About Our Research
People live 20 years less in Malawi than Ireland. Childhood pneumonia remains the single biggest killer of children under 5 years of age across the world. Childhood mortality due to pneumonia is much higher in Malawi than Ireland. The Navigator Project supports research in childhood pneumonia, rheumatic heart disease and chronic health conditions.
BIOTOPE
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To tackle the problem of childhood pneumonia, the BIOTOPE (BIOmarkers To diagnose PnEumonia) initiative has found ways to identify children most at risk of severe illness who needed hospital admission using artificial intelligence approaches. In addition, the work has found proteins in the blood that could be used to help identify which children needed antibiotics. More than 2,700 children have been included in this project and we are working with the Ministry of Health in Malawi and the World Health Organisation to further evaluate its findings and translate it into clinical practice.
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Rheumatic Heart Disease
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In Malawi and Ireland, the healthcare challenges are very different. Poverty in Malawi is at the root of these differences. Rheumatic heart disease, a condition affecting children and young adults has virtually disappeared in Ireland. However, in countries like Malawi it is still common, affecting 1 in 33 children. In this condition, the heart valves become damaged by severe streptococcal throat infections, leading to heart failure and sometimes even death. The average age of death for someone with rheumatic heart disease is 27 years. We are evaluating new models of care for this condition.
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Non-Communicable Diseases
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Understandably, many believe that the main problems in Malawi are infectious diseases, such as HIV and malaria, whereas the big challenges in Ireland are "Western" diseases such as obesity and diabetes. That picture is changing.
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We compared the contribution of so-called “Non-Communicable Diseases” such as high blood pressure, high blood glucose, obesity and high cholesterol to mortality in Ireland and Malawi over the past three decades using the Global Burden of Diseases, Injuries, and Risk Factors Study. We also compared these conditions, medications and measures of heart pumping function in our clinics in Ireland and Malawi between 2014 and 2024.
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We found the results to be surprising. Age-standardised mortality rates due to high blood pressure are now higher in Malawi (Dark Green), than Ireland (Light Green). We see a similar pattern in diabetes. Steady declines in age-standardised mortality in Ireland due to these conditions over the past three decades have not been matched in Malawi.
Women’s Health
Gertrude (right) has beaten the odds, living well beyond the average age of women in Malawi.
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There are many reasons why women die young in Malawi. Poverty and infectious diseases such as malaria, HIV and tuberculosis play a big roll, as do complications during pregnancy. However, chronic cardiovascular diseases and diabetes are already a growing problem. There are at least three reasons for this:
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First, there is very little access to healthcare advise and treatment in the community and rural areas. Malawi has 49 doctors per million of population in 2022 according to the world bank. This compares with over 4,100 per million in Ireland.
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Second, access to medicines is very challenging in Malawi. Even amongst those people diagnosed with problems such as high blood pressure, obtaining and affording good quality medicines is difficult. People can often afford only two out of three of the following: the journey to the clinic; the cost of the consultation or the medicine.
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Third, the challenge of obesity has evolved to similar levels in Malawi and Ireland amongst women. There are many complex reasons contributing to this and it may be surprising for a country that regularly struggles with food insecurity.
The net result is that people attending our clinic in Malawi are 20 times more likely than those in Ireland to have poor pumping function in their hearts.
Are women's hearts different?
The simple answer is yes.
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On average, women have smaller and stiffer hearts than men. Also, if a woman like Gertrude develops diabetes, she is much more likely to suffer heart failure, compared to a man with diabetes. Researchers now believe women are more exposed to "non-traditional" risk factors throughout their lives such as pregnancy, pre-term labour, pregnancy loss and menopause. New work from our research group shows that worsening stiffness in the women's heart and resistance in their blood vessels begins early post-menopause.* Our research links heart stiffness with inflammation and blood vessel problems. Our research also shows that the type of heart problems experienced by women in Malawi are very different to women in Ireland.
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Overall, cardiovascular disease in women globally is under-studied, under-investigated, under-treated and under-appreciated. More research and greater attention is needed.
Are women's hearts different?
Pregnancy is a Stress Test on the Heart
​Non-traditional cardiovascular risk factors which affect women must be studied and considered more. These include a history of adverse pregnancy outcomes (for example, hypertensive disorders of pregnancy, gestational diabetes, pre-term labour, pregnancy loss) and premature menarche or menopause.