BACKGROUND: Malawi performed its first cochlear implantation in 2014. Since then, the number of users has grown. This larger cohort facilitates a more rigorous analysis of the hearing outcomes that have been achieved by the Malawi cochlear implant (CI) program. METHODS: Nineteen children with postlingual severe-to-profound deafness underwent unilateral cochlear implantation between 2014 and 2022. Pure-tone audiometric (PTA) thresholds were obtained for both ears preoperatively, and aided thresholds were determined for the implanted ear postoperatively. To assess hearing outcomes, a battery of open- and closed-set speech environmental sound perception tests were administered postoperatively. Observations related to the educational status of each participant were also documented. RESULTS: Cochlear implantation reduced the mean PTA4 threshold from 110.8 (range 96.3-120 dB hearing loss [HL]) to 37.8 dB HL (31.3-42.5 dB HL) in the implanted ear, improvements which were clinically meaningful and statistically significant (Wilcoxon signed-rank test: z = -3.184
P = .001). Satisfactory environmental and speech sound perception were observed for all tested CI users postimplantation. CONCLUSION: These results demonstrate that the CI program of Malawi can effectively treat severe-to-profound HL in postlingual children. However, several challenges remain for the expansion of this program.