis. Since we have started triaging, we are now categorising the infections. Those who are emergencies are always assisted first.” - Health Worker, Chileka Health Centre, Blantyre


1. Introduce a system, using a mobile phone application, to ensure children with life-threatening illnesses – including meningitis - are prioritised for assessment and treatment

2. Reduce the waiting time for very ill children to be seen by a medical professional

3. Provide equipment to ensure children can be stabilised at the primary health centre in emergencies

4. Raise awareness of signs and symptoms of meningitis and action to take if affected

5. Provide support for children with disabilities by establishing a patient group coordinated by nursing staff

6. Advocate for the triage system to be effectively adopted and implemented by the Ministry in more districts in Malawi


At community level, through radio shows and theatre in communities, the project has raised household knowledge and awareness of meningitis symptoms, and those of other severe bacterial infections, as well as the importance of seeking health care quickly. After watching community theatre performances, 83% of survey respondents stated that they were highly influenced to present promptly at a health clinic and radio listeners stated that they were motivated to seek prompt treatment to ensure proper diagnosis, rather than using home remedies.

At a clinic level, the new triage system enables quick and accurate prioritisation of children at health facilities. The mobile phone app takes the user through an algorithm that gives a result based on a traffic light system: Emergency (red), Priority (amber) and Queue (green) that determines the order that patients are seen. The tool enables task shifting as it can be used effectively by trained lower cadre health workers, helping to deal with the shortages of staff in primary health clinics.

“The power in ETAT is that everyone is involved. If the guard sees a sick child, he rushes to take the child and to weighs him on the scales. Initially, he would just sit at the entrance and guard”. - Health Worker, Mfera Health Centre.

Over 800 health centre staff have been trained and over 500,000 children have been triaged through the system. Emergency equipment provided through the project so that, in emergencies, children can be stabilised at the primary health centre before being referred to hospital for treatment. This means that more children survive the journey between the clinic and the hospital or that some children can safely return home from the clinic, reducing the number of patients needing to go to hospital.

“We have a bed for emergencies. If the child is showing the emergency signs, we take the child here - the child receives the treatment immediately. The child [does not wait] in the queue. It has really helped to reduce the deaths.” - Field Worker, Chikwawa District Hospital

To address the problem of children not reaching hospital when they were referred from primary health facilities, a ‘feedback loop’ has been established with funding from Irish Aid. The feedback loop between eight primary health facilities, the District Health Management Team and Queen Elizabeth Central Hospital in Blantyre uses digital system to track patients through the health system. It provides valuable information that can be used to improve planning and decision making.

“Giving facilities feedback is important so we know what things were done right and what went wrong. This has helped us to work in those areas where there are shortfalls. The messages have helped in strengthening the facility systems. It has helped us to identify the areas in which the facility is doing well. This gives us encouragement and we also learn from what went wrong.” - Health Worker, Mpemba Health Centre


  • Over 800 health centre staff in Blantyre and Chikwawa districts have been trained to use a mobile phone app that makes sure the sickest children are seen by medical staff first.
  • In emergencies, children are now seen in 8 minutes (on average) and can be stabilised in the emergency room. Previously, there was no system for prioritisation and children were seen on a first come first served basis which means they could wait for hours for their consultation.
  • 32 families form the ‘Tikondane Support Group’ who have been assisted through monthly peer support meetings.
  • The Ministry of Health and its partners have expanded the ‘Emergency Triage, Assessment and Treatment’ (ETAT) system to 16 new districts based on the evidence from our programme.

Key partners

We take action that benefits people directly. including, training health professionals and providing support and information services.
Since the charity was founded in 1989, we have awarded 161 research grants. The total value of our investment in vital scientific research is over £19.1 million (€24.7 million).
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Jessica Brown
Former International programmes coordinator

Hello, I'm Jessica.

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