Socio-economic Inequality in Comprehensive Knowledge about HIV in Malawi

BackgroundHaving comprehensive knowledge about HIV is crucial in the fight against HIV and AIDS, and in achieving the global aspiration of ending AIDS as a public health threat by 2030. Low comprehensive knowledge about HIV can undercut efforts to halt the spread of the epidemic. It is important, however, to also determine if socioeconomic inequality is a factor in having a comprehensive knowledge about HIV in order to ensure that socioeconomic considerations are embedded in interventions. In this paper, the objective is to assess trends, as well as socioeconomic related inequality in comprehensive knowledge about HIV in Malawi. MethodsThe current study uses a non-parametric approach and the concentration index. It draws upon secondary data from three rounds of the Malawi Demographic and Health Survey (MDHS) of 2004, 2010 and 2016.ResultsOur results point to an increase in comprehensive knowledge about HIV over the 12-year period, from 28% in 2004 to around 44% in 2016. However, upon using the Erreygers concentration index, a wealth related inequality in comprehensive knowledge about HIV is uncovered. The poorer are less informed and the richer are better informed: comprehensive knowledge about HIV is concentrated among the rich. Furthermore, inequality in comprehensive knowledge about HIV has worsened over this period. Across gender, there is greater inequality among men than women. However, the rural-urban difference in wealth-related inequality in comprehensive knowledge about HIV dropped in 2016. Conclusion The results show that comprehensive knowledge about HIV has increased. Furthermore, it is established that comprehensive knowledge about HIV is concentrated among the wealthier in the 2004 -2016 period. Our results suggest that there should be a targeted approach in messaging and disseminating information regarding HIV and AIDS, using methods that are pro-poor

Competition, regulation and banking industry pricing conduct in Malawi

This study investigates the nature of competitiveness among banks in Malawi where the industry is concentrated and the institutional base is weak. The study uses a model incorporating bank-specific, industry-specific and macroeconomic determinants of conduct and performance, based on monthly data from January 2005 to March 2014. Key findings are asymmetric conduct with collusive price leadership in lending rates and competitiveness in deposit rates and overall high spreads. Apart from dominance, collusive price leadership was facilitated by regulatory stipulations in pricing in banks’ core and non-core business and an economic environment resulting in banks’ high profitability and diminished competitive pressure in lending rates. Further, monopolistic competition via outreach also put upward pressure on spreads most likely via costs as the literature suggests.Keywords: Collusive Pricing; Banks’ Risk Position; Banking Industry; Conduct and Performance; Malaw

Factors Determining the Use of Voluntary Counselling And Testing For HIV and AIDs Among Men And Women In Malawi

Voluntary Counseling and Testing (VCT) is one of the measures used in the fight of HIV and AIDS in Malawi. WHO/UNAIDS/UNICEF (2011) estimated that about 440,000 to 510,000 people living with HIV and AIDS in Malawi were not getting treatment. This could be the case because they did not know their HIV status.  Knowing the factors that lead people to seek Voluntary Counseling and Testing services in Malawi could demystify this.  This study therefore investigated the determinants of Voluntary Counseling and Testing for HIV and AIDS among men and women in Malawi. The principal research focus was on the socio-economic and socio-demographic factors that determine one’s need to demand VCT services. A logistic regression model was used due to the categorical nature of the dependent variable i.e. whether one was tested or not.  Among women, the variables age, residence, education, marital status, employment, mode of employment and lifetime number of sexual partners were found to be significant factors influencing the uptake of VCT. With the lower class as the reference variable, the ‘rich group’ was found to significantly influence the uptake of VCT but not the middle class. On the men’s side, the variables age, education, region of residence, lifetime number of sexual partners, marital status, wealth status and employment were found to have a significant influence on VCT uptake. The results also show that a man’s place of residence and mode of employment do not affect VCT uptake. In summary, the findings show that for both men and women the variables; age, education and lifetime number of sexual partners were significant. The variables; residence and mode of employment were significant only for women while the variable region of residence was only significant for men. The variable wealth status had the rich group being significant among both men and women while middle group was insignificant among both men and women. The variables marital status and employment were significant at all levels for women while for men they had at least one variable not significant. The variable religion was insignificant for both women and men except one variable – other religion affiliation, which was significant among men. Keywords: Socio-economic and socio-demographic factors, Voluntary Counselling and Testing, Logistic Regression Mode

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

BackgroundTeenage pregnancies and childbearing are important health concerns in low-and middleincome countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.MethodsThe study used the 2004, 2010 and 2015–16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.Results The teenage pregnancy and childbearing rate averaged 29% (

Gender differences in willingness to pay for capital-intensive agricultural technologies : the case of fish solar tent dryers in Malawi

To reduce fish postharvest losses, a fish solar tent dryer (image included) is being promoted along Lake Malawi. This paper analyses gender disparities in fish processors’ conditional willingness to pay (WTP), along with their willingness to pay towards a common or co-owned asset. Women have more endowments associated with a high probability of WTP, such as knowledge of the solar tent dryer, while men have more assets (such as education, selling to distant markets and fishing assets) and are therefore willing and able to pay a higher cost in dollars. Women lack access to income, education, capital, and access to markets

Levels of knowledge regarding malaria causes, symptoms, and prevention measures among Malawian women of reproductive age

Background: Malawi is a malaria-endemic country and approximately 6 million cases are reported annually. Improving knowledge of malaria causes and symptoms, and the overall perception towards malaria and its preventive measures is vital for malaria control. The current study investigated the levels of knowledge of the causes, symptoms and prevention of malaria among Malawian women. Methods: Data from the 2017 wave of the Malawi Malaria Indicator Survey (MMIS) were analysed. In total, 3422 women of reproductive age (15–49 years) were sampled and analysed. The levels of women’s knowledge about: (1) causes of malaria; (2) symptoms of malaria; and, (3) preventive measures were assessed. The tertiles of the composite score were used as the cut-offs to categorize the levels of knowledge as ‘low’, ‘medium’ and ‘high’. Multinomial logistic regression models were constructed to assess the independent factors while taking into account the complex survey design. Results: Approximately 50% of all respondents had high levels of knowledge of causes, symptoms and preventive measures. The high level of knowledge was 45% for rural women and 55% for urban dwellers. After adjusting for the a wide range of factors, women of age group 15–19 years adjusted odds ratio ((aOR): 2.58; 95% Confidence Interval (CI) 1.69–3.92), women with no formal education (aOR: 3.73; 95% CI 2.20–6.33), women whose household had no television (aOR: 1.50; 95% CI 1.02–2.22), women who had not seen/heard malaria message (aOR: 1.53; 95% CI 1.20–1.95), women of Yao tribe (aOR: 1.95; 95% CI 1.10–3.46), and women from rural areas had low levels of knowledge about the causes of malaria, symptoms of malaria and preventive measures. Additionally, the results also showed that women aged 15–19 years (beta [β] = − 0.73, standard error [SE] = 0.12); P < .0001, women with no formal education (β = − 1.17, SE = 0.15); P < .0001, women whose household had no radio (β = − 0.15, SE = 0.0816); P = 0.0715 and women who had not seen or heard malaria message (β = − 0.41, SE = 0.07); P < .0001 were likely to have a lower knowledge score. Conclusions: The levels of malaria knowledge were reported to be unsatisfactory among adult women, underscoring the need to scale up efforts on malaria education. Beside insecticide-treated bed nets (ITNs) and prompt diagnosis, malaria can be best managed in Malawi by increasing knowledge of malaria causes, and symptoms especially for younger women, women with no formal education, women whose households have no media, women from Yao tribes, and rural dwellers

Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey

Background: Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa. Methods: The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design. Results: Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN. Conclusions: Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women

Baseline characteristics of study sites and women enrolled in a three-arm cluster randomized controlled trial: PMTCT uptake and retention (pure) Malawi

Abstract Background Malawi introduced an ambitious public health program known as “Option B+” which provides all HIV-infected pregnant and breastfeeding women with lifelong combination antiretroviral therapy, regardless of WHO clinical stage or CD4 cell count. The PMTCT Uptake and REtention (PURE) study aimed at evaluating the effect of peer-support on care-seeking and retention in care. Methods/design PURE Malawi was a three-arm cluster randomized controlled trial that compared facility-based and community-based models of peer support to standard of care under Option B+ strategy. Each arm was expected to enroll a minimum of 360 women with a total minimum sample size of 1080 participants. 21 sites (clusters) were selected for inclusion in the study. This paper describes the site selection, recruitment, enrollment process and baseline characteristics of study sites and women enrolled in the trial. Results Study implementation was managed by 3 partner organizations; each responsible for 7 study sites. The trial was conducted in the South East, South West, and Central West zones of Malawi, the zones where the implementing partners operate. Study sites included 2 district hospitals, 2 mission hospitals, 2 rural hospitals, 13 health centers and 1 private clinic. Enrollment occurred from November 2013 to November 2014, over a median period of 31 weeks (range 17–51) by site. A total of 1269 HIV-infected pregnant (1094) and breastfeeding (175) women, who were eligible to initiate ART under Option B+, were enrolled. Each site reached or surpassed the minimum sample size. Comparing the number of women enrolled versus antenatal cohort reports, sites recruited a median of 90% (IQR 75–100) of eligible reported women. In the majority of sites the ratio of pregnant and lactating women enrolled in the study was similar to the ratio of reported pregnant and lactating women starting ART in the same sites. The median age of all women was 27 (IQR 22–31) years. All women have ≥20 months of possible follow-up time; 96% ≥ 2 years (24–32 months). Conclusion The PURE Malawi study showed that 3 implementing partner organizations could successfully recruit a complex cohort of pregnant and lactating women across 3 geographical zones in Malawi within a reasonable timeline. Trial registration This study is registered at clinicaltrials.gov - ID Number NCT02005835 . Registered 4 December, 2013

The value of informal care in the context of option B+ in Malawi: a contingent valuation approach

Abstract Background Informal care, the health care provided by the patient’s social network is important in low income settings although its monetary value is rarely estimated. The lack of estimates of the value of informal care has led to its omission in economic evaluations but this can result in incorrect decisions about cost effectiveness of an intervention. We explore the use of contingent valuation methods of willingness to pay (WTP) and willingness to accept (WTA) to estimate the value of informal care provided to HIV infected women that are accessing antiretroviral therapy (ART) under the Option B+ approach to prevention of mother-to-child transmission (PMTCT) of HIV in Malawi. Methods We collected cross sectional data from 93 caregivers of women that received ART care from six health facilities in Malawi. Caregivers of women that reported for ART care on the survey day and consented to participate in the survey were included until the targeted sample size for the facility was reached. We estimated the value of informal care by using the willingness to accept (WTA) and willingness to pay (WTP) approaches. Medians were used to summarize the values and these were compared by the Wilcoxon signed-rank test. Results The median WTA to provide informal care in a month was US$30 and the median WTP for informal care was US$13 and the two were statistically different (p < 0.000). Median WTP was higher in the urban areas than in the rural areas (US$21 vs. US$13, p < 0.001) and for caregivers from households from higher wealth quintile than in the lower quintile (US$15 vs. US$13, p < 0.0462). Conclusion Informal caregivers place substantial value on informal care giving. In low income settings where most caregivers are not formally employed, WTP and WTA approaches can be used to value informal care. Clinical trial number NCT02005835

Essays on health insurance for universal health coverage in low-and middle-income countries

This thesis contributes to the understanding of health insurance in low-and middle-income countries (LMIC) via four distinct essays. The focus is on the impact of health insurance on mental health and nutrition outcomes of social health insurance/national health insurance (SHI/NHI), equity and gender differences in community based health insurance (CBHI) payments and the willingness to pay for CBHI. Chapter 1 uses cross-section data from Ghana to explore whether health insurance affects psychological distress. Instrumental variables and propensity score matching methods are used in the analysis. The results suggest that health insurance improves psychological health. Chapter 2 uses longitudinal data from Indonesia to study the effect of health insurance for the poor on body mass index (BMI) and haemoglobin levels. A fixed-effects estimator with and without matching is employed. In general, the results show that health insurance has some negative effects on BMI but not on haemoglobin levels. Moving away from SHI/NHI, Chapters 3 and 4 focus on CBHI in Rwanda and Malawi, respectively. Chapter 3 analyses socioeconomic inequality in CBHI payments in Rwanda using repeated cross-section data. This chapter uses concentration indices, Kakwani indices, and unconditional quantile decomposition methods. The findings suggest that a flat-rate system of health insurance premium payment is more inequitable than the tiered system in which people pay based on community-defined socioeconomic status. Furthermore, female-headed households pay lower health insurance premiums. Chapter 4 uses primary data to examine the factors that affect willingness to pay for CBHI in rural Malawi. The chapter uses quantitative and qualitative data analysis methods. The results show that most people are willing to join and pay for CBHI using fiat money as opposed to commodity money. Furthermore, those who are enrolled in social cash transfer programmes are willing to spend less