Overestimating HIV infection:

In the absence of HIV testing, how do rural Malawians assess their HIV status? In this paper, we use a unique dataset that includes respondents’ HIV status as well as their subjective likelihood of HIV infection. These data show that many rural Malawians overestimate their likelihood of current HIV infection. The discrepancy between actual and perceived status raises an important question: Why are so many wrong? We begin by identifying determinants of self-assessed HIV status, and then compare these assessments with HIV biomarker results. Finally, we ask what characteristics of individuals are associated with errors in self-assessments.accuracy of perceived HIV status, AIDS/HIV, perceived risk, Sub-Saharan Africa

The Malawi Diffusion and Ideational Change Project 2004-06

In this paper, we evaluate the quality of survey data collected by the Malawi Diffusion and Ideational Change Project by investigating four potential sources of bias: sample representativeness, interviewer effects, response unreliability and sample attrition. We discuss the results of our analysis and implications of our findings for the collection of data in similar contexts.AIDS/HIV, data quality, interviewer effects, representativeness, response reliability, sample attrition, Sub-Saharan Africa

Marriage as a Mechanism: Women’s Education and Wealth in Malawi

Research has found that in the United States women have greater economic returns to a college degree than men, because of more stable marriages and other family income. Using cross-sectional data of women aged 19-40 years in Malawi from the Malawi Longitudinal Study of Families and Health (n = 898), we test whether higher education is associated with these same benefits in a context with lower educational attainment levels, fewer job opportunities, and different marriage patterns. We find that better educated women are more likely to have better educated spouses and higher household wealth. Though divorce is negatively associated with wealth, we do not find an association between education and divorce. This analysis provides motivation for further research on the how education is associated with outcomes for women in developing countries

HIV/AIDS and time allocation in rural Malawi

AIDS morbidity and mortality are expected to have a large impact on households’ labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women’s time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor).Africa, AIDS/HIV, economic impact, Malawi, time allocation

Cohort Profile: The Migration and Health in Malawi (MHM) Study

The Migration and Health in Malawi (MHM) Study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. To address these challenges, the MHM Study was designed to measure or control for important characteristics that affect both migration and health outcomes. This approach is particularly well-suited for distinguishing between the effect of migration on health and the selection of individuals of differing health status into migration classes (migrant versus non-migrant). Data are available for two waves of MHM, which took place in 2007 and 2013, and include extensive information on migration history, socioeconomic and demographic characteristics, sexual behaviors, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MHM public use data can be requested by contacting the Principal Investigator (Philip Anglewicz, [email protected])

Intergenerational Transfers in the Era of HIV/AIDS: Evidence from Rural Malawi

Intergenerational transfers and relations in sub-Saharan Africa are only poorly understood, despite the alleged importance of family networks and family resource transfers to ameliorate the implications of the HIV/AIDS epidemic and the effect of the epidemic on the availability of kin and the structure of multi-generational families. Our analyses fill an important niche in the literature by using innovative longitudinal data from rural Malawi that includes extensive information on intergenerational transfer relations across three generations living in a context characterized by high poverty, a generalized HIV/AIDS epidemic and high levels of morbidity and mortality. We estimate the age patterns of transfers and the multiple directions of transfer flows—from prime-aged respondents to their elderly parents as well as their co-residing and non-coresiding adult children age 15+. Our major findings include that: (1) Financial net transfers are strongly age-patterned and the middle generations are net providers of transfers to their adult children and elderly parents; (2) Non-financial transfers are based on mutual assistance rather than reallocation of resources to worse-off family members; and (3), Provision and receipt of transfers are generally not related to the health status of our adult respondents, including HIV+ status and perception of HIV infection despite widespread perceptions that HIV+ status is primary determinant of such transfers

Cohort Profile: The Migration and Health in Malawi (MHM) Study

The Migration and Health in Malawi (MHM) Study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. To address these challenges, the MHM Study was designed to measure or control for important characteristics that affect both migration and health outcomes. This approach is particularly well-suited for distinguishing between the effect of migration on health and the selection of individuals of differing health status into migration classes (migrant versus non-migrant). Data are available for two waves of MHM, which took place in 2007 and 2013, and include extensive information on migration history, socioeconomic and demographic characteristics, sexual behaviors, marriage, household/family structure, risk perceptions, social networks and social capital, intergenerational relations, HIV/AIDS and other dimensions of health. The MHM public use data can be requested by contacting the Principal Investigator (Philip Anglewicz, [email protected])

Evaluating Health and Disease in Sub-Saharan Africa: Minimally Invasive Collection of Plasma in the Malawi Longitudinal Study of Families and Health (MLSFH)

Background: The collection of biomarker-based indicators of adult health and fitness is an important addition to socioeconomic surveys since these indicators provide valuable insights into the biological functions, and the complex causal pathways between socioeconomic environments and health of adult individuals. Other than select Demographic and Health Surveys (DHS), there are almost no population-based sources of biomarker-based indicators of adult health in sub-Saharan Africa (SSA), where most population-based biologic data are focused on HIV, other STDs, malaria, or nutritional status. While infectious diseases---such as HIV and malaria---attract the majority of research and NGOs attention in sub-Saharan Africa, there is an important need to understand the general determinants of adult health in SSA since the region will rapidly age in the next decades in ways that are significantly different from the aging patterns in other developing regions due to the AIDS epidemic, and chronic diseases will increasingly become relevant for understanding the health of sub-Saharan populations. Methods and Design: We document our protocol for the collection of biomarker-based health indicators as a pilot project within the Malawi Longitudinal Study of Families and Health (MLSFH), and we provide basic descriptive information about the study population and the collected biomarker-based indicators of adult health obtained from respondents in rural Malawi. LabAnywhere kits were used to obtain blood plasma from 980 adult men and women living in Balaka, the southern-most region in rural Malawi. The procedure allows for the non-invasive collection of blood plasma, but has not been been previously used in the context of a developing country. We collected biomarkers for inflammation and immunity, lipids, organ function, and metabolic processes. We specifically collected wide-range CRP, total cholesterol, LDL, HDL, total protein, urea, albumin, blood urea nitrogen, creatinine, random blood glucose and HbA1c assays. Overall, the mean values of the biomarkers are below the lower limits of clinical guidelines for adult populations in the U.S. and other developed countries, and only small proportions of the sample are above the upper limits of the normal clinical ranges as defined by U.S. standards. The correlationional patterns of the collected biomarkers are consistent with observations from developed countries, and the comparison with other low-income populations such as the Tsimane in Bolivia or the Yakuts in Siberia show remarkably similar age-specific patterns of the biomarkers despite differences in the mode of blood sampling. Discussion: The MLSFH biomarker sample makes a potentially important contribution to understanding the health of the adult populations in low income environments. The present study confirms that the collection of such biomarkers using the LabAnywhere system is feasible in rural sub-Saharan contexts: the refusal rate was very low in the MLSFH and following the procedures described above, only a small fraction of the biomarker samples could not be analyzed by LabAnywhere. The system therefore provides an attractive alternative to the collection of dried blood spots (DBS) and venous blood samples, providing a broader range of potential biomarkers than DBS and being logistically easier than the collection of venous blood

Implementation of respondent driven sampling in Nairobi, Kenya, for tracking key family planning indicators among adolescents and youth: lessons learnt

Objective: Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15–24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. Results: A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth