Malawi 2015-16

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The information collected in the 2015-16 MDHS will assist policy makers and programme managers in evaluating and designing programmes and strategies that can improve the health of the country’s population. 1.2 SAMPLE DESIGN The sampling frame used for the 2015-16 MDHS is the frame of the Malawi Population and Housing Census (MPHC), conducted in Malawi in 2008, and provided by the Malawi National Statistical Office (NSO). The census frame is a complete list of all census standard enumeration areas (SEAs) created for the 2008 MPHC. A SEA is a geographic area that covers an average of 235 households. The sampling frame contains information about the SEA location, type of residence (urban or rural), and the estimated number of residential households. Administratively, Malawi is divided into 28 districts. The sample for the 2015-16 MDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the 28 districts. Indicators will also be shown for the Northern, Central, and Southern regions of the country. The 2015-16 MDHS sample was stratified and selected in two stages. Each district was stratified into urban and rural areas; this yielded 56 sampling strata. Samples of SEAs were selected independently in each stratum in two stages. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units in different levels, and by using a probability proportional to size selection at the first stage of sampling. In the first stage, 850 SEAs, including 173 SEAs in urban areas and 677 in rural areas, were selected with probability proportional to the SEA size and with independent selection in each sampling stratum. The SEA size is the number of residential households in the SEA as defined in the 2008 MPHC. A household listing operation was implemented in all the selected SEAs during August-October 2016. The resulting lists of households served as a sampling frame for the selection of households in the second stage. Some of the selected SEAs were large. To minimise the task of household listing, each large SEA (more than 250 households) selected for the 2015-16 MDHS was segmented. One segment was selected for the survey with probability proportional to the segment size. A household listing was conducted only in the selected segment. Thus, in the 2015-16 MDHS, a cluster is either an SEA or a segment of an SEA. In the second stage of selection, a fixed number of 30 households per urban cluster and 33 per rural cluster were selected with an equal probability systematic selection from the newly created household listing. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In one-third of all sampled households, all men age 15-54, including both usual residents and other persons who stayed in the household the night before the interview, were eligible for individual interview. In the subsample of households selected for the male survey, anaemia testing was performed among eligible women who consented to being tested. With the parent’s or guardian’s consent, children age 6-59 months were also tested for anaemia. In the same subsample, blood samples were collected for laboratory testing of HIV from eligible women and men who consented. Height and weight information was also collected from eligible women and from children age 0-59 months. 1.3 QUESTIONNAIRES Four questionnaires were used in the 2015-16 MDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. These questionnaires, based on The DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Malawi. Input was solicited from stakeholders who represented government ministries and agencies, nongovernmental organisations, and international donors. After the 2 • Introduction and Survey Methodology
preparation of the definitive questionnaires in English, the questionnaires were then translated into Chichewa and Tumbuka languages. All four questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection, and to offer the option to choose either English, Chichewa or Tumbuka for each questionnaire. The Household Questionnaire listed all members of and visitors to the selected households. Basic demographic information was collected on the characteristics of each person listed such as age, sex, marital status, education, and relationship to the head of the household. Parents’ survival status was determined for children under age 18. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women and men who were eligible for individual interviews. The Household Questionnaire collected information on characteristics of the household’s dwelling unit such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various durable goods. The Household Questionnaire also collected information on the ownership and use of mosquito nets. An additional module developed by UNICEF to estimate the prevalence of disabilities among children age 5-17 was also included in the Household Questionnaire. The Woman’s Questionnaire collected information from all eligible women age 15-49 who were asked questions on: • Background characteristics: age, education, media exposure • Reproduction: children ever born, birth history, current pregnancy • Family planning: knowledge and use of contraception, sources of contraceptive methods, information on family planning • Maternal and child health, breastfeeding, and nutrition: prenatal care, delivery, postnatal care, breastfeeding and complementary feeding practices, vaccination coverage, prevalence and treatment of diarrhoea, acute respiratory infection (ARI), fever, knowledge and use of oral rehydration therapy (ORT), breastfeeding, and feeding practices • Marriage and sexual activity: marital status, age at first marriage, number of unions, age at first sexual intercourse, recent sexual activity, number and type of sexual partners, use of condoms • Fertility preferences: desire for more children, ideal number of children, gender preferences, intention to use family planning • Husband’s background and woman’s work: husband’s age, level of education, and occupation, and woman’s occupation and sources of earnings • STDs and HIV: knowledge of STDs and HIV, methods of transmission, sources of information, behaviours to avoid STDs and HIV, and stigma • Knowledge, attitudes, and behaviours related to other health issues such as injections, smoking, fistula, tuberculosis • Adult and maternal mortality • Domestic violence 1.4 ANTHROPOMETRY, ANAEMIA TESTING, AND HIV TESTING In the subsample of households selected for the male survey, the 2015-16 MDHS incorporated the biomarkers for anthropometry, anaemia testing, and HIV testing. In contrast to the data collection procedure for the household and individual interviews, data related to the biomarkers were initially Introduction and Survey Methodology • 3
Page 1: Malawi Demographic and Health Surve
Page 4 and 5: The 2015-16 Malawi Demographic and
Page 6 and 7: 4.3 Age at First Marriage .........
Page 8 and 9: 13.9.1 Knowledge ..................
Page 11 and 12: TABLES AND FIGURES 1 INTRODUCTION A
Page 13 and 14: 6 FERTILITY PREFERENCES ...........
Page 15 and 16: 11 NUTRITION OF CHILDREN AND WOMEN
Page 17 and 18: Figure 14.1 HIV prevalence by age .
Page 19 and 20: Table A-3.8.1 Type of earnings: Wom
Page 21 and 22: Table A-16.9.1 Women’s participat
Page 23: FOREWORD T he 2016-16 Malawi Demogr
Page 26 and 27: LA LAM LLIN LPG MAD MDHS MICS PPHC
Page 28 and 29: Table 3.4.1 Exposure to mass media:
Page 30 and 31: Example 2: Prevalence and Treatment
Page 32 and 33: Example 3: Understanding Sampling W
Page 34 and 35: xxxii • Map of Malawi
Page 38 and 39: ecorded on the Biomarker Questionna
Page 40 and 41: 1.5 PRETEST The pretest for the 201
Page 43 and 44: HOUSING CHARACTERISTICS AND 2 HOUSE
Page 45 and 46: About half of Malawian households (
Page 47 and 48: A total of 117,177 individuals stay
Page 49 and 50: Patterns by background characterist
Page 51 and 52: school. The attendance rate decline
Page 53 and 54: Table 2.3 Household sanitation faci
Page 55 and 56: Table 2.5 Wealth quintiles Percent
Page 57 and 58: Table 2.9 Household composition Per
Page 59 and 60: Table 2.11 Children’s living arra
Page 61 and 62: Table 2.12.2 Educational attainment
Page 63 and 64: Table 2.14.1 Child functioning and
Page 65 and 66: CHARACTERISTICS OF RESPONDENTS 3 Ke
Page 67 and 68: • Women and men living in urban a
Page 69 and 70: Women and men are most commonly emp
Page 71 and 72: Table 3.1 Background characteristic
Page 73 and 74: Table 3.3.1 Literacy: Women Percent
Page 75 and 76: Table 3.5.1 Internet usage: Women P
Page 77 and 78: Table 3.6.1 Employment status: Wome
Page 79 and 80: Table 3.7.1 Occupation: Women Perce
Page 81 and 82: Table 3.8 Type of employment: Women
Page 83 and 84: Table 3.10.1 Tobacco smoking: Women
Page 85 and 86: 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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Patterns by background characterist
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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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Table 11.11 Nutritional status of w
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Table 11.13 Micronutrient intake am
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The ownership and use of both treat
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12.3 HOUSEHOLD ACCESS AND USE OF IT
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SP during routine ANC visits. Follo
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Trends: The percentage of children
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Table 12.3 Indoor residual spraying
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Table 12.7 Use of existing ITNs Per
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Table 12.11 Prevalence, diagnosis,
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Table 12.13 Type of antimalarial dr
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HIV/AIDS-RELATED KNOWLEDGE, 13 ATTI
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avoid getting HIV; 64% of women and
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Only 1% of all women reported havin
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Forty-two percent of women and 41%
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13.9.3 Premarital Sex The 2015-16 M
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Table 13.1 Knowledge of HIV prevent
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Table 13.4 Discriminatory attitudes
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Table 13.5.2 Multiple sexual partne
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Table 13.7.1 Coverage of prior HIV
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Table 13.8 Pregnant women counselle
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Table 13.10 Self-reported prevalenc
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Table 13.13 Premarital sexual inter
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Table 13.14.2 Multiple sexual partn
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HIV PREVALENCE 14 Key Findings HIV
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The HIV prevalence among women and
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Table 14.1 Coverage of HIV testing
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Table 14.3 HIV prevalence according
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Table 14.5 HIV prevalence according
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Table 14.7 HIV prevalence among you
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Table 14.11 HIV prevalence by male
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ADULT AND MATERNAL MORTALITY 15 Key
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Trends: Table 15.3 shows the probab
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Table 15.1 Completeness of informat
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WOMEN’S EMPOWERMENT 16 Key Findin
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husbands while smaller proportions
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5% participate in neither decisions
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from 78% to 74%. The percentage of
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16.16 REPRODUCTIVE HEALTH CARE BY W
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Table 16.2.1 Control over women’s
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Table 16.4.1 Ownership of assets: W
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Table 16.5.2 Ownership of title or
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Table 16.7.1 Ownership and use of b
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Table 16.9.2 Men’s participation
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Table 16.10.2 Attitude toward wife
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Table 16.12 Ability to negotiate se
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Table 16.16 Reproductive health car
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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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