Modelling the long-term demographic and epidemiological trends in Malawi

1Malawi is facing a dual burden of disease, with an increase in non-communicable diseases coinciding with still-high infectious disease burdens. What this will look like in the future, and how it will impact demand for healthcare, is unknown. In this study, we use the Thanzi La Onse (TLO) model - an individual-based "all diseases - whole health-system" model calibrated to Malawis demographic, epidemiological, and healthcare data - to project population, disease burdens, and healthcare demand from 2020 to 2070. We project Malawis population to grow from 19.5 million in 2020 to 54.2 million in 2070, with median age rising from 17 to 25 years. Infectious disease burdens, particularly HIV/AIDS, TB, malaria, and acute respiratory infections, will decline, though cancers, cardiometabolic diseases, and mental health disorders burdens will increase and account for over one-third of disability-adjusted life years by 2070. Demand for healthcare grows across all cadres, with the steepest increases in clinical and mental health services. Our results highlight the epidemiological and demographic shifts projected to occur in Malawi. In particular, we show the shift away from infectious and disease of childhood toward NCDs and age-related conditions will require adaptations in Malawis health system.