A Qualitative Feasibility Study Examining Barriers and Enablers to Establishing an Adult Peritoneal Dialysis Programme in Malawi

Background: Malawi has a rudimentary NHS providing government-funded haemodialysis for approximately 100 patients. Aim: To explore the feasibility of establishing a peritoneal dialysis (PD) service in Malawi. Methods: An explorative, qualitative design was used. Face-to-face interviews collected data from 16 patients and 9 healthcare professionals. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: Understanding of dialysis was excellent. Many of the nurses had provided PD in the past. Lack of surgical and community expertise; risk of infections when living conditions are poor and availability of affordable consumables were identified as potential barriers. Patients were self-motivated and welcomed a home-based regimen with cost-savings on travel. PD was viewed as an opportunity to expand dialysis provision, especially for those who live remotely. Conclusion: There is need and willing to expand renal services in Malawi. Accurate, transparent records of renal disease and allocation of dialysis provision are essential. This must be prioritized in plans to improve renal care. PD could provide an effective dialysis modality. Concerns regarding education, sanitation and consumables are not unsurmountable.