Malawi 2015-16

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Trends: Participation in HIV testing is slightly higher in the 2015-16 MDHS than it was in the 2010 MDHS. The HIV testing response rate increased from 87% to 90%, from 91% to 93% among women, and from 84% to 87% among men. Patterns by background characteristics • The HIV testing response rate is higher among men in rural areas compared with urban areas (88% versus 83%). For women, the response rate is slightly higher in the rural areas than in urban areas (94% against 93%) (Table 14.1). • By region, the HIV response rate is highest for women and men in the Central region (93%) and lowest in the Northern region (86%). • A lower proportion of men with no education consented to HIV testing (77%) compared with men with primary (87%), secondary (88%), or higher education (83%). Similar patterns in participation according to education level were observed among women (Table 14.2). 14.2 HIV PREVALENCE 14.2.1 HIV Prevalence by Age and Sex HIV prevalence Percentage of women and men who tested HIV positive among those tested for HIV as part of the DHS survey. Sample: Women age 15-49 and men age 15-54 tested for HIV as part of the survey Table 14.3 shows that 8.8% of women and men age 15-49 in Malawi are HIV positive. The HIV prevalence is higher among women than men (10.8% versus 6.4%). Among women, HIV prevalence increases with age from 3.3% among women age 15-19 to 19.8% among women in the 40-44 age group, before decreasing slightly among those age 45-49 (16.9%). Among men age 15-19 and 20-24, HIV prevalence is 1% and then increases to 6.4% in men age 25-29, with the highest prevalence in men age 50-54 at 20.5% (Figure 14.1). 25 20 15 Figure 14.1 HIV prevalence by age Percentage of women and men who are HIV positive Women Men 10 Trends: To assess trends in HIV prevalence over time, it is important to note that the HIV testing 5 algorithm for the 2015-16 MDHS differs from the algorithm used in the 2004 and 2010 MDHS surveys. 0 The 2004 and 2010 MDHS surveys used an 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 algorithm in which specimens with positive results on two ELISAs were classified as positive (NSO and ORC Macro 2005; NSO and ICF Macro 2011). The new algorithm in the 2015-16 survey reflects the change in the international recommendations for HIV testing. This change responded to concerns that the old HIV testing algorithms produced too many false positives and overestimated HIV prevalence because of the reliance on only two enzyme immunoassays (ELISAs) to classify specimens as HIV positive (CDC 2014; UNAIDS/WHO 2015). The 2015-16 MDHS, in accordance with the new guidelines, tested specimens that were positive on two ELISA with a highly specific confirmatory assay, the InnoLia HIV I/II Score line immunoassay. The specimen was labeled as positive only if the InnoLia result was also positive. More details on the HIV testing algorithm are found in the introductory chapter. 230 • HIV Prevalence
The HIV prevalence among women and men age 15-49 age has decreased between 2010 and 2015-16 from 10.6%, CI ([9.6%-11.6%]), to 8.8%, CI ([8.0%-9.5%]). The prevalence was 11.8% in 2004.To assess the trend in HIV prevalence in Malawi with more comparable HIV prevalence estimates across the three surveys, a second HIV prevalence estimate was calculated for the 2015-16 survey with an algorithm similar to those used in the 2004 and 2010 DHS surveys (i.e., the result of the InnoLia assay was ignored, and all specimens with positive results on two ELISAs were classified as positive). The HIV prevalence estimate for the 2015-16 MDHS data with this older testing algorithm was 10.4%, CI ([9.6%-11.1%]), among women and men age 15-49. The estimate with the old HIV testing algorithm for the 2015-16 MDHS is significantly higher than the estimate of 8.8%, CI ([8.0%-9.5%]), based on the new HIV testing algorithm. The results in Figure 14.2, which show the HIV prevalence estimates for all three MDHS surveys with the old HIV testing algorithm, indicate that HIV prevalence among women and men age 15-49 decreased slightly between 2004 and 2015-16. However, the confidence intervals for the HIV prevalence presented in the Figure 14.2 overlap, which indicates that there is no evidence of a statistically significant change in HIV prevalence from 2004 to 2010 and 2015-16. Figure 14.2 Trends in HIV prevalence 16 14 12 10 8 6 4 2 0 11.8 10.6 10.4 13.3 12.9 12.2 10.2 8.1 8.3 2004 2010 2015-16 2004 2010 2015-16 2004 2010 2015-16 Total age 15-49 Percentage of women and men age 15-49 who are HIV positive, with confidence intervals Women age 15-49 Men age 15-49 HIV prevalence estimates presented in this chapter use the new HIV testing algorithm that includes the confirmatory assay on dual-ELISA positive specimens. Patterns by demographic characteristics • Among both women and men, HIV prevalence is twice as high in urban areas as compared to rural areas (14.6% versus 7.4%) (Table 14.4). In urban areas, HIV prevalence is 17.8% among women and 11.0% among men while the prevalence is 9.2% and 5.4%, respectively, in rural areas (Figure 14.3). Figure 14.3 HIV prevalence by residence and sex Percentage of women and men age 15-49 who are HIV positive 10.8 17.8 Total Urban Rural 9.2 6.4 11.0 5.4 Women Men HIV Prevalence • 231
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Malawi Demographic and Health Surve
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The 2015-16 Malawi Demographic and
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4.3 Age at First Marriage .........
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13.9.1 Knowledge ..................
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TABLES AND FIGURES 1 INTRODUCTION A
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6 FERTILITY PREFERENCES ...........
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11 NUTRITION OF CHILDREN AND WOMEN
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Figure 14.1 HIV prevalence by age .
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Table A-3.8.1 Type of earnings: Wom
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Table A-16.9.1 Women’s participat
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FOREWORD T he 2016-16 Malawi Demogr
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LA LAM LLIN LPG MAD MDHS MICS PPHC
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Table 3.4.1 Exposure to mass media:
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Example 2: Prevalence and Treatment
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Example 3: Understanding Sampling W
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xxxii • Map of Malawi
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The information collected in the 20
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ecorded on the Biomarker Questionna
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1.5 PRETEST The pretest for the 201
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HOUSING CHARACTERISTICS AND 2 HOUSE
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About half of Malawian households (
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A total of 117,177 individuals stay
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Patterns by background characterist
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school. The attendance rate decline
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Table 2.3 Household sanitation faci
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Table 2.5 Wealth quintiles Percent
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Table 2.9 Household composition Per
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Table 2.11 Children’s living arra
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Table 2.12.2 Educational attainment
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Table 2.14.1 Child functioning and
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CHARACTERISTICS OF RESPONDENTS 3 Ke
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• Women and men living in urban a
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Women and men are most commonly emp
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Table 3.1 Background characteristic
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Table 3.3.1 Literacy: Women Percent
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Table 3.5.1 Internet usage: Women P
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Table 3.6.1 Employment status: Wome
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Table 3.7.1 Occupation: Women Perce
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Table 3.8 Type of employment: Women
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Table 3.10.1 Tobacco smoking: Women
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Table 3.11 Average number of cigare
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Table 3.13.2 Knowledge and attitude
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Figure 4.1 Marital status Percent d
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marriage. The median age at first i
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Table 4.1 Current marital status Pe
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Table 4.3 Age at first marriage Per
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Table 4.5 Age at first sexual inter
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Table 4.7.1 Recent sexual activity:
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FERTILITY 5 Key Findings Total
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5.3 BIRTH INTERVALS Median birth in
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5.5 AGE AT FIRST BIRTH Median age a
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LIST OF TABLES For more information
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Table 5.3.1 Trends in age-specific
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Table 5.6 Postpartum amenorrhea, ab
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Table 5.10 Median age at first birt
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Trends: The percentage of currently
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Trends: Since 1992, the proportion
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Table 6.1 Fertility preferences by
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Table 6.3 Ideal number of children
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Table 6.5 Fertility planning status
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Overall, the contraceptive prevalen
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Nearly 8 in 10 (79%) of all modern
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Seventy-eight percent of currently
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the survey (Table 7.16). Ten percen
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Table 7.3 Current use of contracept
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Table 7.7 Informed choice Among cur
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Table 7.12.1 Need and demand for fa
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Table 7.13 Decision-making about fa
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Table 7.16 Contact of nonusers with
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• Any method of measuring childho
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Table 8.3 Early childhood mortality
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Table 8.5 High-risk fertility behav
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9.1 ANTENATAL CARE COVERAGE AND CON
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Trends: Since 1992, the rates of C-
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9.7 PROBLEMS IN ACCESSING HEALTH CA
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Table 9.3 Components of antenatal c
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Table 9.5 Place of delivery Percent
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Table 9.7 Caesarean section Percent
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Table 9.10 Type of provider of firs
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Table 9.12 Type of provider of firs
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Table 9.14 Pregnancy outcomes Perce
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Table 9.16 Problems in accessing he
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childhood death. In the 2015-16 MDH
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• Vaccination coverage generally
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of giving the same or more food to
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Table 10.1 Child’s size and weigh
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Table 10.3 Vaccinations by backgrou
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Table 10.5 Prevalence and treatment
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Table 10.7 Prevalence and treatment
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Table 10.9 Oral rehydration therapy
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Table 10.11 Disposal of children’
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which the baby’s weight to be dis
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11.2 INFANT AND YOUNG CHILD FEEDING
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have shown that plant-based complem
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11.3 ANAEMIA PREVALENCE IN CHILDREN
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Information on BMI is presented in
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Table 11.1 Nutritional status of ch
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Table 11.3 Breastfeeding status acc
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Table 11.5 Foods and liquids consum
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Table 11.7 Prevalence of anaemia in
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Table 11.9 Micronutrient intake amo
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Page 235 and 236: HIV/AIDS-RELATED KNOWLEDGE, 13 ATTI
Page 237 and 238: avoid getting HIV; 64% of women and
Page 239 and 240: Only 1% of all women reported havin
Page 241 and 242: Patterns by background characterist
Page 243 and 244: Forty-two percent of women and 41%
Page 245 and 246: 13.9.3 Premarital Sex The 2015-16 M
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Page 249 and 250: Table 13.4 Discriminatory attitudes
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Page 253 and 254: Table 13.7.1 Coverage of prior HIV
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Page 259 and 260: Table 13.13 Premarital sexual inter
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Page 263: HIV PREVALENCE 14 Key Findings HIV
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Page 271 and 272: Table 14.3 HIV prevalence according
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Page 275 and 276: Table 14.7 HIV prevalence among you
Page 277 and 278: Table 14.11 HIV prevalence by male
Page 279 and 280: ADULT AND MATERNAL MORTALITY 15 Key
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Page 293 and 294: from 78% to 74%. The percentage of
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harassment.” Most recently, the M
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• The experience of physical viol
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• Women’s experience of at leas
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women to have ever experienced spou
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• Women in urban areas are about
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Table 17.1 Experience of physical v
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Table 17.3 Persons committing physi
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Table 17.5 Age at first experience
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Table 17.9 Forms of spousal violenc
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Table 17.11 Spousal violence accord
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Table 17.13 Experience of spousal v
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Table 17.16 Violence by women again
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Table 17.18 Sources for help to sto
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World Health Organization (WHO) and
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Table A-2.3 Household sanitation fa
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Table A-2.7 Hand washing: Districts
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Table A-2.11 Children’s living ar
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Table A-2.12.2 Educational attainme
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Table A-3.2.1 Educational attainmen
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Table A-3.3.1 Literacy: Women by di
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Table A-3.4.1 Exposure to mass medi
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Table A-3.5.1 Internet usage: Women
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Table A-3.6.1 Employment status: Wo
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Table A-3.7.1 Occupation: Women by
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Table A-3.8.1 Type of earnings: Wom
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Table A-3.8.3 Continuity of employm
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Table A-3.13.1 Knowledge and attitu
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CHAPTER 4 MARRIAGE AND SEXUAL ACTIV
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Table A-4.4 Median age at first mar
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Table A-4.7.1 Recent sexual activit
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CHAPTER 5 FERTILITY Table A-5.2 Fer
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Table A-5.10 Median age at first bi
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CHAPTER 6 FERTILITY PREFERENCES Tab
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CHAPTER 7 FAMILY PLANNING Table A-7
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Table A-7.13 Decision-making about
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Table A-7.16 Contact of nonusers wi
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CHAPTER 9 MATERNAL HEALTH CARE Tabl
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Table A-9.4 Tetanus toxoid injectio
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Table A-9.6 Assistance during deliv
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Table A-9.9 Timing of first postnat
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Table A-9.11 Timing of first postna
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Table A-9.13 Content of postnatal c
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Table A-9.15 Prevalence of obstetri
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CHAPTER 10 CHILD HEALTH Table A-10.
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Table A-10.4 Possession and observa
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Table A-10.6 Prevalence and treatme
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Table A-10.8 Feeding practices duri
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Table A-10.10 Knowledge of ORS pack
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CHAPTER 11 NUTRITION OF CHILDREN AN
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Table A-11.2 Initial breastfeeding:
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Table A-11.7 Prevalence of anaemia
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Table A-11.9 Micronutrient intake a
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Table A-11.11 Nutritional status of
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Table A-11.13 Micronutrient intake
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Table A-12.2 Source of mosquito net
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Table A-12.6 Use of mosquito nets b
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Table A-12.8 Use of mosquito nets b
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Table A-12.10 Use of Intermittent P
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Table A-12.14 Haemoglobin
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Table A-13.4 Discriminatory attitud
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Table A-13.5.2 Multiple sexual part
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Table A-13.7.1 Coverage of prior HI
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Table A-13.8 Pregnant women counsel
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Table A-13.10 Self-reported prevale
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Table A-13.12 Age at first sexual i
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Table A-13.14.1 Multiple sexual par
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CHAPTER 14 HIV PREVALENCE Table A-1
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Table A-14.3 HIV prevalence: Distri
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CHAPTER 16 WOMEN’S EMPOWERMENT Ta
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Table A-16.4.1 Ownership of assets:
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Table A-16.5.1 Ownership of title o
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Table A-16.6.1 Ownership of title o
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Table A-16.7.1 Ownership and use of
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Table A-16.9.1 Women’s participat
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Table A-16.10.1 Attitude toward wif
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Table A-16.11 Attitudes toward nego
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CHAPTER 17 DOMESTIC VIOLENCE Table
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Table A-17.4 Experience of sexual v
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Table A-17.10 Spousal violence: Dis
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Table A-17.15 Violence by women aga
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SAMPLE DESIGN Appendix B B.1 INTROD
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two-stage stratified cluster sample
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Table B.1 Distribution of residenti
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Table B.4 Sample allocation of comp
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Table B.6 Sample implementation: Me
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Table B.8 Coverage of HIV testing b
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Table B.10 Coverage of HIV testing
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where h represents the stratum whic
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Table C.2 Sampling errors: Total sa
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Table C.4 Sampling errors: Rural sa
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Table C.6 Sampling errors: Central
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Table C.8 Sampling errors: Chitipa
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Table C.10 Sampling errors: Nkhatab
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Table C.12 Sampling errors: Mzimba
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Table C.14 Sampling errors: Kasungu
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Table C.16 Sampling errors: Ntchisi
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Table C.18 Sampling errors: Salima
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Table C.20 Sampling errors: Mchinji
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Table C.22 Sampling errors: Ntcheu
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Table C.24 Sampling errors: Maching
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Table C.26 Sampling errors: Chiradz
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Table C.28 Sampling errors: Mwanza
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Table C.30 Sampling errors: Mulanje
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Table C.32 Sampling errors: Chikwaw
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Table C.34 Sampling errors: Balaka
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Table C.36 Sampling errors for adul
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Table D.2.1 Age distribution of eli
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Table D.5 Reporting of age at death
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Table D.7 Nutritional status of chi
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SURVEY PERSONNEL Appendix E 2015-16
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Team Leaders Benson Mvula Grossveno
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Ireen Yohane Chisomo Mkwapatira Des
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2015-2016 MALAWI DEMOGRAPHIC AND HE
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INTRODUCTION AND CONSENT Hello. My
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HOUSEHOLD SCHEDULE IF AGE 0-17 YEAR
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HOUSEHOLD SCHEDULE IF AGE 0-17 YEAR
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HOUSEHOLD CHARACTERISTICS NO. QUEST
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HOUSEHOLD CHARACTERISTICS NO. QUEST
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MOSQUITO NETS NET #1 NET #2 NET #3
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ADDITIONAL HOUSEHOLD CHARACTERISTIC
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200 CHILD FUNCTIONING AND DISABILIT
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300 CHILD FUNCTIONING AND DISABILIT
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CHILD FUNCTIONING AND DISABILITY (A
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ELIGIBILITY AND CONSENT FOR THE MIC
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INTERVIEWER'S OBSERVATIONS TO BE FI
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WEIGHT, HEIGHT AND HEMOGLOBIN MEASU
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WEIGHT, HEIGHT AND HEMOGLOBIN MEASU
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WEIGHT, HEIGHT, HEMOGLOBIN MEASUREM
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HIV TESTING FOR MEN AGE 15-54 301 C
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SECTION 1. RESPONDENT'S BACKGROUND
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SECTION 2. REPRODUCTION NO. QUESTIO
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212 213 214 215 216 217 218 219 220
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SECTION 3. CONTRACEPTION 301 Now I
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SECTION 3. CONTRACEPTION NO. QUESTI
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SECTION 4. PREGNANCY AND POSTNATAL
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SECTION 5A. CHILD IMMUNIZATION (LAS
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SECTION 5A. CHILD IMMUNIZATION (LAS
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SECTION 5B. CHILD IMMUNIZATION (NEX
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SECTION 5B. CHILD IMMUNIZATION (NEX
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SECTION 6. CHILD HEALTH AND NUTRITI
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SECTION 7. MARRIAGE AND SEXUAL ACTI
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SECTION 8. FERTILITY PREFERENCES NO
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SECTION 9. HUSBAND'S BACKGROUND AND
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NO. QUESTIONS AND FILTERS SECTION 1
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SECTION 10. HIV/AIDS NO. QUESTIONS
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SECTION 10. HIV/AIDS NO. QUESTIONS
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SECTION 11. OTHER HEALTH ISSUES NO.
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SECTION MM. MATERNAL MORTALITY MODU
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SECTION 13. DOMESTIC VIOLENCE MODUL
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INSTRUCTIONS: COL. 1 COL. 2 ONLY ON
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SECTION 1. RESPONDENT'S BACKGROUND
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SECTION 3. CONTRACEPTION 301 Now I
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SECTION 6. EMPLOYMENT AND GENDER RO
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SECTION 7. HIV/AIDS NO. QUESTIONS A
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SECTION 7. HIV/AIDS NO. QUESTIONS A
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INTERVIEWER'S OBSERVATIONS TO BE FI
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MALAWI GOVERNEMNT NATIONAL STATISTI
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Malawi 2015-16

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