Article Text

Establishment of a high-dependency unit in Malawi
  1. Ben Morton1,2,
  2. Ndaziona Peter Banda3,
  3. Edna Nsomba2,
  4. Clara Ngoliwa4,
  5. Sandra Antoine2,
  6. Joel Gondwe2,
  7. Felix Limbani2,
  8. Marc Yves Romain Henrion1,2,
  9. James Chirombo2,
  10. Tim Baker5,
  11. Patrick Kamalo4,
  12. Chimota Phiri4,
  13. Leo Masamba4,
  14. Tamara Phiri4,
  15. Jane Mallewa3,
  16. Henry Charles Mwandumba1,2,3,
  17. Kwazizira Samson Mndolo4,
  18. Stephen Gordon1,2,3,
  19. Jamie Rylance1,2,3
  1. 1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  3. 3Department of Medicine, College of Medicine, Blantyre, Malawi
  4. 4Queen Elizabeth Central Hospital, Blantyre, Malawi
  5. 5Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Ben Morton; ben.morton{at}


Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.

  • treatment
  • cardiovascular disease
  • HIV
  • tuberculosis

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  • BM and NPB are joint first authors.

  • SG and JR are joint senior authors.

  • Handling editor Seye Abimbola

  • Twitter @benjamesmorton

  • Contributors All authors made a substantial contribution to the conception or design of the work, or the acquisition, analysis or interpretation of data for the work and drafting the work or revising it critically for important intellectual content; give final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This project was primarily funded by the Wellcome Trust core grant renewal to the Malawi-Liverpool Wellcome Trust Clinical Research Programme with contributions from Wellcome Trust awards 211433/Z/18/Z and 220757/Z/20/Z.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Malawi College of Medicine Research Ethics Committee approval P.03/19/2625.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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